By John A. Heim, MD
While lung cancer remains the leading cause of cancer deaths in both men and women in the United States, more Americans than ever before are surviving the disease, according to the American Lung Association.
This is in large part due to the lifesaving potential of screening, which can detect lung cancer in its earliest stages when it is easier to treat.
Penn Medicine Princeton Cancer Center offers lung cancer screening for high-risk individuals and provides advanced diagnostic and treatment options, including minimally invasive surgery, if cancer is detected.
Progress is Being Made
The American Lung Association estimates that close to 238,000 people will be diagnosed with lung cancer this year. In addition, more than 125,000 people will die from the disease, which accounts for more cancer deaths than colon, breast and prostate cancers combined.
However, progress is being made.
Over the past five years, according to the American Lung Association, the percentage of lung cancer survivors increased by 22% nationally to 26.6%.
Several factors are contributing to the increase in lung cancer survivors, including a reduction in smoking rates as well as improved early detection through screening.
As the American Lung Association notes, when lung cancer is diagnosed at an early stage the five-year survival rate is 63% versus only 8% when lung cancer is not caught until a late stage.
Moreover, the American Lung Association reports that lung cancer screening has saved 80,000 additional years of life.
Talk to Your Doctor
Smoking is the leading risk factor for lung cancer, accounting for between 80 and 90% of cases, according to the American Lung Association. Other risk factors include:
- Age.
- Family history.
- Secondhand smoke.
- Radon exposure.
- Exposure to asbestos.
- Air pollution.
Lung cancer typically does not have any symptoms in its early stages. As the disease becomes more advanced, symptoms may include:
- Persistent cough that worsens over time.
- Chest pain.
- Shortness of breath.
- Unexplained weight loss.
- Coughing up blood.
- Fatigue.
If you are concerned about your risk for lung cancer or are experiencing symptoms, talk with your doctor. The sooner lung cancer is detected the better the chance of survival.
Screening Guidelines
To detect lung cancer early, Penn Medicine Princeton Cancer Center offers high-risk individuals low-dose CT screening.
A study by the National Cancer Institute has determined that low-dose CT scans are better than traditional chest X-rays for detecting lung tumors.
The National Lung Screening Trial found that lung cancer deaths dropped by 20% when people were screened using low-dose CT scans compared to chest X-rays.
Low-dose CT screening uses low-dose radiation to make a series of detailed pictures of areas in the body. The pictures are made by a computer linked to an X-ray machine that scans the body in a spiral path. The scan takes just a few minutes and does not require any pre-operative lab work. Results are normally sent to your primary care physician in a matter of days.
The U.S. Preventative Services Task Force recommends annual lung cancer screening with low-dose CT scans in people who meet all these criteria:
- Are 50-80 years old, and
- Currently smoke or have quit in the past 15 years, and
- Have at least a 20 pack-year smoking history. This is the number of packs of cigarettes per day multiplied by the number of years you smoked. For example, someone who smoked 2 packs a day for 10 years [2 x 10 = 20] has 20 pack-years of smoking, as does a person who smoked 1 pack a day for 20 years [1 x 20 = 20].
The American Cancer Society, however, recently updated its guidelines and eliminated the “years since quitting” requirement.
Most insurance typically covers the cost of lung cancer screening for people who meet the criteria. However, individuals should talk with their primary care physician about eligibility and confirm coverage with their insurance carrier prior to the test.
An order from your primary care physician is necessary to schedule a lung cancer screening.
Diagnosis and Treatment
If a lung nodule is found during screening, further testing will determine whether it is benign or malignant. In some cases, the abnormality will be monitored with additional tests throughout the year rather than being surgically removed.
In addition, molecular testing can help determine the genetic makeup of the mass and whether immunotherapy, which stimulates a person’s immune system to destroy cancer cells, is a treatment option.
Surgery for lung nodules can often be performed using a minimally invasive, robotic assisted approach with patients benefiting from fewer complications, less blood loss, shorter hospital stay, less pain and faster return to normal activities. Chemotherapy and/or radiation may or may not be necessary afterward.
It is important to note that in many cases, lung nodules are found incidentally on CT scans for other conditions, often in the Emergency Department. To ensure emergency patients receive appropriate follow up care, Penn Medicine Princeton Cancer Center uses artificial intelligence to flag suspicious scans.
The scans are then reviewed by board-certified physicians who specialize in the diagnosis and treatment of lung cancer to determine whether additional testing and care is necessary.
As part of Penn Medicine, the experts at Princeton Cancer Center work with teams at the Abramson Cancer Center, a world leader in cancer research, patient care and education, which means patients have access to highly specialized care, including proton therapy and clinical trials.
Lung cancer screening saves lives. Whether you currently smoke or kicked the habit years ago, talk to your doctor about screening. And remember, no matter how old you are or how long you smoked, it’s never too late to quit.
To find a physician with Penn Medicine Princeton Health, call (888) 742-7496 or visit www.princetonhcs.org.
John A. Heim, MD, is board certified in general and thoracic surgery and is the chairman of the Department of Surgery at Penn Medicine Princeton Health.
