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March 19th, 2021

New lung cancer screening rule opens more people to early detection

March 19, 2021 • Courtesy of NWI Times

Written by Christine Bryant, Times Correspondent

As more Americans are about to become eligible for lung cancer screenings thanks to new guidelines, local hospital officials say they are hopeful more people will take advantage of these life-saving tools.

As the country’s top cancer killer, lung cancer causes more than 135,000 deaths every year. In many cases, lung cancer is diagnosed too late, dropping chances of survival dramatically.

While annual low-dose computerized tomography (CT) scans can catch lung cancer earlier and improve a patient’s prognosis, the scan has only been available to older individuals with a heavier history of smoking, unless a doctor’s order is provided.

Earlier this month, the U.S. Preventive Services Task Force recommended updating the eligibility for these screenings to anyone who is 50 to 80 years old, has smoked at least 20 “pack years” and either still smokes or has quit within the last 15 years.

A “pack year” is defined as someone smoking an average of one pack of cigarettes each day for a year. For example, an individual could qualify for a low-dose CT scan under this new criteria by smoking one pack a day for 20 years or two packs a day for 10 years.

“Annual screening for lung cancer with a low dose CT scan is one of the most valuable tools we have to screen those who have a high risk for developing lung cancer,” said Melissa Plavsa, a family nurse practitioner and manager of Oncology Navigation Services with Community Healthcare System. “The only way to reduce this large number of lung cancer deaths is through early detection, as early-stage lung cancers have a significantly better prognosis and can potentially be cured.”

Each year, several hospital systems in the region perform hundreds of scans, which takes just a few minutes to complete and involves using a low dose of radiation to create detailed images of a patient’s lungs.

At Franciscan Health Michigan City, about 450 individuals are scanned each year, and that number is increasing, says Laura Peo, health promotions specialist and screening coordinator.

“We have had many patients with findings that have helped them prior to something bad happening,” Peo said.

One patient came in for a heart scan and after a long conversation, Peo discovered he qualified for a lung scan as well. She discovered he not only had a high calcium score on his heart scan, which poses a higher risk of heart disease, he also had concerning findings in his lungs.

“He had a stent placement in his heart and after recovery we addressed his lung findings and he is doing very well at this time,” Peo said.

The Community Healthcare System performs about 1,450 lung cancer screenings each year. Plavsa says the screenings have been successful at detecting lung cancer at very early stages, before any symptoms begin.

“LDCT (low dose CT) lung cancer screening has been proven by research to be more effective at saving lives than other screening methods, because we are screening a particular population with higher risk factors,” she said.

Experts say these new guidelines likely will open up the screenings to more individuals at risk, including African Americans and women.

According to the panel that released the guideline recommendations, African Americans and women tend to be less heavy smokers and may not have met the earlier screening threshold despite being at risk for lung cancer. Since 2013, the scans have been recommended for those who have a 30 pack-year history and are at least 55 years old.

“There are numerous individuals that have been saved by the scan,” says Jim Concato, director of Methodist Hospitals Oncology Services. “The recent expanded recommendations by the USPSTF will allow us to screen a population that has been excluded because they don’t meet the current criteria.”

Methodist Hospitals, which performs about 200 low dose CT screenings annually, offers cessation programs to help individuals quit smoking as well, he says.

“We know that tobacco is one of the primary causes of lung cancer,” Concato said. “Many individuals currently engaged in tobacco use started smoking before the impact was clearly understood.”

To help prepare for these guideline changes, many screening coordinators will continue working with family physicians who often have the best direct connection to patients, said Susan Krueger, oncology service line director for Northwest Health – Porter, which performs more than 500 lung cancer screenings each year.

“What we do is, internally, once we get the new guidelines, we need to start talking to physicians so that they can start having those conversations with patients,” she said.

During a patient assessment, a physician can offer a gentle reminder that an individual is eligible for certain screenings, she says.

“About 60% of the lung cancers we’ve found through the lung screening program have been diagnosed at stage 0 or stage 1, which has a much better chance of survival,” Krueger said.

“What we do is, internally, once we get the new guidelines, we need to start talking to physicians so that they can start having those conversations with patients,” she said.

During a patient assessment, a physician can offer a gentle reminder that an individual is eligible for certain screenings, she says.

“About 60% of the lung cancers we’ve found through the lung screening program have been diagnosed at stage 0 or stage 1, which has a much better chance of survival,” Krueger said.

The Affordable Care Act requires that private insurance and Medicaid Expansion plans to cover these new guidelines by January of 2023.

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