Kent Hospital’s Lung Cancer Screening Program for lung cancer is committed to offering a comprehensive, state-of-the art approach to the early diagnosis of lung cancer, and increasing our community’s awareness of the dangers of continued tobacco product use.
How can I reduce my risk of lung cancer?
Although it is one of the hardest things to change, quitting smoking is the single best way to reduce lung cancer risk. It is far and away the best step towards living longer and being cancer free. Although there is weak evidence that cutting your smoking in half is helpful, quitting smoking is the only advisable strategy.
For help with quitting, talk with your primary care doctor, and consider the following resources:
Learn More About Lung Cancer
First, consider what your lungs look like and what they do. Lungs are the organs that allow for you to breathe in oxygen and remove carbon dioxide. The lungs are made up of air sacks called alveoli that exchange the gasses in and out of the blood stream. Smoking causes irritation, inflammation and genetic changes that can cause cells to grow in an uncontrolled manner. Smoking can lead to structural damage known as emphysema or COPD. Lung cancer is an abnormal growth of cells in the lung.
In addition to smoking, exposure to some other substances has been associated with lung cancer.
Asbestos - found particularly in shipyard work, railroad work, firefighters, plumbers and electricians. Significant asbestos exposure when combined with smoking creates a very high risk of lung cancer.
Polycyclic Aromatic Hydrocarbons (PAHs) - PAHs occur in oil, coal, and tar deposits, and are produced as byproducts of fuel burning, such as diesel.
Radon - US EPA risk analysis table found in “A Citizen’s Guide to Radon” indicates that at the 4pCi/liter radon level 7 out of 1000 people have the possibility of developing lung cancer. The chances of lung cancer increase greatly if a person smokes tobacco products.
Nickel - used in electroplating, aircraft engine and part refurbishing, machine part refinishing, and others.
Arsenic – used in wood preservatives (like pressure treated wood) has been associated with lung cancer.
If you are concerned about your exposure to any of these substances, please consult with your primary care physician. Your employer will also have information on any potential exposure you may have at work, and steps you can take to reduce it.
When a lung cancer is just starting to grow, there are usually no symptoms. This is why it is difficult to find lung cancer in an early, possibly curable stage. Unfortunately, when lung cancer is found in a more advanced stage it is harder to treat and that is one reason why more people die from lung cancer than from any other cancer. Right now, there is no screening program for lung cancer.
Kent Hospital is offering the Lung Cancer Screening Program only to patients at high risk for developing lung cancer. A special kind of CT scan that uses less radiation than a normal CT scan allows doctors to see the lungs better than a regular chest x-ray. Our hope is that a cancer may be found when it is small so that more treatment options are available.
Lung cancer can cause symptoms but they are usually the result of extensive damage to the lung or surrounding structures or from the cancer spreading. The most common symptoms include persistent or worsening cough, coughing up blood, shortness of breath, frequent pneumonia and chest pain. Other symptoms are more vague such as weight loss, fatigue, headaches or bone pain. If you are experiencing any of these symptoms you should see your primary care doctor.
If you wish to participate in the Lung Cancer Screening Program, it is important that you get a referral from your primary care or pulmonary doctor so that you can have them help you determine if you are in a high risk group for developing lung cancer.
The Lung Cancer Screening Program uses a special CT scan technique that uses less radiation than standard techniques but can still find small abnormal nodules or “spots” in the lungs. CT scans can find nodules, but cannot tell you exactly what the nodule is made of. Most nodules that are found are benign (not cancer) and can be due to scarring, inflammation or old infection. Some patients may have multiple nodules, and some nodules don’t change over many years and some actually go away.
When a new nodule is found it may need to be watched closely to determine if it is changing. Your doctor may also recommend other procedures to figure out if the nodule is cancer with additional x-rays and/or a biopsy. If a nodule is suspicious, then the patient may be advised to do one of several things:
- Get a repeat CT scan (standard technique in 3 months).
- See a lung specialist (pulmonologist).
- See a chest surgeon (thoracic surgeon).
- Get a PET scan.
Any nodule found will need some form of follow up which you can discuss with your primary care doctor. If a nodule is detected, usually your health care insurance will cover any additional testing or evaluation.
If a nodule is suspicious for cancer, then the patient is further evaluated to try to determine the extent of the problem. Initially, this will require a biopsy of some kind. If cancer is found, the next step is called “staging”, and your doctor will determine if the cancer has spread from the nodule. The cancer stage is used to make recommendations for the best treatment plan.
Patients may need to undergo a standard CT scan of the chest and/or belly (abdomen), bone scan, CT or MRI of the brain, and/or PET scan. In addition, the patient may need to have breathing tests to determine their lung capacity or reserve.
Treatment of lung cancer must be individualized and is determined by the stage of the cancer and the overall health of the patient. Kent has a multidisciplinary team of doctors (chest surgeon, medical oncologist, radiation oncologist, pulmonologist, radiologist, pathologist) who meet to review the findings and to determine the best combination of treatment.
If the nodule that was found on the initial study is small and the only abnormal area, then surgery may be an option to remove the cancer. Newer surgical techniques using video (VATS) allow chest surgeons to make smaller incisions with the aid of a small camera. It may also be treatable with Cyberknife (stereotactic radiosurgery) if the patient is not a candidate for surgery.
Treatment of larger nodules or cancers that are found in a more advanced stage may be a combination of chemotherapy, radiation therapy and/or surgery.
Chances are your doctor has already talked to you about the risks of lung cancer if you have risk factors for it. If you have any concerns after reviewing the information here, please do bring it up with your primary care physician as soon as you are able to.
The Lung Cancer Screening Program is not for everyone. It is required that you have a referral from your primary care doctor (or other physician taking care of you) before you have a low dose CT scan looking for lung nodules. This will give you a chance to discuss the risks and benefits of the Lung Cancer Screening Program.
What is the science behind the Lung Cancer Early Detection Program?
The Lung Cancer Screening Program is modeled after the International Early Lung Cancer Action Program.
I-ELCAP (1) screened 31,567 patients with no symptoms using baseline CT scans. Of those, 27,456 received an annual screening scan, and follow-up by protocol. CT scan results requiring further workup were found in 13 percent (n=4186) of initial scans and 5 percent (n=1460) of subsequent scans. Lung cancer was identified in 484 patients; 412 were stage I.
Stage I lung cancer has an excellent prognosis, and is usually curable. This is the goal of the Lung Cancer Screening Program – to catch these cancers before they grow to an incurable size. Even if we find an advanced cancer, treatment can be individually designed to help everyone.
Is there a cost associated with the Lung Cancer Early Detection Program?
After talking with their primary doctor, the patient may undergo a low-dose CT scan – a lower radiation imaging scan – that can be helpful in finding small, abnormal nodules in the lungs. Because this program is not yet covered by insurance, there is a fee of $300 to cover testing costs. If abnormalities are found, future testing or procedures should be covered by insurance. Doctors from Kent’s multidisciplinary team will provide consult and additional referrals based on testing outcomes. Recently, a decision was made that the screening cost would be covered for Medicare eligible patients.