“Once you have tasted flight, you will forever walk the earth with your eyes turned skyward, for there you have been, and there you will always long to return.”
—Leonardo da Vinci
Lung cancer CT screening may have had no greater advocate than Claudia I. Henschke, PhD, MD. In the face of unrelenting controversy, Dr. Henschke, who is Professor of Radiology, and Head, Lung and Cardiac Screening at Mount Sinai Medical Center in New York, has firmly maintained that certain smokers and former smokers should be offered low-dose computed tomography (CT) scans to detect lung cancer when it is still at a curable stage. After decades of work and intense criticism from skeptics of cancer screening, she was finally vindicated this year, when the U.S. Preventive Services Task Force (USPSTF) recommended low-dose CT scans for certain adults at high risk of having lung cancer.
Dr. Henschke was born in Berlin. When her father, a scientist, was recruited to work on the U.S. Air Force “Man in Space” project, the Henschke’s immigrated to the United States, landing in Dayton, Ohio, where Dr. Henschke spent her early childhood.
After her father completed his service with the Air Force, he became head of radiotherapy at Ohio State University in Columbus. Shortly after, he received an appointment at Memorial Sloan-Kettering Cancer Center in New York.
The Henschke family settled in Forest Hills, New York, where Dr. Henschke attended high school. “Competitive tennis was one of my passions. I was ranked as an amateur back in Ohio. At Forest Hills, my girlfriend was the number 1 ranked player in the East, and I was number 2. We were ranked first in doubles,” said Dr. Henschke.
A prodigious student, Dr. Henschke graduated high school at the age of 16 and seized an opportunity to attend the University of Geneva and the University of Munich, where she majored in mathematics and learned French.
Competitive tennis and world travels were not enough to sate Dr. Henschke’s appetite for adventure and challenge. “My father had a seaplane in the Bronx on the Hudson River, and he taught me how to fly. I earned a pilot’s license, an instructor’s license, and a commercial pilot’s license. I was hired as a private pilot by a family from Dallas, so while working for them, I finished my undergraduate studies at Southern Methodist University in Dallas,” explained Dr. Henschke. She added that she also received her master’s degree in mathematical statistics from Southern Methodist, still flying the wealthy family around the country in their twin engine plane.
From Statistics to Oncology
To supplement her income, Dr. Henschke took a position at the Graduate Research Center of the Southwest in Dallas. When her professor at the Center was offered an opportunity to head the mathematical statistics and computer sciences department at the University of Georgia, Dr. Henschke followed him there and earned her PhD in mathematical statistics and computer science.
While doing her graduate work at the University of Georgia, Dr. Henschke worked once again as a private pilot. “Flying was a very important part of me,” she said. However, staying in one place was not yet in the cards for the peripatetic PhD. Newly married, Dr. Henschke swapped Atlanta, Georgia, for Bethesda, Maryland, where her husband had taken an appointment at the National Cancer Institute (NCI).
Asked how a tennis-playing pilot with a doctorate in mathematical statistics and computer science made another giant career leap into oncology, Dr. Henschke responded, “While my husband was at the NCI, I took a position at the Georgetown Medical School’s biostatistics department. I liked statistics, but both of my parents were physicians and my younger sister was finishing medical school. I realized that to do something truly meaningful, I needed to become a medical doctor as well. So I decided to go to medical school. It was an abrupt but firm decision.”
In 1974, Dr. Henschke entered Howard University Medical School in Washington, DC, a traditionally African American institution. “Of the three medical schools I applied to—sort of on the spur of the moment—Howard was the only one with an immediate opening. I was the sole white woman in my class, but I never felt out of place—in fact, Howard ended up being a wonderful experience, one that opened my eyes to the challenges that many in underserved communities live with on a daily basis.”
Choosing which oncology field to pursue was not a hand-wringing decision. “Both of my parents were radiotherapists, I always wanted to do research in clinical medicine, and my father told me that radiology offered more opportunity for research than other fields. So, in 1977, I began a residency at Brigham and Women’s Hospital/Harvard Medical School, Boston, which included a 1-year research fellowship. I went into chest radiology because that was my interest at that time,” said Dr. Henschke.
A Seminal Paper
In 1983, Dr. Henschke accepted a position as Assistant Attending Radiologist at the Cornell Medical Center in New York. “After being there a while, my chairman gently let me know that it was time for me to begin working on some grants. We organized a multidisciplinary group of physicians and began discussing what kind of exciting projects to do. At the time, we were seeing CT scans of people with incidental pulmonary nodules, and nobody had any idea on what to base their follow-up recommendations for these patients,” she said.
The group decided that making clinically relevant recommendations on incidental pulmonary lesions that prevented unnecessary procedures required a good database, which was nonexistent at the time. “As the database idea percolated among the group, my colleague Dr. David
Yankelevitz suggested that with my background in statistics, I should evaluate the literature on lung cancer screening,” said Dr. Henschke. Dr. Yankelevitz is Professor of Radiology and a Director, Lung Biopsy Service, at Mount Sinai Medical Center, New York.
By chance, an old colleague of Dr. Henschke’s father, who had written early papers on statistical modeling in lung cancer screening, helped her develop a mathematical model to project possible outcomes from CT screening in lung cancer. “It was very exciting,” she said. “We immediately began submitting papers to the NCI, which culminated in a grant to compare CT screening and chest x-ray in 1,000 subjects. We developed an optimal approach to evaluate screening for this purpose, called the Early Lung Cancer Action Project (ELCAP), and that is what was reported in The Lancet in 1999.”1
Dr. Henschke said she didn’t fully comprehend the impact of the Lancet paper until her phone began ringing off the hook. “A reporter for The New York Times called me multiple times. She said that her editor kept asking her questions. I remember wondering where the article would be placed in the newspaper, figuring it would be buried in the back section. When I picked up the paper, I was shocked to see the story on the front page,” she said.
“Between The Lancet publication and the front-page story in The New York Times, my life sort of exploded into a new direction,” she continued. “Calls were coming in from all over the world. Smokers eager for a new test came out of the woodwork. In fact, a smoking couple came to my office demanding a CT scan. I explained that the study was over, but they said they’d go to Washington and complain. So I jumped through the hospital administration’s hoops and got them screened. Both of them ended up having lung cancer.”
Early Lung Cancer Action Project
Building on the success of the first lung cancer screening trial, Dr. Henschke and her colleagues updated their approach and began accruing patients for another screening trial, which would offer only low-dose CT screening. “In October 1999, we also began the New York–ELCAP and then the International–ELCAP (I-ELCAP), which held international meetings every 6 months to discuss how to refine our lung cancer screening methods and data collection. We are now approaching our 29th International Conference,” said Dr. Henschke.
Dr. Henschke is proud that I-ELCAP was the seed for valuable international collaboration and consensus-building on the issue of lung cancer screening, given that prior to her work, early detection in lung cancer was never a priority in the research and regulatory world.
“I never dreamed that it would take close to 15 years for lung cancer screening with low-dose CT to be accepted by the medical community. I consider the USPSTF’s recent B recommendation for lung cancer screening to be a highlight of my career. It means that Medicare will now cover screening, and people at high risk for lung cancer can finally get screened, no matter what their socioeconomic status. That’s all I ever wanted.”
The decades-long struggle to have CT screening made available to people at high-risk for lung cancer has consumed most of Dr. Henschke’s career. It still does, giving her little to no time for other passions such as tennis and flying. Although she plans to start hitting the ball around again someday, her passion to fly will be experienced vicariously, with her eyes turned skyward at planes crossing the sky. ■
1. Henschke CI, McCauley DI, Yankelevitz DF, et al: Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 354:99-105, 1999.