For more than 50 years now, we have known the dangers of
smoking. That smoking causes heart disease, emphysema, and lung and other
cancers is not in dispute. For fifty years, we did not have an effective
screening tool for lung cancer.
Now we do.
Medical imaging has improved so much that we are now able to
do computerized tomography (CT) scans with significantly lower dose to the
patient and at a low enough cost to warrant widespread use as a screening tool.
Not everyone needs a scan, of course. But smokers who are at high risk of
developing lung cancer now have an option for screening, much like mammography
for early detection of breast cancer.
In 2011, the results of the National Lung Screening Trial (NLST)
were published in the New England Journal of Medicine, arguably the foremost
medical journal in the world. This trial screened current or former heavy
smokers aged 55 to 74 with low-dose CT scanning of the chest and compared it to
standard chest x-ray. The NLST primary trial results show 20 percent fewer lung
cancer deaths among trial participants screened with CT compared to those who
got screened with chest x-rays. This is huge news, because we haven’t cured a
lot of lung cancer over the last 50 years! Based on these results, the Centers
for Medicare & Medicaid Services (CMS) decided in 2015 to start paying for
the procedure on January 1, 2016.
According to the American Cancer Society, in 2016 an
estimated 224,390 people in the U.S. (117,920 men and 106,470 women) will be
diagnosed with, and 158,080 men and women will die of, cancer of the lung and
bronchus, the leading single cancer killer in the U.S. If everyone who was
eligible got screened, more than 30,000 deaths from lung cancer could be
averted every year.
There are more than 94 million current and former smokers in
the U.S. at high risk for lung cancer. In 2014, an estimated 18.1 percent, or 40
million U.S. adults, were current cigarette smokers. Unfortunately, smoking
rates in East Texas are higher than state and national averages. That means a
lot of East Texans are eligible to be screened.
Starting last fall, CHI St. Luke’s Health Memorial began
offering low-dose CT lung cancer screening to eligible patients. Medicare
covers ages 55-77 (commercial insurance 55-80, but Aetna 55-79). Even within
those age ranges, an eligible patient must be a current smoker (or quit no more
than 15 years) with at least a 30 pack-year history of smoking (for example,
smoking 1 pack per day for 30 years, or 2 packs per day for 15 years). And,
eligible patients must have no symptoms of lung cancer (such as coughing up
blood or unexplained weight loss of more than 15 pounds in the last year). If
lung cancer is suspected, a standard CT chest should be done.
Finally, Medicare
requires “shared decision making” on the risks and benefits of lung cancer
screening, which means you must meet face to face with your primary care
provider to get an order for screening.
Since we started screening at CHI St. Luke’s Health
Memorial, more than 70 patients have been screened. Six abnormalities have been
found (including an incidental kidney mass), and two lung cancers have been
diagnosed. Those two cancer patients’ lives may have been saved by screening;
only time will tell.
Of course, the best way to prevent lung cancer is by not
smoking. Ever. Quit if you do smoke. And if you meet the criteria listed above,
talk to your doctor about getting screened for lung cancer. If you have
questions, feel free to contact the Temple Cancer Center at (936) 639-7466 for
more information.
