Lung Cancer’s Mammogram?
Low-dose CT scan detects deadly lung cancers early, boosts survival
Sharon Baltzell will tell you that she's alive today for two reasons: 1) She quit smoking 10 years ago, and 2) She heeded a public-service announcement from HealthONE’s Swedish Medical Center to have a low-cost lung scan. The Nebraska resident even dragged her husband along because of a short history of cigar smoking.
"He got a postcard. I got a phone call," says Baltzell, 71, referring to her husband’s "all clear" message, and her less than good news.
The nodule detected on Baltzell's CT scan was so small that Dr. Matt Fleishman, a radiologist specializing in lung cancer at Swedish Medical Center, and his diagnostic team opted to carefully monitor it with six-month scans to see if it would grow, becoming large enough for biopsy. Two years later, the nodule had grown, was found to be cancerous, and was removed using a minimally invasive procedure.
"And that was it," Baltzell says. "There was no follow-up care needed. It was contained." Baltzell, now cancer-free, believes the outcome would have been different if it were not for the scan.
Study Shows that Screenings Help Detect Lung Cancer Sooner
Findings from a National Lung Screening Trial released in June suggest she could be right. The multi-center study set out to determine if low-dose CT scans, already known to detect lung cancers sooner, could actually save lives. The answer was yes. Lung-cancer deaths were reduced by 20 percent in the CT-scan group.
"The NLST study definitely proves that earlier diagnosis and treatment leads to better outcomes," says Dr. Timothy Kennedy, pulmonologist and medical director of thoracic (chest) oncology at Presbyterian St. Luke's Medical Center. "We’ve been waiting for this for decades," Dr. Kennedy says. "Low-dose CT-scan screening is the mammogram equivalent for lung cancer."
The study involved more than 53,000 patients, half screened with X-ray, half screened with CT scans. All were 30-pack-year (one pack daily for 30 years, or two packs daily for 15 years) smokers or former smokers. Published in the New England Journal of Medicine, the study was stopped early because of its positive results.
"The 20-percent increase in survival rate is really, really big," says Dr. Fleishman. Most cancers are discovered too late, with as many as 30 percent of cases already spreading outside the lung once symptoms arise, Dr. Fleishman says.
The Importance of Early Detection of Lung Cancer
"Screening provides the only hope of making an impact," says Dr. Joseph Forrester, a pulmonologist with The Medical Center of Aurora. Once early tumors are detected, HealthONE patients are treated by top thoracic surgeons and pulmonologists who are equipped with state-of-the-art technology.
Video-assisted and minimally invasive procedures, such as Baltzell’s thoracoscopic surgery performed by Swedish Medical Center’s board-certified thoracic surgeon Dr. Randy Kessler, allow doctors to perform complex thoracic surgeries with less pain, less blood loss, faster recoveries and shorter hospital stays. The small tumors detected by CT scans particularly lend themselves to advanced surgical procedures.
"Look at me," Baltzell says. "I didn’t have to have radiation or chemotherapy. I didn’t have a long, drawn-out hospital stay."
Advanced diagnostic tools and dedicated lung conferences with physicians of various specialties at Swedish, TMCA and P/SL result in high-quality, individualized patient care, sometimes for very complicated cancer cases, Dr. Forrester says. Specialties include pulmonologists, radiologists and surgical and medical oncologists.
Benefits of Screening Outweigh the Downfalls
Although some concerns, such as cost, radiation exposure and false-positives, are always raised with routine screening, the evidence suggests the benefits outweigh the downfalls, Dr. Kennedy says. And HealthONE will remain integral in evaluating and influencing future guidelines, he says. "We believe the number of lives saved compels us to do this, and we will continue to refine criteria and treatment options to minimize risks and costs," Dr. Kennedy says.
"Preventive medicine is always better," Baltzell says. Of course, she and HealthONE doctors agree, quitting smoking is the best prevention. Of the nearly 157,000 people who die of lung cancer this year, most will be from the group of 94 million current and former smokers in the United States. Quitting the habit can reduce health risks over time. And Baltzell assures it is well worth the effort. "If at first you don’t succeed," she says, "try, try forever."
Just the facts
- Lung cancer is the leading cause of cancer death among both men and women. More people die of lung cancer than of colon, breast, and prostate cancers combined.
- The vast majority of lung cancer is caused by smoking.
- Most lung cancers are detected when symptoms arise (shortness of breath, coughing up blood), but by that time, it’s often too late for life-saving treatment.
- The single best way to prevent lung cancer is to never use tobacco or quit permanently; most damage is reversible over time.