10 Steps to Beat Lung Cancer

CT Scans are painless and non-invasive.

CT Scans are painless and non-invasive.

Screening for lung cancer can save lives – 26,000 to 36,000 Americans every year – by use of low dose CT scans. Dr. Florian Fintleman from Massachusetts General Hospital in Boston reported on the 10-step model at the 2016  American Roentgen Ray Society (ARRS) meeting in Los Angeles.

Dr. Fintelman’s program can be summarized as follows:

  1. Patient Eligibility:
    • Current smokers age 55-77 years old
    • Former smokers age 55-77 with a 30-pack-a year history
    • Former smoker who quit within 5 years
  2. Physicians and Patient Education:
    • Educating primary care physicians on the US Preventative Services Task Force (USPSTF) guidelines and results. Stressing that nearly 30,000 lives can be saved every year. Only 15% of lung cancer patients are found with stage I or stage II disease, with survival rates of 80-85%. With lung cancer screening, that percentage can nearly be doubled, saving many more lives when the lung cancer is caught early.
    • Medicare (CMS) requires a visit between the referring physician and patient, with the visit focusing on “counseling and shared decision making”, i.e. part of a routine visit.
  3. Ordering screening lung CT scans:
    • CMS guidelines call for a physician or qualified non-physician provider such as a nurse practitioner, physician assistant or nurse specialist to order the low dose CT scan.
    • Patients who would simply like a CT scan screening may self refer as long as they meet the screening criteria.
    • First Dayton Cancer Care has special LDCT Lung Screening order forms with the established criteria. We will even acquire the prior authorization if needed. Call us today.
  4. Image Acquisition:
    • The American College of Radiology (ACR) and CMS established parameter for low dose, non-contrast CT scan optimal for lung screening.
    • First Dayton Cancer Care is an approved imaging facility through the Intersocietal Accreditation Commission with the longest accreditation term that they grant so you can be rest assured that the best possible low-dose, non-contrast CT lung screenings will be given here.
  5. Image Review:
    • At First Dayton Cancer Care our scans are read by board certified diagnostic radiologists from ProScan Imaging, a nationally recognized group of radiologists based in Cincinnati.
  6. Communication with Physicians:
    • Clear and concise reporting to referring physicians is provided within 24-48 hours of scan.
    • Images are available for viewing by physicians who so desire.
    • Images are compared to any previous screening scans if made known by the patient or ordering physician.
    • Referring physicians will get a telephone call from the Medical Director, Dr. Edward Hughes, to follow up on any positive CT Scans. Referring physicians can call Dr. Hughes for his medical opinion regarding further follow up, like biopsies and/or PET/CT scans.
  7. Communications with the Patient:
    • First Dayton Cancer Care will educate the patients with a negative screening to continue to follow up with their General Practitioner and the importance of routine care and need for future screenings.
    • Clinical research showed that an unexpected result from screening was the patients with a negative CT scan felt they have a new lease on life and continue to smoke. So we stress that a smoking cessation and or an appointment with their General Practitioner to discuss this habit is imperative.
  8. Quality Improvement
    • CMS has begun a program to collect data on lung screenings. They are just beginning to role out this registry but the hope is that these results will help fine-tune the guidelines and provide some benchmarks for further understanding the importance of these screenings.
  9. Cost/Insurance Coverage
    • Since December 2013, many private insurers will cover the cost of this routine screening for those meeting the criteria.
    • CMS covers lung cancer screening by its own criteria since February 2015 for those enrolled in the registry. Medicare is rolling this registry program out and hopefully soon all screening centers will be enrolled.
    • For other eligible patients, a low dose CT scan is only $99, the cost of a couple of cartons of cigarettes.
  10. Research Frontiers
    • As always, many questions remain unanswered, like the optimal interval between CT scans and how long should one have low-dose screenings.
    • Stereotactic radiosurgery, like that delivered by the Cyber Knife, has the same results as open surgery, but without the risk of thoracotomy. And the risk of surgery is not only confined to surgical complications, but there is a defined risk of death from thoracotomy, especially in elderly patients with multiple medical problems.

If you have any questions, please feel free to write or to call me, Dr. Edward Hughes at 855-DAYTON1.

Lung Cancer Screening with Low Dose CT scans: Do The Pro’s Outweigh the Con’s?

A simple and painless CT scan, could save your life.

The Heart of the Problem

Death from lung cancer in the USA is staggering-160,000 Americans will die of lung cancer each and every year.  Over 225,000 American men and women are diagnosed with lung cancer, but the vast majority, nearly 85%, are diagnosed with locally advanced lung cancer.  And only 17% of all lung cancer patients will survive.  That’s why, for many Americans, lung cancer represents a death sentence.  Less than 15% of Americans are diagnosed with early stage lung cancer, usually as the result of a CT scan of the chest done for other reasons.

American medicine has made tremendous breakthroughs in the treatment of lung cancer: stereotactic radiosurgery, like that delivered by Cyber Knife, and immunotherapy, like Nivolumab, are leading the way in the treatment of early stage and locally advanced lung cancer, respectively.  But the problem is that only 15% of Americans are diagnosed at an early stage, when their lung cancer is highly curable.  In fact, early stage lung cancer has an 80-90% cure rate.

Is Screening with Low Dose CT scans the Answer?

A major study, called the National Lung Screening Trial or NLST for short, enlisted 53,454 men and women smokers and screened them every year for 3 years with low dose CT scans.  The NLST results were outstanding-a 20% reduction in death from lung cancer as a result of the use of low dose CT scans.  These breakthrough results translate into saving about 20,000-30,000 American smokers each and every year from the ravages of lung cancer.

 But screening alone is only part of the answer.  One study showed 14% of smokers who underwent screening quit, twice the rate of the smoking population in general.  Yet another recent study showed quite the opposite-many smokers with negative low-dose CT scans continued to smoke.  It was as if a negative low dose screening CT scan gave them a new lease on their smoking lives.  So enrolling smokers in a program to get them to quit smoking may also be the key.

So What are the Pitfalls of Low-Dose CT scanning?

The American NLST study was huge-enrolling over 53,000 Americans.  And the NLST was the so-called gold standard- a prospective, randomized trial.  The NLST was twice the size of the European NELSON trial that had 15,522 participants.  Still, a major point of concern in the American NLST study is that the results have not been reproduced.  At least 2 similar studies in Europe, albeit much smaller, failed to show any effect on lung cancer survival by low dose CT scan screening.

The second cause for concern is that a number of smokers may have a so-called “false positive.”  That is to say, a worrisome spot found on low-dose CT scan that is benign-not cancer at all.  A number of maneuvers may help reduce the anxiety and expense of a so-called “false positive.”  For example, if the cut off in size of a worrisome spot was increased from 4 mm to 6 mm, the “false positive rate” in the NLST study would have been reduced by over 50%.

And other imaging studies, like PET scans, can help sort out whether a biopsy or bronchoscopy or even an open surgery is needed.

So What Is a Smoker To Do?

The upfront, out-of-pocket self pay cost for low-dose CT scan for lung cancer screening is $89-$99 in Dayton Ohio-the cost of the couple cartons of cigarettes.  In addition, a number of private insurance companies have agreed to start paying for low-dose CT scan screening for smokers. Medicare is sorting out the details for reimbursement right now. CMS has agreed that this should be a routine annual screening for those who qualify.

The unspoken risk is also that of radiation exposure.  Yet the radiation exposure risk of a low-dose CT scan is very low-about 1.5 mSv.  So what does that number mean?  Whether you know it or not, the yearly exposure of all Americans to “background” ionizing radiation, mostly from cosmic rays, is 2.4 mSv.  So not such a big deal for an occasional screening low-dose CT scan that can save your life.

So when all is said and done, I think screening with low dose CT scans is a good thing for smokers. If you fall under this criteria, you need to have a conversation with your physician about having a screening. You need to be a part of the decision making process that may include counseling for smoking cessation if you are a current smoker.

These are the recommendations for who should be screened.

Screening men and women age 55-77:

Asymptomatic (no signs or symptoms of lung cancer);

               • Tobacco smoking history of at least 30 pack-years (one pack-year =            smoking one pack per day for one year; 1 pack = 20 cigarettes);

Current smoker or one who has quit smoking within the last 15 years.

If you have any questions, please feel free to call me, Dr. Hughes, at 855-Dayton1.