Screening can help reduce lung cancer mortality rate
Current and former heavy smokers — quit within the past 15 years — have a 20 percent less chance of dying from lung cancer by getting a low-dose screening CT scan that can show the early stages of the disease, according to a recent national study.
The scans — recommended for those age 55 to 74 who smoke or previously smoked at least one pack a day for 30 years or two packs a day for 15 years and have no history of lung cancer — will be offered through a new Lung Cancer Screening Program with follow-up provided by a Comprehensive Lung Nodule Management Program, both being launched Oct. 3 by Abington Memorial Hospital.
More people in the United States die from lung cancer than any other type of cancer, according to the Centers for Disease Control and Prevention. About 200,000 in the United States are diagnosed with lung cancer every year, with more than 150,000 dying from the dis- ease.
Results from the National Lung Screening Trial show “clear, compelling evidence lung cancer screening is costeffective and has an overall health benefit … a survival benefit for those 55 to 74,” said Dr. Paul O’Moore, part of a team of radiologists, pulmonologists, thoracic surgeons, radiation oncologists, medical oncologists and primary care physicians who developed the AMH programs.
The study, in which 53,000 current or former heavy smokers received either lowdose CT or standard chest X-rays exams, concluded that those who had three low-dose chest CT scans over a three-year period had a 20 percent lower risk of dying from lung cancer than those who received the chest X-rays.
The screening and “one-stopshopping” approach lung nodule programs include the CT scan, speaking with a radiologist and working with a nurse navigator who will guide the patient through the process of having any abnormal findings treated. Both will be offered at the PET scan facility at the hospital’s Blair Mill Road complex, said O’Moore, an interventional radiologist for 25 years who will be reading the scans and speaking with patients at the Willow Grove facility.
“We were finding that a lot of people have scans for other reasons,” perhaps to rule out pneumonia for a cough, and sometimes the scan picks up nodules in the lungs and the patient doesn’t know what to do, O’Moore said. “This [program] is a comprehensive and consistent solution to managing that.”
A CT scan “has a much greater sensitivity to small things,” he said. It can pick up a nodule 1 mm to 2 mm in size, while on a chest X-ray anything smaller than 5 or 6 mm is hard to see, he said.
“By the time you can see [some nodules] on a chest X-ray, there’s a chance of it being a significant threat to health,” O’Moore said. “It [lung cancer] may be past stage 1 or 2 … at stages 3 and 4 almost none are cured.”
The specific low-dose technique being used for the scan does not have a significant risk in causing secondary cancers, he said; “the benefit clearly outweighs any risk.”
The AMH programs will conform to the methods used in the study, with patients having the scan three years in a row, he said.
About one in 20 smokers in the 55 to 74 age group have nodules in their lungs, O’Moore said, but “it may be the result of infection or scar tissue.” Monitoring the nodules “becomes a management burden” for a primary care physician, he said.
“We tried to build a resource within the Abington hospital system to properly, reliably and in a uniform way provide a thorough and consistent management scheme,” O’Moore said.
Those whose scans show nodules would be advised to have a followup scan. If, over a period of time there was no change in the nodule, it would probably be nothing, he said.
A PET scan will show if something is growing, O’Moore said, and those with a nodule 4, 6, or 8 mm — the size of a pea — or one that is changing would have a follow-up scan within three to 12 months.
“The point is to find cancers when they can be cured,” he said. “If you wait for symptoms, the show’s over.”
At stage 1 or 2, the size of a hazelnut or smaller, “there is a high likelihood of being completely cured of cancer,” O’Moore said. “By pecan size, you’re on the bad side of the survival curve.”
Treatment can be surgery or a combination of radiation, chemotherapy and surgery, he said.
The goal of the new programs is to have a coordinated team effort to treat the cancer as well as it can be treated, he said.
“We’re trying to provide a cutting-edge comprehensive solution … and benefit people at risk of developing lung cancer,” O’Moore said.
“We want to catch it early,” he said. While the screening, which costs $350, is not yet covered by insurance, he said, “What else can you spend $350 on to lower your risk of dying by 20 percent?”