Hope For Lung Cancer Patients

Low-dose CT screening often finds the disease early, when treatment has its best chance to save a life. Learn your risk and find out more about Saint Peter's new screening and treatment programs.

Should You Be Screened?

As a result of the National Lung Screening
Trial, the Aational Comprehensive Cancer
Network (NCCN) recommends that high-risk
individuals undergo annual low-dose
CT screening.

The NCCN defines high-risk individuals
as those who:

>> are from 55 to 74* years old;
>> have a smoking history of at least 30
pack-years (that is, a pack a day for 30
years, two packs a day for 15 years, or
the equivalent);
>> smoke or are former smokers who quit
in the past 15 years, and
>> have no history of lung cancer.

Patients who do not meet these criteria but
have discussed lung screening with their
primary care physician may also be screened
by bringing a prescription from their doctor
to their lung screening appointment.

There is also a secure, encrypted website,
created by the american Lung association,
where you can determine whether you should
be screened. Log onto:

Lung cancer is the third most common cancer in the United States, after breast and prostate cancer—but it’s the leading cause of cancer deaths, claiming more lives than the next five cancers combined. One big reason for this has been that lung cancer has not had a reliable screening test comparable to mammography for breast cancer or colonoscopy for colon cancer, a test that can detect the disease at its earliest, most treatable stages.

Until now. research over the past couple of years has confirmed that low-dose CT (computed tomography) screening effectively enables physicians to diagnose lung disease at its earliest stages, improving patients’ chances for curative treatment and long-term survival. The National Cancer Institute reports that in one recent study, one life was saved among every 320 high-risk persons screened using low-dose CT scanning over a two-year period (three screenings), resulting in a 20 percent reduction in the lung-cancer-specific mortality rate when compared with chest X-rays. That data led The New England Journal of Medicine to conclude: “Low-dose CT reduces mortality from lung cancer.”

Major medical groups quickly followed with new recommendations that people at high risk for lung cancer should be screened and in December of 2013, Saint Peter’s University Hospital became the first hospital in Middlesex county to offer low-dose CT screening for the detection and treatment of lung cancer.

“There is no doubt that early diagnosis leads to better outcomes,” says Robert Caccavale, M.D., a cardiothoracic surgeon at Saint Peter’s. “If cancer is found too late, the opportunity for a surgical cure is gone.” That is because by then, the cancer has spread to other areas of the body. Physicians have long known that the idea of screening for lung cancer “was a no-brainer for those at high risk,” he says, but finding the right test proved elusive.

“Twenty years ago we were doing chest X-rays, but they were not very sensitive,” says Gopal Desai, M.D., chairman of Radiation Oncology at Saint Peter’s. Another test called sputum cytology, which looked for signs of cancer in mucus from the lung, also wasn’t very effective, he says.

Know Your Risk

You can take a quick health survey
to discover important information
about your risk of developing lung
cancer at:

Fortunately, CT technology has progressed. It now allows for clear imaging with lower doses of radiation, giving doctors the tool they’ve needed. “It has all come together now, with the right test and the right information to improve survival rates,” says Douglas Frenia, M.D., a Saint Peter’s pulmonologist.

If anything, a CT scan can sometimes be too sensitive. “Often, the problem with CT scanning is that it shows too much, including a lot of things that are not cancer,” says Dr. Caccavale. But at Saint Peter’s, diagnoses are confirmed by a multidisciplinary team of clinicians with a variety of technical and surgical options at their disposal, minimizing any worries caused by “false positive” scans. Anyone with a suspicious scan enters the program, and the team includes a patient navigator, a nurse practitioner and a team of pulmonologists, thoracic surgeons, radiation oncologists, radiologists, pathologists and medical oncologists.

“We have also started a new lung cancer tumor board conference, in association with the screening program,” says Dr. Frenia. “We meet once a month to review cases found from the screening or by other means.” Those results are then reviewed with the patient’s providers, and together, in consultation with the patient, they decide the best course of action.

Says Dr. Desai: “We look at every single case and discuss what we should be doing.”

Because smoking remains the biggest preventable cause of lung cancer, patients who undergo low-dose CT screening and are current smokers will be given information about smoking-cessation resources available in their community. And because there has been a significant increase in lung cancer in women, the Saint Peter’s lung cancer team is also collaborating with the Saint Peter’s Breast Center as it participates in a national research trial. The study, “Low-Dose Computed Tomography (CT) Screening for Women Who Are at High Risk for Lung Cancer,” evaluates women who are at significant risk of developing the disease.

Of course, finding cancer is only the first step; treatment must then be administered, and lung cancer patients are fortunate to have new and better options here as well. These include less invasive surgeries that sometimes use robotic technology. “We often do surgery now in 20 to 30 minutes, with just a one-night stay in the hospital,” says Dr. Caccavale. “That’s a far cry from the seven to 10 days in the hospital, sometimes in the Intensive Care Unit, that used to be required.” There are also new chemotherapy agents and more precise radiation treatments, such as the CyberKnife® Robotic Radiosurgery System, that can pinpoint radiation to target cancerous cells and avoid surrounding healthy tissue, thus reducing side effects.

All of these developments greatly raise the odds of a cure, but catching the cancer early remains a paramount need. “For stage 1 lung cancer, the cure rate is now between 70 and 80 percent,” says Dr. Desai. “When it progresses to stage 4, average survival is less than two years.”

To be screened, patients should call the lung cancer patient screening program navigator, Nancy Pingitore, R.T.T., who will coordinate all necessary steps with the patient’s primary care physician or pulmonologist. Any follow-up services, including connecting a patient with a primary care physician, may also be arranged. Because these recommendations are so new, health insurers have yet to catch up; most private insurers, Medicaid and Medicare do not yet cover low-dose CT screening. Saint Peter’s, however, charges a nominal $99 per screening.

“When people hear they have to pay they’re sometimes reluctant, which is a shame,” says Dr. Caccavale. “But it costs about the same as a dinner out, and it could save your life.” —David Levine

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