Of the top four deadliest cancers in the US (lung, prostate, breast, and colorectal), lung cancer is the only one not subject to routine screening, until now.
Mammograms, colonoscopies, and prostate exams have all made a huge contribution to diagnosing the cancer they screen for at an earlier stage and therefore, directly impacting the overall survival rate for people with breast, colorectal, and prostate cancer. Early detection is the No. 1 factor that improves survival of cancer, but what about those people at risk for lung cancer?
The overall five-year survival rate continues to linger around 16 percent, a trend that hasn't really improved much since 1975. Lung cancer to this point has not had a good early screening tool hence the fact that most people present at a late stage when the treatment options for them are only palliative. The good news is that we may now have a game-changer with lung cancer -- low-dose CT lung screening.
While it's shown that a large percentage of the lung cancer population present with late-stage cancer, the National Lung Screening Trial (NSLT) demonstrated LDCT (low-dose CT) screening of high-risk populations could reduce lung cancer related deaths by 20 percent versus those screened by chest X-ray.
In August, Monica Key posted a blog titled Lung Cancer Screening Recommendations: To Scan or Not to Scan. In her article she gives an overview of who fits the "high-risk" population and who would be eligible for the screening. She makes an excellent point that "with almost 90 million smokers or former smokers in our country, about 7 million people would qualify for this screening." The NSLT study showed that 1 in 100 people screened were found to have lung cancer at the time of the baseline screening. This could result in tens of thousands of lives saved every year.
Of course, this screening doesn't come without risks -- should people be concerned about the radiation exposure with a LDCT lung screening? Radiation can increase a person's risk of cancer, but by utilizing a low-dose approach, the amount of radiation with a lung screening CT is fairly equivalent to the amount a person would receive from a mammogram screening.
So what are some of the other risks associated with lung screening? Approximately one out of four LDCT lung screening exams will detect something suspicious in the lung that may require additional imaging or evaluation. Most of the time these findings are lung nodules, which the vast majority of are benign and will be followed with a diagnostic chest CT. A very small percentage of those people may require a biopsy. Additionally, in a small percentage of cases (5 percent to 10 percent), the scan will show an abnormal finding not related to lung cancer that may also require further evaluation.
People should weigh the risks versus benefits before proceeding with any testing, and as for high-risk lung cancer individuals, LDCT screening is something that definitely warrants consideration. The National Comprehensive Cancer Network (NCCN) considered all the risks and benefits of lung screening and concluded that the screening should receive a Category 1 recommendation. Current NCCN recommendations for mammography are a Category 2A. This means LDCT lung screening is actually more highly recommended by NCCN than the widely accepted mammogram.
As the lung nurse navigator at our facility and the coordinator of our LDCT screening program, I've had firsthand experience with about 90 people who have paid $50 to have the screening performed through our program in the past five months. The No. 1 comment I hear from those screened is, "The peace of mind that this testing has given to me has been well worth any additional testing I may have to undergo." A favorite comment came from a former smoker: "This testing gives me an opportunity to rise above my unhealthy habits of the past and take a healthy step forward."
After screening 90 people, our facility is currently working up two patients who both look highly suspicious for lung cancer. Both of these individuals appear to be healthy, neither showing any signs of lung cancer. Their screening has been the only indication that they could be harboring such a malicious disease. If a lung cancer diagnosis is proven in either of these patients, based on the current size and the imaging that has been completed, both will likely be a stage IA. Remember that the survival status increases significantly when lung cancer cases are diagnosed in their early stages.
Could LDCT lung screening at least be a start in the right direction of improving statistics that have barely budged in over 35 years?