Lung Cancer Screening and the Efforts of Columbus Regional Hospital’s Multidisciplinary Lung Nodule Review Board
Lung Cancer is by far the leading cause of cancer deaths in Indiana and the United States, at over 150,000 deaths per year related to lung cancer. The team of cancer specialists at CRH is continually seeking new treatments and technologies to fight all cancers and improve cancer outcomes.
Early detection is vital for best outcomes in the treatment of lung cancer. Patients with heavy smoking histories should be informed that studies have shown that annual low-dose computed tomography (CT) screenings can reduce lung cancer mortality by 20% and even reduce all-cause mortality by 7%. The 2011 major study of heavy smokers and lung screening, called the National Lung Screening Trial, compared screening for lung cancer using lung CT scans and chest x-rays. This was the first study to show that lung cancer screening may save lives by showing that lung CT scan for screening lowered the risk of dying from lung cancer by 20% among screened current and former heavy smokers. Low-dose CT lung screening can result in 3 less cancer deaths per 1000 persons at risk (age, smoking history) compared to chest x-ray screening for the same patient group. For comparison, this is a larger reduction in cancer deaths than occurs by doing mammograms for breast cancer screening.
The dedicated team of cancer professionals and CRH leadership partnered together in early 2017 to increase the public awareness of the need for cancer screening and went to local primary care physician’s offices to help get more patients screened by increasing the awareness of the lung cancer screening benefit and the ability of CRH to perform such studies. Our low-dose CT scans ensures minimal radiation exposure during the screening study and all patients that are screened are aggressively counseled on smoking cessation and provided resources and contact for smoking cessation efforts if elected. Cigarette smoking is the number one cause of lung cancer and is linked to at least 80% of lung cancers.
A short-term $10 promotional price and patient/physician education was provided to offer low-dose CT lung screening to all patients ages 55-77 with a 30 pack/year smoking history who are current smokers or quit in the last 15 years. The NCCN (National Comprehensive Cancer Network) current guidelines for high-risk patients to screen also gives consideration for patients ages 50 and older with greater than 20 pack /year smoking history.
Frequently Asked Questions About Lung Cancer Screening
(Answers from the Multidisciplinary team.)
Q- What is the goal of lung cancer screening?
A-To save lives! If we wait until a patient develops symptoms we are typically diagnosing patients with more advanced cancer and potentially less curative treatment options. At CRH, we are able to meet every Tuesday morning as a dedicated team of Radiologists, Pulmonologists, Thoracic Surgeons, Medical and Radiation Oncologists to review worrisome lung screening studies and aid patients and their primary care physicians in the need to navigate towards improved pulmonary health.
Q- Who should get a low-dose CT lung screening exam?
A-Low Dose Lung Screening CT scans are recommended for people with high-risk findings as per the two risk groupings above. If you feel that you are at high risk, please call our screening number at 812-376-5362 and an expert will talk through your unique case with you to see if screening is right for you.
Q- How is the exam performed?
A-The low-dose CT lung screening is very straightforward. It does not require IV contrast, no medications are given and no needles are used. You can eat before and after the exam. The test does require a person to hold their breath for at least 6 seconds while the chest scan is being taken.
Q- Are there any risks to low-dose CT lung screening?
A-There are several risks and potential limitations of low-dose CT lung screening.
- Radiation exposure: By using special techniques, the amount of radiation in low-dose CT lung screening is small—about the same amount a person would receive from a screening mammogram. Your doctor and the screening team at CRH have determined that the benefits of screening outweigh the risks of being exposed to the small amount of radiation from this scan.
- False negatives: No screening test is perfect. Lower radiation doses, lack of IV contrast or other factors could lead to inability to identify a medical condition, including cancer, on a low-dose CT lung screening study. This is one of the reasons that patients who are high risks are followed over time, at least annually, to ascertain that if a cancer were to develop that it would be detected as early as possible.
- False positive/additional testing: Further testing and work-up may be needed to more completely evaluate a patient’s scan. All patients who have a low-dose CT scan are reviewed carefully by a radiologist and assigned a lung-RADS score (one to four, with four being more worrisome) and recommendation for next steps. Patients with lung-RADS scores of 3-4 are evaluated by the weekly meeting of a multidisciplinary lung nodule review board which may assign further recommendations. With any testing, anxiety and worry can be increased if additional testing or further study is needed. No further testing will be ordered or recommended without alerting your primary care physician or getting your permission. Occasionally, patients need a procedure, such as a biopsy, that can have potential side effect or could need a different radiology investigation which could give more radiation. In a small percentage of cases, the screening study may capture an area of clinical question outside or next to the lungs (including kidneys, adrenal glands, liver, thyroid, etc.) and this may require further study. Your health care provider will be notified of this by a member of our multidisciplinary lung nodule review board.
Q- What are the goals of CRH and the lung multidisciplinary nodule review board
A-To assist our community to leading more high-risk smokers to the path of smoking cessation and using the lung screening program to assist them in ascertaining their lung health through the years ahead. We strongly want to spread the word on the complete thoracic care program we offer that is truly unique in the state of Indiana.
Columbus Regional Cancer Center Outcomes
In 2017 (1/1/2017 through 09/30/2017), a total of 419 patients have been screened with low dose CT lung screening studies. A total of six cancers have been identified on these initial screening scans. Four patients were identified with Stage I disease, one patient with stage II disease and one patient with stage III disease.
Please see how we can partner with your long-term health moving forward if you or a loved-one meets the criteria of high-risk lung screening noted above. Finding abnormalities earlier is important and we are ready to be your partner in pulmonary health going forward.
Thanks,
John A. Cox, MD