Lung cancer is the leading cause of cancer death in the United States, with approximately 150,000 annual deaths out of 220,000 diagnosed each year.
One reason for this high mortality rate is that the disease is often undiagnosed until it is in a later stage -- stage three or four.
"When a patient is diagnosed with lung cancer it's often already in an advanced stage," said Michael Costello, MD, a medical oncologist with the Abramson Cancer Center at Chester County Hospital in West Chester, PA. "At these later stages, treatments can hopefully control the cancer and prolong the patient's life, but they aren't curative."
Early detection makes a difference. "Patients who are diagnosed in stage one or two have highly curable diseases, with cure rates sometimes as high as 90 percent," Costello said.
Improving the outlook for lung cancer patients has been the goal of Dr. Costello and Chester County Hospital since they began Low-Dose CT Lung Screening (LDCT) in 2012. The hospital reports that LDCT has proven effective in detecting lung cancer early and can lower the risk of death from lung cancer by 20 percent in people who are at high risk for the disease.
Chester County Hospital implemented LDCT not long after results of the National Lung Screening Trial, involving more than 50,000 current or former heavy smokers, were published in 2011.
"Historically, we didn't have a way to detect these patients as early as we have other cancers," Costello said. "The national trial showed that by screening asymptomatic patients, we are able to find early-stage lung cancers where therapies are curative."
Following the guidelines from the trial, Chester County Hospital recommends LDCT for adults between the ages of 55 and 77 who:
- Have a "30-pack-year" history of smoking. (A pack year is the number of packs of cigarettes smoked daily, multiplied by the number of years smoking, i.e. a pack a day for 30 years or two packs a day for 15 years.)
- Meet the above criteria and currently smoke or have quit within the last 15 years.
- Have no symptoms or history of lung cancer.
For those in the high-risk group, annual screenings are recommended -- as are smoking cessation programs. The screening requires no medications or needles. Patients need only to hold their breath for six seconds while the chest scan is being taken.
It takes time to incorporate something new into routine medical care, but the impact can be dramatic.
"People know about mammograms and colonoscopies. These are routine cancer screenings that many patients and their family members have had completed," Costello said. "Something new, though, can cause angst. But as you talk patients through the anxiety of something new, they start to understand. 'Yes, I'm at risk and this test could save my life.'"
As for the impact, consider what Costello calls "number needed to treat."
"That's the number of patients I need to test to make an impact, and I use it to compare LDCT to other cancer screenings," Costello explained. "For example, colonoscopies. If you want to save one patient's life from colon cancer, you have to screen about 1,200 people. For LDCT, you have to screen 300."
As part of pre-test counseling, patients are alerted to the high false-positive rates of screening.
"A lot of things will show on CAT scans that aren't going to be cancer," Costello said, "but if you follow patients year after year, with repeat scans -- we normally do three of them for patients we consider high risk -- we are able to distinguish between those patients who are completely fine from those who need intervention."
Costello says that being involved in the startup of such groundbreaking screening "feels fantastic." He added, "And I can tell you the moment that was the most fantastic: When we found our first lung cancer this way, and that person had surgery behind him, and he was completely asymptomatic. That patient, not having had this test, likely would have died of his disease.
"That's an amazing thing, to have that kind of impact on people's lives."
With Chester County, PA having one of the higher rates of lung cancer in the country, Dr. Costello would like to expand beyond the current 20 screenings a month.
"The number of people that can be considered at risk for lung cancer is still much higher than the number of people being screened," he said. "We need to add this test to our understanding of what good health care is. Providers need to ensure they present this as an option for those at risk, but patients can also be their own advocates and ask their primary care physician about the test."
Learn more about low-dose CT lung screens and find out if a screening is right for you.
Related Lung Information from Chester County Hospital: