Lung cancer’s deadly nature is proven by its mortality statistics, leading as the number-one cause of cancer death in both men and women. It is a particularly challenging disease given its tendency to present late in the course of disease, having already compromised the function of one or more vital organs or spread beyond the lung into other parts of the body.
Up until about seven years ago, there was no way to identify lung cancer at an early stage. Individuals would often present to their physician with concerning symptoms like an unrelenting cough or unintentional weight loss, which could be signs of more advanced disease. Now, through the use of a simple CT scan, individuals deemed to be at risk for lung cancer can be identified at an early and curable stage.
“Lung cancer screening is focused on trying to identify subgroups of individuals in our community who may be at higher risk for the cancer,” states Patrick Nana-Sinkam, M.D., who is the Linda Grandis Blatt Endowed Chair in Cancer Research, a member of the Cancer Cell Signaling (CCS) and Cancer Prevention and Control (CPC) research programs at VCU Massey Cancer Center, and a professor and chair of the Division of Pulmonary Disease and Critical Care Medicine in the Department of Internal Medicine at the VCU School of Medicine. “In individuals who are diagnosed with lung cancer in the early stages and who have curative treatment, the five-year survival rate is 60 to 70 percent. Conversely, when people present late in the course of their disease, their five-year survival is often less than 10 percent.”
While the primary impact of lung cancer screening is a reduction in lung cancer-associated mortality (approximately 20 percent reduction), lung cancer screening holds other benefits. Namely, identifying additional diseases that may have gone unrecognized for many years, such as chronic obstructive pulmonary disease (COPD) or coronary artery disease.
Comprehensive Early Detection Program
The CT scan involves acquiring images of the chest and only takes around ten seconds to complete. In standard care, results are sent to one’s primary care physician and discussed at a later date. The VCU approach is a bit different, providing real-time results and counseling prior to and after the scan.
“In collaboration with our colleagues in Radiology, we have implemented an early detection program, which involves providing in-person counseling for high-risk individuals. We first review the risks and the benefits of being screened. We also provide additional information to address any misconceptions and to place any CT findings in context. For example, we review the likelihood that they will have a spot on their lung, which is about 25 percent for high-risk active or former smokers. But, the important second point is that the majority of spots we detect are not cancerous. It’s important to stress that to a patient before they have the CT scan,” says Nana-Sinkam.
The initial consultation also includes a review of the patient’s risk of developing lung cancer, based on their demographics and risk factors. “We make that discussion very individualized,” he adds. “We also discuss results of the screening with them in real time, which we find has been very beneficial. It takes away some of that anxiety of waiting for a call from your physician, or for a letter, or receiving a report in the mail and not really understanding how to decipher those results.”
A large clinical trial was used to establish recommendations for who should be screened, which Nana-Sinkam says is a very particular subset of individuals. Guidelines advise individual screening for those between ages 55 and 80 and with a 30-pack/year smoking history.
“We determine smoking based on pack years. If you have smoked a pack of cigarettes a day for 30 years, we would say you have a 30-pack/year smoking history. Equally, if you smoked two packs a day for 15 years, you would qualify,” he explains.
Guidelines also encompass those who were 30-pack/year smokers, but who quit within the last 15 years—the window in which individuals are still at risk for developing lung cancer, even if they stopped smoking.
Research is also demonstrating additional risk factors beyond age and smoking history. For example, if an individual has a first-degree relative with lung cancer or has a history of COPD, they are also at increased risk. Asbestos exposure heightens risk, as well.
While VCU encourages individuals to take part in the more in-depth screening process, the hospital does offer the standard screening in which patients can come in at their convenience and results are sent to a primary care provider.
VCU also provides smoking cessation counseling. “We recognize that the most important intervention a person can take to decrease their risk of lung cancer is for them to not smoke. So, we use that particular opportunity to provide real time education on smoking cessation if a patient is so inclined,” notes Nana-Sinkam.
Obstacles to Screening
Despite the statistics showing the dramatic difference in mortality in individuals who are screened versus those who are not, analytics reveal that only five percent of eligible candidates in the United States actually undergo screening. One reason, Nana-Sinkam says, is access to screening centers that have proper CT scanners and the ability to accurately interpret results, as well as a system in place for appropriate follow-up if someone requires an intervention.
An additional obstacle is lack of education. Many individuals believe the scan will automatically lead to biopsy or have fears about radiation exposure. In reality, the radiation exposure is very low.
“We often hear the fear, ‘If I go to be screened, I am most certainly going to have lung cancer.’ The program we put into place is designed to allay many of those fears, with an intention of educating people upfront on what they can expect,” shares Nana-Sinkam. “The second value to our program is that for those few individuals who do have a spot of concern, we offer a second phase of education that helps put into context what that spot means.”
By having this type of comprehensive program available, Nana-Sinkam and his colleagues are in a position to expedite evaluations. “This is important, because if a problem area is identified, the next fear of patients is, ‘How quickly are we going to do something about it?’ We can provide treatment options in a streamlined manner,” he assures.
Listen to a full interview with Patrick Nana-Sinkam about lung cancer screening by clicking here. For more episodes, find the Healthy with VCU Health podcast on any major streaming platform or by visiting the VCU Health Podcast library at vcuhealth.org/podcasts.