Health Talk: Catching lung cancer

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Lung cancer is the leading cause of cancer deaths in the United States. The biggest cause of lung cancer is smoking, followed by radon and radiation exposure, and environmental pollution.

Usually the symptoms of lung cancer don’t appear until the disease is already at an advanced, non-curable stage.

Patients can have cancer growing and would not know unless the cancer grows into a rib or blood vessel. By that time they are experiencing late symptoms like coughing up blood, chest or bone pain. If we are able to diagnose it at an earlier stage their survival rate is very good.

However, most lung cancers are diagnosed at stage three, and only about three out of ten patients with stage three lung cancer survive past five years.

Physicians have looked for many years for a good screening test for lung cancer, but only in recent years has there been a study that has shown that a test known as low-dose CT scan (LDCT), which has less radiation than a regular CT scan, can help lower the risk of dying from this disease. Between 2004 and 2009, the National Lung Screening Trial did a large clinical trial looking at LDCT scan of the chest to screen for lung cancer.

More than 50,000 people ages 55 to 74, who were current or former smokers, and in fairly good health, were screened. To be included in the study, participants needed to have at least a 30-pack-per-year history of smoking; meaning they needed to have smoked a pack of cigarettes per day for 30 years, or two packs a day for 15 years.

The study did not include people who had a prior history of lung cancer or lung cancer symptoms, had part of a lung removed, needed to be on oxygen to help them breathe, or had other serious medical problems. After several years, the study found that people who received the low-dose CT Scan had a 20 percent lower chance of dying from lung cancer than those who received chest X-rays.

Rutland Regional Medical Center began the Early Lung Cancer Screening Program in 2016. If patients want to be screened, they must be referred to the program by their primary-care physician or through the Pulmonary Clinic.

The first step is a shared-decision appointment, which is required by the insurance companies before the LDCT scan is done. During that time, a respiratory therapist determines a lung cancer risk score to provide an assessment of whether or not an individual patient can participate in the program. The score involves getting information from patients about whether or not they have a history of lung cancer, are between 55-77 years old, have at least a 30-pack-per-year smoking history, are willing and able to participate in the program, can undergo procedures like biopsies and surgical intervention, and are non-symptomatic for lung cancer at this point in time. Our team also discusses the tobacco cessation programs at RRMC that will provide support in helping you to quit smoking.

Once it has been determined that the patient is covered by insurance, the LDCT scan is scheduled. The patient is put on the scanner for only a minute or two. We are looking for nodules as small as one millimeter. If no suspicious nodule is found we continue to screen on a yearly basis. If something requires more attention because the nodule is a little bigger or there is something else of concern, the follow-up could be as soon as three or six months, and the patient will discuss the results with their physician.

If we can find a cancer in its early stages, we can surgically remove it and have more success with medical treatment such as chemotherapy or radiation therapy, and help people live a longer and healthier life.

This week’s Health Talk was written by Dr. Mark Jacobs, formerly of Rutland Regional Medical Center, and Dr. Darius Seidler, pulmonary and critical care physician at Rutland Regional Medical Center.

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