Lung cancer is the No. 1 cause of cancer deaths in the United States, despite the fact it is largely preventable. For people at high risk of developing lung cancer, such as current or former longtime smokers, screening for the disease with low-dose CT scans is now a viable option that has been shown to significantly reduce mortality rates. In conjunction with National Lung Cancer Awareness Month, Seattle Cancer Care Alliance (SCCA) wants to raise awareness about the importance of prevention and early detection for at-risk populations.
A majority of patients diagnosed with lung cancer already have incurable disease at the time of diagnosis. The large number of patients with advanced lung cancer is the reason it is the leading cause of cancer-related death in the United States - more than breast, colon and prostate cancer combined. However, by participating in screening that can detect cancer in its earliest stages, lung cancer mortality can be lowered by as much as 20 percent, according to results from the National Lung Screening Trial (NLST) that were published in June 2011.
"Low-dose computed tomography screening for patients at high risk of lung cancer saves lives," said David Madtes, M.D., director of SCCA's Lung Cancer Early Detection and Prevention Clinic and director of the low-dose CT screening program. "It is recommended by more than a dozen medical societies and patient advocacy groups including the American Cancer Society and the American Lung Association."
While lung cancer screening is not currently a routine part of preventive medical care like mammography for breast cancer screening or the PSA blood test to screen for prostate cancer, the results of the NLST trial are changing clinical practice. Lung cancer experts now support lung cancer screening to provide the opportunity to detect cancers at an earlier, treatable and curable stage.
Douglas Wood, M.D., professor and chief of Cardiothoracic Surgery at the University of Washington and a member of the multidisciplinary team that treats lung cancer patients at SCCA, chairs the National Comprehensive Cancer Network (NCCN) Lung Cancer Screening Panel which supports creating policies that allow more patients access to screenings. Wood led the NCCN group that published the initial set of guidelines in November 2011 and the guidelines revision process this summer, which aims to make screening available with the support of insurance and Medicare.
"Lung cancer screening for those at high risk is the biggest game changer in lung cancer treatment in a generation," Wood said. "The NLST study found that such screening could reduce mortality by 20 percent. We are on the cusp of changing guidelines and policies to help offer screening that could impact millions of people."
Patients at high risk for lung cancer who benefited from CT screening in the NLST met the following characteristics:
• Ages 55-74
• Current smokers or those who quit within the last 15 years
• Previous smokers with a 30 or more pack-year smoking history ("pack years" equals the average number of packs of cigarettes smoked per day multiplied by the number of years a person has smoked)
In addition to the above characteristics, the NCCN considers individuals to be at high risk for lung cancer if they have the characteristics listed below.
• Age 50 or older
• Smoked for 20 or more pack years
• Documented high radon exposure
• Occupational exposure to silica, cadmium, asbestos, arsenic, beryllium, chromium, nickel or diesel fumes
• A survivor of lung cancer, lymphoma or head and neck cancer
• A history of chronic obstructive pulmonary disease or pulmonary fibrosis
• A family history of lung cancer
Currently, low-dose CT screening is not covered by most insurance carriers, yet the out-of-pocket cost is relatively low at $300. Most follow-up care required after the exam will be covered by insurance or Medicare/Medicaid.
Those who may qualify for low-dose CT screening can call the SCCA Lung Cancer Early Detection and Prevention Clinic at 206-288-6734, or have their physician call with a referral.
Those who need help quitting smoking can contact SCCA's Smoke-Free Life Program at 206-288-7517.
Seattle Cancer Care Alliance