Evidence-based screening can find cancer before it spreads
Doctors who treat lung cancer want to catch the disease in its earliest stages, before patients even start showing symptoms.
That’s because symptoms — such as a cough that does not go away, weight loss or chest pain that is worse with deep breathing — too often come after the cancer has spread too far to cure. Part of our ability to save lives, then, is about testing healthy people for the presence of cancer.
That’s a particularly pressing concern in treating lung cancer, which kills more Americans than colon, breast and prostate cancers combined.
At Beebe Healthcare, new investments in technology and training have allowed us to meet the best evidence-based clinical practice guidelines around who should be tested for lung cancer and how they should be treated.
This includes our use of 3D imaging to navigate the lung’s narrow passages where most tumors reside and test growths for the presence of cancer, a technique called “navigational bronchoscopy.” If we catch lung cancer early enough, we use a team approach to remove tumors before they have a chance to spread.
Our screening process begins with a more established technology, a low-dose computed tomography, or CT, scan. This quick and painless test can spot potential growths that, if necessary, we can investigate further with navigational bronchoscopy and other tools.
We developed our low-dose CT lung cancer screening guidelines based on the National Lung Screening Trial, a landmark study that used new ways to identify those at risk and test them for cancer. The study’s methodology led to an impressive 20 percent drop in lung cancer deaths.
If all of the following criteria apply to you, a test could help you find lung cancer early:
• 55 to 74 years old
• Have smoked a pack a day for 30 years (or the equivalent, such as 15 years of two packs a day)
• Are either smoking or have quit within the last 15 years.
If you do not have health insurance that covers screenings and you meet other eligibility guidelines, including for income, the State of Delaware will pay for these screenings. Beebe also offers lung cancer screenings for those without health insurance, for $99, which also includes the interpretations of the images.
Not just smokers<.h3>
These guidelines focus on smoking, of course, because it is a major risk factor for lung cancer. People who smoke are 25 times more likely to develop lung cancer than nonsmokers are.
However, not everyone who develops lung cancer smokes — up to 20 percent of the people who die from lung cancer in the United States, about 30,000 people a year, have never smoked. If lung cancer in non-smokers were in its own category, it would rank among the top 10 fatal cancers in the country.
After the scan?
By itself, a CT scan of the lungs cannot detect lung cancer. It can find a nodule, or a small growth of cells, but the vast majority of these — about 19 in 20 — are not cancerous. These nodules can be formed from non-cancer damage to the lung, including from pneumonia and other illness.
Based on the size of the nodules, whether they’re growing, a patient’s risk for lung cancer and other factors, we may decide to get a sample of these nodules. That’s where our technology investments come in.
Thanks in part to a 2015 donation of $275,000 from the Beebe Auxiliary, we have acquired navigational bronchoscopy equipment. This allows us to navigate the maze of complex airways that make up much of our lungs.
Using images from a CT scan, the technology creates a road map to the nodule and lights up a path on a screen for a doctor to follow. It’s a little like using a GPS navigation device to navigate an unfamiliar neighborhood by car.
We also pair this technology with a form of specialized ultrasound to provide real-time images of the lung’s interior.
Once we reach the tumor, we snip off a small piece to study. If it comes back as cancerous, we will search the patient for cancer to determine how large it is and whether it has spread.
At Beebe, we also use highly sensitive ultrasounds to spot lung cancer.
This technology is helping us find more early-stage lung cancers. In 2016, we found eight first-stage lung cancers in this screening program, followed by 12 early cancers in 2017. Each cancer found early is potentially a life saved.
As this program becomes better known, we hope it will continue to find lung cancer in its earliest stages, when we can offer more effective treatment.
If you’re interested in having a health screening but not sure where to start, Cancer Screening Nurse Navigator Deb Campbell can help. Call her at (302) 645-3169.
Dr. Victor Banzon, MD, FCCP, is a pulmonologist, a doctor who treats illnesses of the lungs and other parts of the respiratory system, at Beebe Healthcare’s Respiratory Care Services. To learn more about the services offered, call (302) 645-3298 or visit www.beebehealthcare.org/patient-care-services/respiratory-care-services.
By Dr. Victor Banzon