New program takes aim at hidden lung cancers
L+M’s Early Detection Lung Screening Program seen as a potential life saver for current and former smokers
New London — It’s been more than a year and a half since Robin Gilebarto learned she has lung cancer. She’s still counting her blessings. Not because she has cancer, of course, but because the disease was discovered at an early stage — early enough to be treated with radiation delivered with pinpoint accuracy as well as a limited course of chemotherapy. Even after a second, separate tumor was detected, her prognosis was — and is — excellent.
None of it would have happened if Gilebarto, a Bozrah resident, had not been referred to the Early Detection Lung Screening Program at Lawrence + Memorial Hospital.
Founded in 2013, the program launched soon after a national study documented the effectiveness of lowdose CT scans in detecting lung cancer in smokers and former smokers who exhibit no symptoms of the disease.
The American Cancer Society now recommends such scans for people who are 55 to 78 years old and are currently smoking or have quit smoking within the past 15 years and have at least a “30 pack-year” smoking history. Pack years are calculated by multiplying the number of years a person has smoked by the number of packs of cigarettes a day. A person who smoked a pack a day for 30 years or who smoked two packs a day for 15 years would have a 30 pack-year history.
Gilebarto, now 64, fit the profile of someone at high risk for lung cancer, said Dr. Louis Mazzarelli, the diagnostic radiologist who coordinates L+M’s lung cancer screening program.
Mazzarelli laments the fact that nationally, only 1 in 20 people who fit the profile get low-dose CT scans, which Medicare covers in many cases.
Gilebarto was filling out forms in connection with her 2017 search for a primary provider when Lori Ciccone, a physician assistant at a Gales Ferry practice, told her about L+M’s screening program. At that point, Gilebarto had been a nonsmoker for “a year or two,” she said, having previously smoked a pack a day for some 45 years. She felt fine, showing no sign of lung cancer, such as a cough, shortness of breath or recent weight loss.
“Lung cancer is the No. 1 killer (among cancers). If it’s at Stage 4 when it’s discovered, the survival rate is 5 percent. If we find it when it’s Stage 1, the survival rate is 90 percent.” DR. LOUIS MAZZARELLI, DIAGNOSTIC RADIOLOGIST AND COORDINATOR OF LAWRENCE + MEMORIAL HOSPITAL’S EARLY DETECTION LUNG SCREENING PROGRAM
She stopped working nine years ago, having driven school buses for more than two decades.
Her mother died of lung cancer in 2005.
Gilebarto had her first lowdose CT scan in the spring of 2018, and was told it revealed something that had to be investigated further. A biopsy and more scans confirmed that a small tumor on her lung was Stage 1 cancer. An oncologist determined that it could be targeted with radiation therapy that delivers precise, intense doses of radiation to cancer cells while minimizing damage to healthy tissue.
Gilebarto’s treatment was complicated by the tumor’s proximity to her heart and the presence of a defibrillator previously implanted in her chest.
“I had radiation five times a week for about eight weeks. Each time was about three minutes,” she said. “They threw in a little chemo once a week. I wouldn’t have cared what they had to do. You hear the word ‘cancer,’ it scares you. I wanted that (tumor) out of me yesterday.”
After the first phase of treatment, “it looked like it was pretty well kicked,” Gilebarto said of the cancer, but a follow-up scan a few months later found the second tumor. She’s had several doses of radiation since then, with another scheduled in March.
“My mother was a strong woman and she had radiation all over, but she had a snowball’s chance in hell of recovering,” Gilebarto said. “I have a much better outlook.”
Mazzarelli said doctors expect Gilebarto to do “exceptionally
well,” though she will need “long-term surveillance.”
Detecting lung cancer early is the key to saving lives, which is why L+M and its affiliate, the Yale New Haven Health System, are focusing on promoting awareness of the lung screening program while urging smokers to quit.
National study
The national study that prompted L+M to launch its screening program found that participants in the study who had low-dose CT scans had a 15 to 20 percent lower risk of dying of lung cancer than those who had standard chest X-rays. And yet, nearly a decade later, only 1 in 20 of those at high risk for the disease gets a low-dose scan, as Mazzarelli pointed out.
“Lung cancer is the No. 1 killer (among cancers),” he said. “If it’s at Stage 4 when it’s discovered, the survival rate is 5 percent. If we find it when it’s Stage 1, the survival rate is 90 percent.”
Low-dose CT scans, which deliver far less radiation than conventional diagnostic CT scans, can find small cancers that “hide” from detection on standard chest X-rays, which for years were the favored tool in detecting lung cancer. Lowdose scans require no preparation on the part of the patient and take about 20 seconds, Mazzarelli said.
“You can have your lunch, get changed and lay down on the table,” he said. No dye is injected.
The prone patient, lying on his or her back, then moves feet-first through an open, tube-like structure, or “gantry,” which makes one, quick pass, taking images of the chest area. Compared to an MRI scan, it’s less invasive, less time consuming and less expensive.
“It’s not like going into a capsule or anything,” Gilebarto said. “You lay down, breathe in, breathe out. The whole thing takes two or three minutes.”
Mazzarelli said surgery is an option for many patients in whom early-stage tumors are detected. Gilebarto, he said, would have been a candidate for surgery had her first tumor not been so near her heart. The tumor’s location, and the presence of her pacemaker called for a lower dose of radiation than otherwise would have been prescribed, as well as some chemotherapy “for a boost,” he said.
Physicians expect to find one lung cancer for every 320 low-dose CT scans. By comparison, one incidence of breast cancer is expected for every 1,500 mammograms.
In 2019, Mazzarelli said, the L+M program did about 1,100 low-dose CT scans and found five cancers — more than the three that would be predicted, statistically. Over the course of many years, he said, the relatively high incidence may prove to be an anomaly.
The scans also can highlight things other than lung cancer, including heart abnormalities, aneurysms and other cancers.
Anyone eligible for a lowdose CT scan ought to strongly consider it, said Gilebarto, who believes people should advocate for their own medical care.
“You don’t have to know all the criteria,” she said. “If you’re a smoker or a former smoker, you should ask your doctor about it. Absolutely.”