In 2015, CarePoint Health announced that Christ Hospital has been named an American College of Radiology (ACR) designated center for lung cancer screening, making it the first facility to receive this designation in Hudson County. The designation recognizes organizations for meeting the highest standards in providing safe, effective diagnostic care for individuals at the highest risk for lung cancer.
Early detection and treatment have been proven to help save lives. A recent National Lung Screening Trial (NLST) found that lung cancer deaths were decreased by 20 percent among current or former heavy smokers who were screened with low-dose computed tomography (CT) versus those screened by chest X-ray. Prior to the implementation of this relatively new technology, there was no effective way to screen for lung cancer; now, low-dose CT is the only recommended screening test for lung cancer. Traditional chest X-rays were used during late stages, when treatment was no longer an option. For the first time, low-dose CT can reduce death from lung cancer through early detection. While this is great news for the medical community, the test has risks as well as benefits and is not recommended for everyone. Here are key points you may want to use in discussion with your patients who may be at risk for lung cancer or are worried about their risk for lung cancer.
What are the risks factors associated with lung cancer?
Though risk factors include exposure to radon (radioactive gas in homes), asbestos (especially in the workplace) and lung scarring from pneumonia, and certain types of pulmonary disease and emphysema, the number one risk factor is cigarette smoking. In fact, tobacco accounts for nearly 90 percent of all lung cancers. The best way to prevent lung cancer is to never smoke or stop smoking now. If your patients are still smoking, talk to them about ways you can help them quit smoking.
What is a CT Scan and what are its benefits?
CT scan uses X-rays to scan the entire chest in about 7 to 15 seconds during a single, large breath-hold. The CT scanner rotates around the person, who is lying still on a table, as the person passes through the center of the scanner. A computer creates images from X-ray information transmitted from the scanner and assembles these images into a series of two-dimensional slices of the lung at very small intervals so that increased details within the organs in the chest can be identified. This is an outpatient procedure that does not require special medications or blood work, and takes about 30 minutes from start to finish.
Low-dose CT scans make early detection – and treatment – possible. Low-dose CT scans also have about five times less radiation than conventional CT scans so they are even safer.
How do I know if my patient makes a good candidate for lung cancer screening?
According to the US Preventive Services Task Force, candidates for screenings are current or former smokers (former smokers having quit within the past 15 years), 55 to 80 years of age with a smoking history of at least 30 pack-years (1 pack/day for 30 years, 2 packs per day for 15 years, etc.) with no symptoms of lung cancer.
There is no evidence at this time that other high-risk groups should be screened. Patients with lung disease, particularly COPD, should be evaluated by a pulmonologist regarding the advisability of CT screening in the context of the severity of their disease. At this time, CT scans are recommended for screening; chest X-rays are not.
Why is a CT scan not recommended for everyone?
It is important to only scan individuals with increased risk of lung cancer. CT scans are very sensitive and can sometimes produce false positives that can lead to undue anxiety and even unnecessary procedures.
What should I discuss with my patient who may be a candidate for a CT scan?
Prior to recommending a CT scan, you should evaluate your patient’s complete health history. If the patient is a current smoker, you should advise him or her to quit immediately and offer help with appropriate medical or behavioral options. You should thoroughly discuss the symptoms of lung disease and lung cancer, the benefits, risks and possible procedures associated with the screening process and alert him or her to any possible associated costs.
Where should I refer a patient for lung cancer screening?
Now that CarePoint Health – Christ Hospital offers lung cancer screening, you should refer patients to the Cancer Center at Christ Hospital. A nurse navigator can make all of the arrangements including confirming eligibility, writing a prescription for the low-dose CT, and scheduling an appointment for the screening. If the patient prefers to follow-up on his or her own, he or she can call (844) 494-LUNG (844-494-8564), Monday through Friday, 9 am and 5 pm, Eastern Time.
What does it cost to have a CT scan for lung cancer?
Because the NLST results are recent, health insurance companies may not cover the cost for a CT scan to screen for lung cancer at this time. That means that your patient may have to pay for the procedure out of own pocket. However, Medicare now covers the cost of the exam for patients that are eligible. If your patient is eligible for lung cancer screening, a nurse navigator will be assigned to help answer any questions about the procedure and associated costs. However, be sure to advise your patient to check with his or her insurance company to see if the screening and any resulting additional procedures are covered.
What do the results mean?
According to the American Lung Association, a “positive” or “suspicious” result means that the CT scan shows something is abnormal. This could mean lung cancer or some other serious condition. It could also mean there is no serious condition and thus is a “false positive”. Your patient may need to have additional procedures that may carry additional risks. If your patient does have lung cancer or some other serious condition, you and your team of experts should discuss all possible treatment options with the patient, including clinical trials and palliative care.
A “negative” result means that there were no abnormal findings on the CT scan at this time. It does not mean that your patient absolutely does not have lung cancer or that he or she will never get lung cancer. You should discuss when and if they should be tested again. There may also be an “indeterminate” result and you and your team will need to recommend monitored follow-up and further imaging at a later time. Whatever the result, if your patient is still smoking, talk to them about ways to help them quit.
How can I help my patient to quit?
CarePoint Health offers smokers several options to help them kick the habit. During a visit, the nurse navigator will discuss these options and help find a program that is right for your patient. In addition, the National Cancer Institute (NCI) provides additional resources at http://smokefree.gov or through their smoking quitline at 1-877-44U-QUIT (1-877-448-7848). NCI smoking cessation counselors are available to help and provide answers to smoking-related questions in English or Spanish, Monday through Friday, from 8 am to 8 pm, Eastern Time.
Where can I get more information about lung cancer and lung cancer screening?
CarePoint Health provides comprehensive cancer care services at all three of its award-winning facilities. With the recent ACR accreditation at Christ Hospital, CarePoint Health doctors and staff are now fully equipped to handle questions about lung cancer and screening eligibility. Moving forward, patients are encouraged to call (844) 494-LUNG (844-494-5864) or to visit our website at www.carepointhealth.org. In addition, the American Lung Association has assembled an expert committee to review the results of the NLST and offer recommendations for the best possible guidance to physicians, their patients and the general public regarding lung cancer screenings. The full report may be found at www.lung.org/lung-cancer-screen. You and your patients are also encouraged to contact the American Lung Association to find out more about lung cancer and lung cancer screening.