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Dan J. Raz, M.D.

Assistant Professor and Co-director of the Lung Cancer and Thoracic Oncology Program, City of Hope

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New Lung Cancer Screening Recommendation Is a Breath of Fresh Air

08/28/2015 01:00PM | 24813 views

One of the big healthcare related news stories this month was the announcement by CVS Caremark that it was going to stop selling cigarettes and all other tobacco products in its stores. 

As the country’s largest drugstore chain in terms of overall sales, second only to Walgreen’s in number of stores, the announcement made headlines across the nation. The decision will cost the company an estimated $2 billion in annual sales, a loss the company is willing to take to strengthen its brand as a health care provider and not just a retail business.

This announcement comes on the heels of the new recommendation by the U.S. Preventive Services Task Force that adults at high risk for lung cancer undergo annual screenings with low-dose radiation CT scans. Those at high risk are defined as adults 55 years or older who are smokers or former smokers with a 30 pack-year smoking history (calculated by multiplying packs per day by the number of years a patient has smoked).

Both developments are good news in the fight against lung cancer. While CVS is cutting the problem off at its source – and hopefully more retailers will follow – lung cancer screening will save lives with the potential to reduce lung cancer mortality by up to 60%.

Safe and cost effective, lung cancer screening is a huge opportunity to prevent lung cancer deaths, the most common cause of cancer death in both men and women – more than breast, colon, prostate and pancreas cancer combined.

Yet, for a variety of reasons, it seems that relatively few of those deemed high-risk are taking advantage of the opportunity to be screened for lung cancer. We’re seeing this firsthand at City of Hope, where only 10% of those being screened for lung cancer are Latino, even though they represent nearly half of the population in our catchment area – and despite the fact that we are the only lung cancer screening center here in the San Gabriel Valley.

In an effort to change that, I’d like to address some of the reasons why people at high-risk for lung cancer are not coming in for screenings – and why they should.

Lung cancer screening is relatively new and so hasn’t had time to gain traction in the public consciousness. In fact, it’s so new that not all insurance companies are paying for it yet. This will change as of January 2015 when all insurance companies must cover lung cancer screening. (Until then, City of Hope is offering screening at a discounted price of $150). Those at high-risk should make lung cancer screening a priority and not wait until the new year if at all possible. The sooner lung cancer is diagnosed, the more treatable it is and the better the odds of survival.

There’s also some confusion within the medical community about the potential risks of lung cancer screening versus the benefits, and not everyone is up to speed on the new recommendations for high-risk patients. Many times, we do more harm than good by talking about the minimal risks because it can scare people off, and for those at high-risk not getting the screening could be a death sentence.

Ultimately, it’s education and better understanding of the benefits of lung cancer screening that will create awareness and motivate patients at high-risk to seek it out. Misperceptions about lung cancer screening can be created by the lack of awareness of the life saving benefits to people at high risk. In addition, both patients and physicians hear mixed messages when recommendations for screening are coupled with an emphasis on the small risks of screening, such as exposure to radiation and false positives creating added anxiety.

To help alleviate patient fears and misinformation, the Lung Cancer Alliance, an important advocacy group for lung cancer patients, has been working to educate the public and physicians alike on lung cancer screening. In addition, to improve lung cancer screening quality, they have put together a framework of excellence – a set of criteria that lung cancer centers can follow to gain recognition as a National Center of Excellence for cancer screening. City of Hope is one of only three Centers of Excellence in all of Los Angeles County.

This designation means that we use low-dose radiation CT scans for lung cancer screenings. In fact, the amount of radiation is only slightly higher than that for a diagnostic mammogram. We also have coordinated care whereby findings of screening exams are managed by a team of physicians with different specialties in order to minimize risk and make the process more efficient and comforting for the patient.

The Centers of Excellence designation also means that we have practices in place to reduce the amount of invasive testing and unnecessary procedures such as biopsies on people who don’t have cancer. For example, close to 25% of people screened for lung cancer will have a positive finding. But not all of them should have a biopsy as most of these nodules are not cancerous and will not grow. Most of the time we will order another scan in a few months and if these nodules haven’t grown, it usually means they aren’t cancerous. Because of this process, in the first 100 patients that we screened, we only did lung nodule biopsies on three people, and all three had lung cancer which was early stage and curable.

These are just a few of the benefits of coming to a Center of Excellence where there is a set way of doing screenings based on evidence from studies and trials. We’re specifically focused on making screenings as safe as possible and getting patients’ results to them as quickly as we can.

Though it is natural to have some anxiety when going through any screening process – whether mammogram, lung cancer or any other screening – when something is detected, chances are that it will be benign. But many patients will be anxious until a nodule is proven to be non-cancerous. Here at City of Hope, we are studying how to reduce anxiety in lung cancer screening with better patient education, counseling, and communication of results.

In tandem with or until you can get lung cancer screening, here are three additional pieces of advice regarding the prevalence of lung cancer:

  • Quit smoking – it’s not only the best thing you can do to prevent lung cancer, but also heart disease and emphysema, the other major causes of death among smokers and former smokers. You can’t afford to put it off for even a day, and you can find help available through City of Hope’s tobacco decision program and quit lines.
  • Be aware that, although screenings are currently only recommended for smokers and former smokers, anyone can get lung cancer. In fact, 15% of lung cancers overall are found in non-smokers, and for women it’s even higher at 25%. You should be scanned for lung cancer if you are exhibiting symptoms, such as coughing up blood, or a cough or chest pain that won’t go away.
  • Be wary of electronic cigarettes and the perception that they are a safe alternative. E-cigarette vapors still contain chemicals and unlike conventional cigarettes there is no regulation whatsoever. Furthermore, because they are so new, the long-term effects of inhaling e-cigarette vapors are not known. Even though they may be safer than conventional cigarettes, that doesn’t necessarily make them safe. 

E-cigarettes seem to be taking the spotlight these days. I’ll discuss this topic in a future blog for those using or thinking about trying e-cigarettes, who might want to consider that – unlike lung cancer screening, where the benefits clearly outweigh any perceived risk – the opposite is true of e-cigarettes, with potential harm down the road that we don’t yet know about.

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    • LeahAdamson
    • 03/30/2015 07:07 a.m.
    • It is good to see the work being done for lung cancer screening. Certainly many patients get a great survival advantage by early detection of lung cancer. Patient who has an increased risk of this disease generally go for computerized tomography (CT) scans. However, doctor prescribes number of tests performed with the help of tools present at for detecting cancerous cells and to rule out other conditions. It includes imaging tests, sputum cytology and tissue sample (biopsy) to detect the disease.