Fort Wayne doctors urge more smokers to get annual lung cancer screenings | Health & Science

Colonoscopies, mammograms, Pap smears and prostate exams are designed to detect early signs of cancer.

Local health care officials want to raise the profile of a fifth cancer-detection test that’s appropriate for patients who smoke: lung cancer screenings.

The number of expected lung cancer deaths this year is almost equal to the projected death toll from colon, breast and prostate cancers combined, according to data from the American Cancer Society.

Early detection increases the chances of survival, physicians say.

This week, the Indiana University Melvin and Bren Simon Comprehensive Cancer Center and IU Health announced the launch of the state’s first mobile lung screening program. Staff will travel across Indiana in a 40-foot truck, conducting lung cancer screenings using a CT scanner, officials said.

Although no specific dates have been confirmed for northeast Indiana, IU Health officials said this region will be included on the mobile’s schedule in coming months.

Parkview Health and Lutheran Health Network already offer screenings locally, but the number of patients undergoing the scans is a fraction of those who are referred for screening by their primary care providers, officials say.

Getting screened

In January, Parkview used its electronic medical records software to search for all lung cancer screening orders that remained unfilled after more than one year. They found 1,860 instances when a patient had not received a recommended scan, according to Dr. Alan Yahanda, a surgical oncologist and president of the Parkview Packnett Family Cancer Institute.

Those patients were sent two reminders, six weeks apart, to schedule a scan. Less than 1 in 4 followed through, he said.

Dr. Patricia Rich, an oncologist with Parkview, offered some potential reasons patients might not get screened.

Rich said patients might not be aware that most nodules found during lung screenings aren’t cancerous. They also might not realize that cancer can be curable when it’s detected early, she said.

And some patients might fear that if cancer is found, she said, they will be told they deserve the disease because they are – or were – a smoker.

Dr. Nasser Hanna, an oncologist with IU Health, spoke at the Indianapolis ceremony that launched the mobile screening unit. In this remarks, he also acknowledged the shame some lung cancer patients feel after diagnosis.

“I know that most suffered gracefully in silence, but they were burdened with an unwarranted stigma and self-blame in many cases,” Hanna said. “But no one deserves lung cancer, and anyone with lungs can get lung cancer.”

But waiting for testing comes at a cost, according to Dr. Eustace Fernandes, a pulmonologist with Lutheran Health Physicians.

“Early detection is essential in finding the most simple path to a cure. An early-stage lung cancer may be treated with a limited surgical procedure that removes the lung cancer before it can spread,” he said in a statement. “… Identifying cancer at an early stage provides the best possible opportunity for disease-free survival and reduces the need for chemotherapy or other additional therapies.”

Yahanda said patients who wait to see a doctor until they show symptoms of lung cancer have a 60% chance of being diagnosed with an advanced case.

Fernandes agreed.

“By the time a patient with lung cancer has real symptoms such as coughing, shortness of breath or weight loss, they may already be a Stage III or IV cancer, and the likelihood of cure is greatly diminished,” he said.

Less than 1-in-4 latter stage lung cancer patients survive five years after diagnosis, Rich said.

Who qualifies?

The providers agree that not everyone should be screened for lung cancer, unlike some other cancer scans.

Medicare and some insurance companies’ criteria for coverage state a patient must be 50 to 77 years old and have a smoking history of 20-pack years, Rich said. Someone who smoked one pack a day for 20 years would qualify, as would someone who smoked two packs a day for 15 years, she said.

Although consistently being exposed to second-hand smoke increases a person’s chances of developing lung cancer, Medicaid and some insurance companies don’t pay for lung screenings for that population, she said. Also, vaping doesn’t prompt screening referrals because not enough studies have been conducted to establish a high risk of cancer in the users, who are primarily young, Rich said.

Guidance varies, however. The American College of Chest Physicians recommends a yearly low-dose CAT scan of the chest for current or former smokers who have smoked at least a pack of cigarettes a day for 30 years, Fernandes said. For those who have already quit, they are eligible for screening if they quit within the last 15 years, he added.

Fernandes said it doesn’t make sense to open up lung screening to everyone.

“Lung cancer screening is done with a low-dose CAT scan,” he said. “This involves radiation exposure, cost and time. In light of this, choosing the right patient to screen is essential.”

The list of appropriate patients extends beyond smokers to include those who work in certain industries, including foundries, mines and mills.

“Patients may have other risk factors, such as a high risk occupation or a strong family history of lung cancer,” Fernandes said. “The decision to obtain a screening CAT scan in these patients should be made on an individual basis and made between the patient and the doctor.”

What’s next?

Rich outlined what happens after a lung cancer screening finds something concerning. Yahanda said that at the current rate of testing, one death could be prevented for every 265 screenings performed.

If a nodule is considered worrisome, a physician will decide whether it’s best to do a biopsy now or perform a second scan in three months to see whether the nodule has grown, Rich said. Naturally occurring nodules won’t change size, and those related to an infection could disappear altogether, she said.

Robotics allow doctors to perform minimally invasive biopsies when the procedure is necessary, Rich said.

Yahanda said biopsy options include placing a scope down the patient’s windpipe to retrieve the needed sample or insert a needle through the patient’s chest to reach the affected lung.

Rich said positive results for cancer prompt an oncologist and patient to adopt a treatment plan.

“We are getting better. Chemotherapy isn’t the only (option),” she said, adding that advances in treatment continue. “We’re not 100% there or we’d be able to cure every patient.”

Hanna, with IU Health, agrees there is reason for optimism.

“Lung cancer mortality is falling more rapidly than any other cancer,” he said.

Rich doesn’t want smokers to gain a false sense of security from the fact that some lung cancers can be cured, however.

Prevention in the form of not smoking, she said, tops everything else.