By any measure, UW Surgery Professor and Chair Dr. Douglas Wood is a thoracic oncology trailblazer. He has spent his career saving the lives of lung cancer patients — individually as a world-renowned thoracic surgeon and en masse as a national leader in the development and expansion of lung cancer screening.
The first in his family to go to college, Dr. Wood attended Harvard University and stayed in the Boston area for medical training before joining the University of Washington in 1992. At that time, “There was little development of specialized thoracic surgery,” he says. “Now, we have one of the premier cardiothoracic training programs and one of the largest thoracic surgical practices in the country.”
Dr. Wood is the winner of the UW 2025 University Faculty Lecture Award, which has been honoring a current or former faculty member and the societal impact of their research or art for more than 50 years. He is only the second physician to receive the award. Dr. Wood will present his lecture, “A breath of fresh air: The science and policy saving lives from America’s deadliest cancer,” on Thursday, Feb. 5 at 5:30 p.m.
This talk is intended for a general audience, and attendees are invited to register to join in person at the HUB Lyceum or livestream it online.
In advance of his lecture, Dr. Wood spoke with us about his path to the UW and the work he’s doing to raise lung cancer awareness, increase access to early detection, and ultimately, change lung cancer victims to lung cancer survivors.
Tell us about why you chose to study medicine, and the lungs specifically.
My sister and I grew up on a farm, and my parents, who just completed high school, appreciated, respected and emphasized education for both of us, so it was a clear path to university.
I was always interested in science, particularly biology, and considered being a marine biologist. But as I went through college and was exposed to medicine, I really felt it was a place where I could apply my interest in science and biology in a way that had an impact on people. When I talk to my faculty or trainees now about the privilege of what we do, I say, “We are so lucky. We get to do something every day that helps people live better or live longer.” I think about it with more clarity now than I think I did as a college student, but that was a connection that I made.
I always had a surgical interest when I entered medical school. And as I considered different areas of surgery, I liked the anatomy, the physiology and the diversity of problems in cardiothoracic.
It’s alarming to hear that lung cancer is the most common cancer fatality — more than breast, colon and prostate (the following three most common) combined. What work are you doing to change that?
The other statistic that is important is that the sixth most common cause of cancer death in the U.S. is lung cancer in never-smokers. Lung cancer death rates peaked about 20 or 30 years ago and have been falling at a rate of about 2% to 3% per year, which is significant. More recently, that has increased to falling at a rate of 5% to 6% per year. That is huge.
Part of it relates to decreasing smoking rates in the United States. But it also relates to early detection and the advanced therapies that have developed in the last 10 to 15 years for people even with advanced lung cancer.
As for what I’ve done, I would put it in three categories:
For my whole career, the most common disease I treat is lung cancer. So, one of my impacts, and maybe the one that I care most about, is the one-on-one of being a cardiothoracic surgeon who cares for patients.
If I may give an anecdote about patient experience, 10 years ago, I was in my clinic. My nurse came and said, “Dr. Wood, there’s one of your former patients here, who does not have an appointment. Can you see her?”
Even though I was running late, I went in, and there’s a woman who says, “Dr. Wood, I’m here, because 10 years ago you saved my life, and I’m here for our anniversary.”
I can still actually get emotional thinking about that. This connects to what I said about this being a privilege, to be able to do that for people. I got an email from her two months ago. It’s been 20 years now. She reminded me she was 54 when I operated on her, she had been told that she did not have any treatment options and had made funeral arrangements. I did a very high-risk big operation on her. And now she’s 74. That’s pretty great!
At the end of the day, that’s what matters most. 
I have also been the national leader in lung cancer guidelines. The National Comprehensive Cancer Network (NCCN) is a prominent network of major cancer centers in the United States, and they do national and even worldwide cancer guidelines. I’ve been working on that almost since its inception, about 25 years.
We meet annually to update the guidelines. And in 2009, we had a lot of debate about lung cancer screening because there were some initial reports that it might be useful. At the end of the day, two things happened: First, we said there wasn’t enough data to support routine screening. Second, the board of directors of the NCCN felt that there was enough importance to lung cancer screening as to create a new guideline panel specifically on lung cancer screening, which they asked me to chair.
We gathered a strong group of experts and put together the evidence around lung cancer screening to create national guidelines. It so happened that a landmark clinical trial of lung cancer screening was published while we were doing this work that changed the whole field of lung cancer screening. There was a publication in the New England Journal of Medicine from this trial that showed a 20% mortality reduction if you screen people with low-dose CT who were at risk for lung cancer.
This study led our panel to produce the first guidelines about lung cancer screening in 2012. And so, I’ve had the privilege of leading that guideline work, and this has been a really important part of my career for the past 15 years.
That connects to the third thing, which is advocacy, because I learned a lot in this process. I thought, “Spectacular, we’ve written guidelines, now people can get screened.” And that was the naivete of me not really understanding the complexities of health-care policy in the U.S. and that our guidelines alone were insufficient.
If insurers were not going to pay for lung cancer screening, it wasn’t going to get done. The United States Preventive Services Task Force (USPSTF) is the agency that sets guidelines for preventive services in the U.S. They’re the ones that say who can get mammograms for breast cancer, whether prostate cancer screening should happen and a variety of other things. And their recommendations about lung cancer screening had been that there was no evidence to support it. So, we had to help USPSTF realize that new evidence did exist showing lung cancer screening saved lives and encourage them to revise their guidelines. We were successful in getting them to recommend lung cancer screening. Under the Affordable Care Act, private insurers are required to pay for what USPSTF recommends.
That decision by the USPSTF on Dec. 31, 2013, went into effect in terms of requiring insurer coverage on Jan. 1, 2015. Just 10, almost 11, years ago, so it’s recent. It seemed like that was the victory we needed to embark on lung cancer screening in the U.S. Then I learned that Medicare doesn’t have to follow USPSTF recommendations. And 70% of patients who are at risk for lung cancer are in the Medicare age group.
Medicare has a process for reviewing a decision like this through the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), and they put together a MEDCAC panel in April 2014. I testified to that panel, as I had also testified to a U.S. Senate briefing before. Remarkably, MEDCAC listened to the evidence supporting lung cancer screening and still recommended against lung cancer screening for Medicare beneficiaries, an enormous backwards step in trying to help people have access to the benefits of early detection.
That was a pretty dark day for those of us in the lung cancer care and screening space. But then we doubled down and put together a collaborative of experts. We worked directly with senior Medicare administrators to develop a major document to describe how they could safely implement lung cancer screening in an effective and reasonable way — and they ultimately agreed with us.
So, on Feb. 5, 2015, Medicare approved coverage for lung cancer screening for Medicare beneficiaries. To my knowledge, it’s the first time in history that Medicare has reversed a decision from their own advisory MEDCAC committee. That’s really when lung cancer screening could legitimately start.
The last part of that advocacy work is that our guidelines have continued to evolve, more data has come in, and we’ve learned things to make them simpler, more applicable, and more equitable. We haven’t stopped, because there are still aspects of the inclusion criteria by our policymakers that I think are inappropriately restrictive.
Help us understand what screening looks like. Also, is there a downside to screening additional people?
It’s important to emphasize that screening is more than a procedure, it’s a process. The procedure is a low-dose CT scan, a single deep breath you hold for a few seconds. Our technology now is very sophisticated, so it’s simple and not invasive.
But the whole point is discipline and regularity of the follow-up. That’s the process. If there’s a spot in their lung, there’s expertise needed to evaluate and advise that individual. The guidelines that we developed in the NCCN have algorithms for what to do with all those scenarios. If you have a spot and it’s a certain size and appearance, here’s how you manage it. That’s an important part of the process.
The second part is that it’s not one and done. For those who are at risk, screening is meant to be annual. One of our problems in screening implementation is people doing a scan, getting a good report, and then not coming back. Mammography has developed a really systematic approach of reminders and processes for getting people to come back — and that just hasn’t developed to the same degree for lung yet. The whole point is your risk continues. In fact, as you get older, the risk keeps increasing, because it is both age and smoking exposure related.
Regarding downsides, I think non-physicians think, “If we can catch something, let’s scan everybody.” But there are downsides, which is why we’re trying not to screen people who aren’t at high risk for lung cancer. And the biggest downside is false positives. There’s lots of stuff that we shouldn’t know about, because if there’s something noted on a CT scan, then we start investigating, we create worry, we might do invasive tests that have risks, and many of those things might be unimportant. So benign neglect is sometimes good. It keeps healthy people out of doctor’s offices for things that are benign and unimportant.
Many people associate lung cancer specifically with an older audience of smokers. What would you say to people who might think, “Oh, that doesn’t apply to me or my family?”
I guess I would say that it’s not just people that have a smoking history that get lung cancer, and it’s not just old people that get lung cancer. I’m vice chair at the American Cancer Society National Lung Cancer Roundtable, and one of our points is the risk of getting lung cancer is having lungs. There’s currently not a role for lung cancer screening in people that don’t have smoking exposure. But there’s research going on about how we might evolve lung cancer screening to groups that don’t have just the risk of smoking, but have other risks, like familial risks, which do exist for lung cancer.
Early detection of lung cancer gives a high opportunity for cure. The five-year survival for patients with lung cancer is 22%, which is really bad. The five-year survival for individuals that have undergone lung cancer screening is 84%. There aren’t many interventions in medicine that make that big of an impact.