Referring Physicians >> Newsletters >> Lung Cancer Screening Program Saves Lives of High-risk Patients
Lung Cancer Screening Program Saves Lives of High-risk Patients
By Angela Morgan, PA-C, and Stephanie Pano, PA-C
Lung cancer in the United States is responsible for the highest number of cancer-related deaths in men and women combined — 27% of cancer deaths in men and 26% of cancer deaths in women. The current 5-year survival rate for all people diagnosed with lung cancer is currently 17.7%; however, early detection of lung cancer increases a person’s chance of surviving five years to 55.2%.
Stages and survival
Currently, only 15.7% of lung cancers are diagnosed when the disease is at an early, or “local stage.” The Surveillance, Epidemiology, and End Results Program (SEER) database tells us that in early stage lung cancer, Stages IA and IB, the average 5-year survival rate is approximately 49% and 45%, respectively. When lung cancer is Stage II at the time of diagnosis, the survival rate for 5 years falls to approximately 30%. Stage IIIA lung cancer has a 5-year survival rate of 14%, and patients with more advanced stage disease at the time of diagnosis will have a 5% or less chance of surviving 5 years (American Cancer Society most recent rates published for the current AJCC staging system).
Research tells us that people who are eligible for surgery to remove lung cancer increases their chances of 5-year survival up to 67% for early stage disease and up to 23% for intermediate stage disease. (Survival after Surgical Resection in Lung Cancer TNM 7, Mountain et al). All of the data we have studied agree with this report. The best results for long-term survival for our patients with lung cancer are connected to identifying lung cancer early and treating aggressively with surgery when possible. To treat lung cancer successfully, we have to know both “if” cancer is present and “where” it is located. Screening patients who are at higher risk for developing lung cancer provides us the opportunity to do this.
The National Lung Cancer Screening Trial began in 2002. It was established to investigate the effectiveness of various screening tools in improving survival outcomes for patients with lung cancer. The study compared low dose CT scan to chest x-ray as a detector of early disease in high-risk patients. The results indicated that low dose CT is a more sensitive tool for early detection of lung cancer, reporting a 20% decrease in lung cancer related deaths in patients who underwent low dose CT scan for screening compared to those who underwent chest x-ray for screening. Chest X-ray should not be used for lung cancer screening.
The study also reported that there is one life saved for every 320 persons screened for lung cancer with low dose CT. This is a significant finding when compared to other tests for early cancer detection including mammography for breast cancer screening, in which one life is saved for every 1,339 women screened, and sigmoidoscopy for colon cancer screening in which one life is saved for every 817 persons screened.
The data shows that low dose CT screening is sensitive for finding lung nodules; however, a high percentage (up to 96%) of these are not cancer. With this in mind, undergoing lung cancer screening itself, in addition to the risk of lung cancer, causes anxiety for the patient. Therefore, an important part of lung cancer screening is shared decision-making between patients and their health care providers. This shared effort should occur so that patients understand the meaning of a decision to proceed with a low dose CT for lung cancer screening. Discussions involving the individual patient’s unique risk factors, the risks associated with the screening CT and the ability to understand and work logically with the information provided by the results of the screening are vital to the process of lung cancer screening.
Eligibility criteria for lung cancer screening of high-risk patients
Patients are considered “high-risk” and therefore eligible for lung cancer screening when all three of these risk factors are present:
Additionally, patients are considered “high-risk” and eligible for lung cancer screening if they are older than 50 years of age, have a more than a 20 pack year smoking history, and have at least one of these additional risk factors:
For more information
Patients who are eligible for and have decided to proceed with low dose CT for lung cancer screening may do so with a referral for Lung Cancer Screening CT from their health care provider. UW Health currently offers accredited Low Dose CT scans at University Hospital and 1 S. Park, which are read by UW Health radiologists with specific expertise in Thoracic Radiology. Patients who desire lung cancer screening should be evaluated annually for continued eligibility for Low Dose CT until 74 years of age.
The Thoracic Surgery specialists at UW Health are committed to supporting early detection of lung cancer and early intervention to reduce deaths associated with lung cancer. We are currently developing a consultation service to provide patients and health care providers with results interpretation and follow up coordination services to enhance the existing Lung Cancer Screening Program. We will also be offering this service to patients found to have lung nodules identified on other imaging tests. Together, we can reduce the impact of lung cancer within our communities.