Early diagnosis and treatment of lung cancer can increase survival

November is Lung Cancer Awareness Month. Lung cancer is the third most common cancer in the United States. Both men and women in the United States die from lung cancer more than any other type of cancer.¹ Like other cancers, there are few symptoms at initial stages, but early detection greatly improves chances of survival.

Lung cancer in its initial stages starts as a nodule, a small mass in the lungs. Although most nodules are benign, the cancerous ones, if left undiagnosed or untreated, will increase in size and spread outside the lungs. However, if nodules are detected early using a low-dose chest CT scan (LDCT), evaluation and treatment can improve survival.

Because LDCT is safe, with radiation exposure slightly higher than an X-ray or mammogram,² the National Cancer Institute piloted a nationwide study titled ”National Lung Cancer Screening Trial” to determine if LDCT could be used widely as a screening method. The study started in 2002, enrolled over 53,000 men and women 55-74 years old with a history of smoking. The study results published in 2011 showed a 20% reduction in death from lung cancer in those screened annually with low-dose CT scans.³ Further analysis showed that for every 256 participants screened, lung cancer was detected early and prevented death in one individual. While the benefit of early screening is obvious, only about 12% of eligible individuals are currently being screened for lung cancer.

As covered by most insurance companies, current eligibility for lung cancer screening includes people 50-77 years old who either are active smokers for 20-pack years or have quit smoking within the past 15 years. Pack years are calculated by multiplying the number of packs of cigarettes smoked per day by number of years smoked. For example, smoking one pack per day for 20 years or half a pack per day for 40 years, both amount to 20-pack-year smoking.

If a nodule is found on the screening CT, it warrants a quick evaluation. Time and again, delay in starting treatment for lung cancer results in reduced chance of survival⁴ and a higher chance of cancer recurrence even after treatment.⁵ With this in mind, Northside Hospital Cancer Institute started the Lung Nodule Clinic (LNC), the primary goal of which is a timely diagnosis and treatment of any suspicious lung nodules.

Patients are self-referred or referred by their providers to the LNC for evaluation of lung nodules or any other suspicious lung lesions found on screening LDCT or other radiographic imaging. A physician in the LNC evaluates patients, and multiple sub-specialists, including pulmonology, thoracic surgery, medical oncology, interventional radiology and radiation oncology discuss their case in detail at the LNC conference. Each patient is assigned an oncology nurse navigator, who will communicate with the patient to coordinate and ensure all the necessary testing, imaging studies, consultations and procedures recommended by the LNC team are done in a timely and organized manner for optimal outcome.

After patients have discussed their diagnostic and treatment pathways, they will follow up with the appropriate subspecialists from the LNC until completion of therapy.

Currently, Northside Hospital Lung Nodule Clinics are operating at three locations: Cherokee, Gwinnett and Midtown Atlanta. Click here to learn more. 

References:

1. “Key Statistics for Lung Cancer,” American Cancer Society, accessed August 30, 2022, https://www.cancer.org/cancer/lung-cancer/about/key-statistics.
2. "Radiation Dose," RadiologyInfo.org, accessed October 31, 2022, https://www.radiologyinfo.org/en/info/safety-xray.
   
3. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. https://doi.org/10.1056/NEJMoa1102873.
4. Bott MJ, Patel, AP, et al. Pathologic Upstaging in Patients Undergoing Resection for Stage I Non-Small Cell Lung Cancer: Are There Modifiable Predictors? Annals of Thoracic Surgery, 2015-12-01, Volume 100, Issue 6, Pages 2048-2053. https://doi.org/10.1016/j.athoracsur.2015.05.100
5. Heiden BT, Eaton DB, Engelhardt KE, et al. Analysis of Delayed Surgical Treatment and Oncologic Outcomes in Clinical Stage I Non–Small Cell Lung Cancer. JAMA Netw Open. 2021;4(5):e2111613. https://doi.org/10.1001/jamanetworkopen.2021.11613.