Tuesday, November 25, 2014

Saving Lives: One Person At A Time

Bibb Allen, Jr., MD FACR Diagnostic Radiologist Trinity Medical Center

About 450 Americans die every day from lung cancer. Lung cancer kills more of us than any other type of cancer – 160,000 people every year – more than breast, colorectal, prostate and pancreas cancers combined! But we know that if we can catch lung cancer in its earliest stages, it can be cured. The problem has always been how to find it early because for the vast majority, by the time lung cancer causes symptoms, it is already in an advanced stage and much more difficult to treat.

Well that’s about to change. We now have a tool that will actually save lives in lung cancer patients by detecting the disease in its earliest stages. Recent scientific studies show we can lower the overall mortality of lung cancer by 20% through early detection of the disease in high-risk individuals. Tobacco use continues to be the highest risk factor for lung cancer, and by targeting this group of individuals for early detection, we can save 50 lives a day. A study sponsored by the National Cancer Institute and the National Institutes of Health conclusively demonstrates that screening for lung cancer in high-risk individuals with low dose computed tomography would save lives – ten to twenty thousand lives – each and every year. Early detection through screening high-risk patients will save more lives than the decades of work we have spent on new ways of treating lung cancer.

Who should be screened? Current or former smokers who smoked a pack of cigarettes per day for 30 years or more are considered at high risk for lung cancer. Our veterans, rescue workers, firefighters and construction workers are unfortunately over-represented in this group and make up a significant portion of our population in Alabama. Even former smokers who have quit smoking in the last 15 years remain at risk and should be screened as well. So beginning at 55, these individuals should be screened for cancer every year until they are 80. This is the recommendation of the United States Preventative Services Task Force and because of this recommendation insurance carriers are required by the Affordable Care Act to provide coverage and we expect this to happen beginning in 2015 or even sooner.

How does screening work? Lung cancer screening is easy. We use standard computed tomography (CT) equipment, and the CT scan takes less than 10 seconds to perform – no medicines, no needles. Although the CT scan uses x-rays to look at the lungs, the examination is considered very safe. We use the lowest possible amount of radiation for satisfactory examination, and it is an amount similar to that used for a routine screening mammogram. Considering the overwhelming benefits, risk of radiation exposure should not deter high-risk patients from being screened.

How good is screening? When an early lung cancer is detected, patients have a 93% chance of being cured, and while that’s exciting news, no test, including CT screening for lung cancer is perfect. Sometimes patients can have a cancer or other medical condition that will not be detected by the screening examination. Sometimes, the screening examination detects an abnormality that could be cancer but is not. In order to make sure these findings are not cancer, patients may need to have some follow-up tests that will only be performed after consultation with he patient. Most times this may be short interval follow-up CT scan to make sure a likely benign finding is not changing. Sometimes, more invasive procedures are required to determine a diagnosis including bronchoscopy and/or biopsy. Finally, in 5 to 10% of cases the screening CT examination may detect abnormalities in areas of the body adjacent to the lungs including the kidneys, adrenal glands, liver or thyroid. These findings may not be serious, but sometimes need to be examined further.

Overall, about 1 out of 4 lung screening exams will find something in the lung that may require additional imaging or evaluation, and most times these findings are lung nodules. Lung nodules* are very small collections of tissue in the lung that are quite common, and almost always – 97% of the time – they are not cancer. Most are small areas of scarring from past infections. But less commonly, lung nodules are cancer. If a small lung nodule is found to be cancer, the cancer can be cured in the vast majority of cases. But to distinguish the large number of noncancerous nodules from the few nodules that are in fact cancer, we may need to get more images before the next yearly screening exam usually in about six months. If the nodule has suspicious features (for example, it is large, has an odd shape or grows over time), patients are referred to a specialist for further testing.

At Trinity Medical Center, we have put together a Lung Cancer Screening Program that is dedicated to saving lives of people with lung cancer in Alabama. Our program is a multi-specialty effort between radiology, pulmonary medicine, medical and radiation oncology, thoracic surgery and primary care. We offer all of our enrollees a smoking cessation counseling to help them stop smoking. Our equipment specifications and protocols exceed all of the minimum standards for lung cancer screening, and our personnel are trained and highly qualified to perform and interpret the examinations. We have a structured reporting system that ensures appropriate and standardized management and multi-specialty follow-up of nodules and other abnormalities detected in the examination.

As a radiologist, who for years has seen mostly advanced lung cancers, it is an exciting time to finally be able to help the people of our state by offering a way to make a dent in mortality from our country’s largest cancer killer. My hope is that the folks in our state will take advantage of this opportunity to beat lung cancer.

*For more information on Lung Nodules see September 2014 blog by Dr. Karl Schroeder, Pulmonologist.

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