Guest Columnist: Sarah Bashaw, 3rd Year Medical Student The Commonwealth Medical College
Recent headlines in The Times-Tribune reported with alarm that lung cancer rates in Northeastern Pennsylvania are on the rise, especially among women, while the incidence of the deadly disease is declining elsewhere in the country. In fact, according to the Northeast Regional Cancer Institute, NEPA’s rate is 15% higher than the expected average.
Lung Cancer is a very serious and often deadly disease. Until recently, there was not a well-documented study to support an effective and safe screening test. A chest X-ray, often used only after patients developed symptoms, discovered the disease when it was in the late stages. This is about to change… those who are at high risk for lung cancer can now be screened annually using low-dose spiral CT scans.
No new technology is without controversy. A recent study published in the Journal of the American Medical Association suggests that there is a possibility that CT screening may lead to over diagnosis of lung cancer. For example, it is predicted that for every 320 patients screened for lung cancer, while at least one life will be saved, 1.3 cases of previously undetectable slow growing and possibly non fatal tumors will be discovered. Currently, the medical community is unsure of how these patients will be best managed but it is hard to imagine when early detection is not advantageous, even if only to provoke a patient into living a healthier lifestyle and quit smoking.
FACT 1: Each year over 250,000 people in the United States are newly diagnosed with lung cancer.
FACT 2: Almost 90% of individuals who have lung cancer will eventually die of the disease, making lung cancer the most deadly cancer in the United States for both men and women. However, detection of early stage lesions has significantly higher survival rates.
FACT 3: 85% of all lung cancers is caused by smoking.
FACT 4: According to the Pennsylvania Department of Health, 22% of people aged 18 years and older residing in Northeastern, PA smoke as compared to 19% nationally.
FACT 5: The best prevention measures are; not smoking or using tobacco products, and avoiding second-hand smoke or high air pollution environments.
One of the reasons for the high mortality rate in lung cancer is that the disease is often not discovered until it is advanced and treatment is not as effective. Some of the most common signs and symptoms of lung cancer are easily mistaken either for a mild illness or for things such as “smoker’s cough”. By the time many patients are diagnosed, their disease is advanced and may involve lymph nodes or other organs.
For some cancers, there are established screening tests that help to identify these cancers at an earlier stage. For example, routine screenings through colonoscopies, mammograms, and pap smears are well established and have saved thousands of lives. Historically, lung cancer has not had such a screening test. This however, has changed due to recent research. This past summer, the United States Preventative Task Force (USPTF), an independent committee charged by congress to evaluate the most current data and make recommendations for disease screening, released a draft of a new proposal for a lung cancer screening test.
The USPTF now recommends that all persons who are at high risk for lung cancer should be screened annually using low-dose spiral CT scans. High risk persons are identified as those who are between the ages of 55 and 79, who have a history of 30 pack years or more of smoking, and who are either still smoking or who have quit within the last 15 years. A “pack -year” is defined as smoking 1 pack of cigarettes a day for a year. For example, a person could have 30 pack -years of smoking if they smoke 1 pack of cigarettes a day for 30 years. Similarly, they could have a 30 pack-year history by smoking 2 packs of cigarettes a day for 15 years.
CT, or computed tomography scans, are a form of three-dimensional imaging used by clinicians to visualize the organs and other anatomy of patients. The scan can detect abnormalities on a patient’s lung with much earlier and with greater sensitivity than an x-ray. Much like a mammogram, low-dose CT scans do not diagnose cancer but are a way to identify patients with abnormalities that need to be investigated further for the possibility of cancer. This new screening test will allow physicians to see possibly cancerous abnormalities of the lung before the disease can spread and become difficult to cure. Early stage nodules can be seen and surgically removed before they spread. The scan is non-invasive and generally considered very safe. Low-dose CT scans carry about 5 times less radiation than traditional high-dose CT scans and are equivalent to about 15 x-rays.
It is projected that this new screening practice will save the lives of between 18 and 20% of those diagnosed with lung cancer by detecting cancers before they can progress to the point that they are resistant to medical treatment. The draft of the new proposal for lung cancer screening that the USPTF released this summer was based off of a landmark article in The New England Journal of Medicine in 2011. In view of this, clinicians have been encouraged to implement these screening practices and insurance companies will use these recommendations to adopt their policies regarding coverage for testing.
While this screening is a major step in the detection and treatment of lung cancer, it is not a substitute for quitting smoking. The best proven methods to prevent lung cancer and its deadly consequences is to not smoke, use other tobacco products, and avoid exposure to second-hand smoke.
If you think that you or a loved may be in need of lung cancer screening, contact your family physician or pulmonary specialist for more details. For help quitting tobacco products, you may also contact your physician or call 1-800-QUIT-NOW or visit www.lung.org.
NOTE: These signs and symptoms can be attributed to many different causes and are not exclusive to lung cancer. Always discuss your symptoms with your physician.
Who should be included in annual low-dose spiral CT screening for lung cancer?
Patients who fit all of the below criteria:
*A pack year is defined as 1 pack of cigarettes per day for a year
Guest Columnist, Sarah Bashaw, is a third year medical student at TCMC. She has discovered a love for the heart and plans to become a cardiovascular surgeon. She also is dedicated to patient centered medicine and is eager to be an integral part of a health care team which is compassionate and focused on patients and their families. She comes to our area from a small town in Vermont and enjoys skiing and being outdoors. She received her bachelor’s degree in Chemistry from Skidmore College in Saratoga Springs, NY, in 2011 where she was also the president of the College’s Honors Forum.
Medical Reviewer: Greg Cali, DO, Pulmonologist, Dunmore, PA
Read “Health & Exercise Forum” in the Scranton Times-Tribune Every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
Paul J. Mackarey PT, DHSc, OCS is a Doctor of Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.