By Joanne Pallotta, Beth Israel Deaconess Medical Center Correspondent
Lung cancer is the nation’s number one cancer killer. “It’s an aggressive cancer, detected at a late stage in the vast majority of patients,” says Dr. Sidhu Gangadharan, Chief of Thoracic Surgery at Beth Israel Deaconess Medical Center. “We believe in the effectiveness of lung cancer screening in the high-risk population.” Detection of lung cancer before any symptoms appear may save the lives of smokers or former smokers, according to the results of the National Lung Screening Trial (NLST). Dr. Adnan Majid in the Division of Pulmonary Medicine at BIDMC can’t agree more. “It’s important to screen for lung cancer,” Dr. Majid stresses. “If lung cancer is detected at an early stage, you can treat it and this will translate into decreased mortality. The NLST, a large randomized trial of screening with low-dose CT scan in high-risk individuals showed a 20% decrease in lung cancer mortality.”
Who should be screened?
The criteria from the NLST is very clear. You should be tested if:
– you are a current or former smoker who quit within the past 15 years.
– you are between the ages of 55 and 74.
– you have a smoking history that averages 1 pack a day for 30 years (i.e. 2 packs a day for 15 years or 1/2 pack a day for 60 years would also qualify).
Both Dr. Gangadharan and Dr. Majid say the best way to screen for lung cancer is a low-dose CT scan. But the test does not come without risk, including exposure to radiation. “We think the risk is exceptionally low,” says Dr. Gangadharan. “But it is not zero.” Also, the detection of abnormalities that provide a false positive reading might create unwanted anxiety or invasive procedures. Both physicians state that an at-risk patient would need to weigh the risks and the benefits.
If an abnormality is detected
Doctors will look at old images, if available, and the characteristics of the lesion – size, shape, presence/pattern of calcification, and the speed at which it grows – categorize it as low or high-risk, and base the course of action from there.
While several options for eliminating the abnormality exist, surgery appears to be the most effective in early-stage lung cancer. “There are patients with early-stage lung cancer who have a very high likelihood of not ever having the cancer come back after treatment,” says Dr. Gangadharan. “And the primary treatment is surgery.” But he cautions, this is not necessarily a cure and vigilance for recurrence is important.
Both Dr. Gangadharan and Dr. Majid say there are alternative therapies to surgery. One of those therapies is Stereotactic Body Radiation Therapy (SBRT). “SBRT is very focused, high-intensity radiation that, for some patients with early-stage lung cancer who are not candidates for surgery due to limited lung function or medical comorbidities, can provide excellent results,” says Dr. Majid.
There are cost concerns about lung cancer screening for at-risk patients. According to a recent USA Today article, the cost of screening older adults for lung cancer could be in the billions of dollars for Medicare patients. Despite a U.S. Preventative Services Task Force (USPSTF) recommendation in 2013, Medicare, Medicaid and many private insurers do not cover the cost of the scan.
Dr. Gangadharan is optimistic about the future. “I expect that as more data roll out about this that we will see screenings covered because it is an important game-changer in the field of lung cancer treatment.”
Beth Israel Deaconess Hospital – Needham
Recently, Beth Israel Deaconess Hospital – Needham recently announced a new lung cancer screening program using low-dose CT scans, enabling the identification of asymptomatic patients at high risk for developing lung cancer. The radiation dose is approximately 25% – 30% lower than a standard CT exam of the chest. An experienced imaging team reviews and interprets the scan.
“Patients who undergo these screenings will also come and see me in the clinic,” points out Dr. Gangadharan. “I go over their test results. I can also talk to them about things like smoking cessation, lung cancer risk, lung cancer treatment and options.” He stresses that even if a high-risk patient has nothing on a scan, he or she should not take that as a green light to smoke because the risk does not go away.
Dr. Gangadharan and Dr. Majid stress that the best way to decrease lung cancer mortality is to eliminate smoking.
For more information on the lung cancer screening program or to schedule a screening, call 617-632-8062.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted July 2014