Issue 9 Stories

Targeted Screening to Fight Lung Cancer

Low-Dose CT Lung Scans of Longtime Smokers Help Save Lives

Jay Dean wasn’t worried about having lung cancer. He felt fine. 

Then he began seeing TV ads about cancer screenings at Sentara RMH using a low-dose computed tomography (LDCT) scan. 

“I wasn’t concerned, but I’d been a smoker for more than 50 years,” says Dean, 71, of Elkton. He had quit smoking a few years before, but for many of those 50-plus years he had smoked two and a half packs per day. 

“After seeing those ads several times, I decided to talk to my doctor,” says Dean. 

Dean’s primary care physician referred him for an LDCT lung screening. The image showed a cancerous growth on Dean’s right lung. 

Within weeks he had surgery to have the cancerous nodule removed. 

Since Sentara RMH began offering the LDCT scans in March 2014, more than 20 lung cancers have been detected, according to Matthew Blurton, MD, a radiologist at Sentara RMH. 

“Most of those cancers were found at an early stage, meaning they were small nodules that had not yet spread,” says Dr. Blurton. “Many of these patients may not have survived their disease if they had waited until the onset of cancer-related symptoms.”

A Leading Cause of Cancer Deaths 

Lung cancer is a deadly disease, notes Dr. Blurton. While lung cancer is the third-most common cancer in the United States, it’s actually the leading cause of cancer-related deaths. In fact, more people die of lung cancer than of prostate, breast and colon cancers combined. The reason for this high mortality is that lung cancer typically remains “silent,” producing no symptoms as it grows and spreads. Eventually, however, it grows large enough or spreads far enough to cause symptoms such as weight loss, cough or shortness of breath. 

“About 85 percent of lung cancers are diagnosed after the cancer has grown or spread to the extent that a cure is unlikely,” Dr. Blurton says. In other words, by the time lung cancer causes symptoms, it’s usually too late. 

But all lung cancers start small and then grow, and that’s where CT screening comes in. 

“Our goal is to find the cancer while it’s still silent—before it has grown or spread,” says Dr. Blurton. “This significantly increases the patient’s chance for a complete cure.” 

Locally, most of the cancers found during LDCT scans at Sentara RMH since the hospital began offering the service have been in an early stage, allowing for greatly improved chances of survival. 

The Screening 

“The Sentara RMH LDCT lung screening program helps detect lung cancers early in high-risk patients, when there’s a higher likelihood of a cure,” says Libbi Fitzgerald, RN, integrated care manager in women’s imaging at the Sentara RMH Women’s Center. “Without CT lung screening, lung cancer is usually not found until a person develops symptoms.”

The “low-dose” part of LDCT refers to the fact that this type of scan exposes patients to less radiation than a regular CT scan. 

“The LDCT scan is noninvasive for patients,” Fitzgerald says. “The entire test takes about 10-15 minutes, with the actual CT scan taking only about 10 seconds.” 

Patients don’t have to prepare in any way for the test, nor do they experience any discomfort during the scan. 

“With LDCT, patients are not enclosed like they are with an MRI,” Fitzgerald says. “There is no fasting required, no needles are used, and no contrast is administered.” 

To qualify for LDCT lung screening, a patient must be between ages 55 and 77 and have a 30-packyear smoking history, meaning they have smoked an average of at least one pack a day for 30 years or two packs a day for 15 years. They also must be a current smoker or have quit smoking within the last 15 years, and be free of any new symptoms. 

All patients receive a letter with their test results within five to seven days after the screening, and typically they also receive a call from the provider who ordered the scan. 

The LDCT detects pulmonary (lung) nodules, which are common in patients who smoke. However, most of these types of nodules are benign, or noncancerous, according to Fitzgerald. If the radiologist detects a nodule that appears suspicious based on its size and other characteristics, he or she will recommend a short-term follow-up LDCT, additional imaging studies like a PET scan, or a lung biopsy. 

“If a patient requires a PET scan or biopsy, and they have not been seen by a pulmonologist in the past, I can help them get that referral,” Fitzgerald says. 

If the radiologist does not detect any suspicious lung nodules, the recommendation is to have the LDCT screening repeated annually, as long as the patient continues to meet all of the criteria. 

The Big Picture 

Dr. Blurton says the evidence from multiple landmark research studies has shown that lung cancer deaths occur at lower rates among patients who undergo annual screening exams. 

“This kind of potential health benefit cannot be ignored,” he says. “It’s not only a national trend, but an international one.”

On this large scale, research has shown that the overall chance of dying from lung cancer in high-risk individuals has decreased by 25 percent among those who undergo routine annual LDCT lung screening exams. 

Thanks to these promising findings, lung cancer screening is now covered by Medicare and most private insurers, provided patients meet the criteria stated above. In addition, patients must have access to a high-volume, high-quality cancer screening and treatment center, like the Sentara Hahn Cancer Center.

A Great Outcome 

Jay Dean thought he felt fine before his nodule surgery, but he noticed a difference after recovering from the procedure. That’s when he realized he’d unknowingly been having trouble breathing. 

“After the lung cancer was removed, my breathing seemed to be improved,” says Dean, who is retired from Reynolds Flexible Packaging in Grottoes and McDaniel Contractor Services in Elkton. “Before the surgery, I thought I was just getting old.” 

Dr. Blurton says the measure of the program’s success is “how many lives we have potentially saved by detecting the disease early.” 

As it turned out, a biopsy after Dean’s surgery revealed that the nodule removed from his lung was stage 1 cancer. Fortunately, it had not spread to his lymph nodes, so he needed no further treatment.

“I’m really pleased,” Dean says. “I figure those doctors saved my life.” 

To schedule an LDCT lung screening, patients who meet the criteria for eligibility should either contact their primary care provider or call 1-844-EARLY-DX (844-327-5939) to begin the process.

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