Early detection and a Chance to Survive Lung Cancer
By Patricia Shapiro
I am nine years old and, for the third time this week, Mom is taking me and my three brothers to our cousins’ home all the way in town. I adore my cousins; we share everything with them. Thanksgiving is at their home; Christmas is at ours. We take swim lessons together in the summer, and vacation together in the cabins at Goldhead Branch State Park—but three trips to town in one week? My Uncle Frank is Mom’s only brother. He loves to read, which is a good thing, because my aunt and my mother are librarians! I know he has been sick. We visited him in the hospital when he had surgery, and he has to wear a patch over one eye because he has double vision. When we arrive at their home, I run in to give him a hug. He is in bed. It is summer, and a white sheet is draped loosely over his legs. I can see one leg, all the way up to his hip, and it is very, very thin. An IV pole is in the room, and my aunt in putting medicine in the line. I stop, and suddenly I know that Uncle Frank is going to die. My six-, four- and one-year old-cousins will not have a father. He is only 42 years old.
I am in high school. Juniors and seniors on honor roll have the privilege of leaving campus for the lunch hour. It is cool to smoke, and the lunch hour is frequently not just eating a sandwich but walking along the river bank with friends, bonding over cigarettes, plans for the weekend, and sports teams. I am not in this “in crowd” and, years later, reflect that I am grateful that my father threatened torture if he ever caught us smoking.
I finish reading a CT scan of the chest and go to share the results with the patient. He is 38 years old, looks young for his age, trim and obviously works out. His wife is with him, beautiful with long auburn hair. They are a striking couple. I review the findings of the scan and my fear that he has lung cancer. They return many times over the next two years, often bringing their young daughter. They are so hopeful—so kind and so appreciative of all our efforts. But we cannot save him.
A 55-year old-woman is referred for a screening chest CT. She has no symptoms. I find a small tumor in the left lung and a tiny dot in the right lung. The left lung mass is removed and is a stage 1 lung cancer. Six months later, the dot in the other lung has doubled in size, is removed and is also a stage 1 lung cancer. I see her annually, and after seven years, she is disease free and we joyfully hug. I am as thrilled as she!
All of these patients had lung cancer. Lung cancer is the leading cause of cancer deaths in men and women, more than prostate or breast cancer. Eighty-five percent of smokers begin smoking before their sixteenth birthday. They are addicted before they know it is happening, and as adults, they are scared. They want to quit, but it is so hard. Even if they quit, they are still scared of the consequences of smoking, especially lung cancer. They fight the stigma of society viewing lung cancer as their fault for smoking. They should have known better; they should never have smoked. There is finally hope.
The difference between dying and the possibility of surviving lung cancer is early detection. Since Uncle Frank died in 1965, there was little hope for early detection until now. A large multicenter study has shown a 20 percent reduction in mortality from lung cancer for patients having an annual low dose screening chest CT. This means that four out of five patients diagnosed with a Low Dose Screening Chest CT will be alive in five years. It is the only way currently that stage 1 disease can be routinely detected. Prior studies with chest X-ray and sputum samples every six months did not detect lung cancer early enough to make a difference. The CT scan takes less than a minute, there is no injection, and private insurance plans as of January 1, 2015 must provide the scan as part of preventative services for patients ages 50-80 years with a 30-plus pack per year history of smoking. Medicare is expected to begin coverage within months, and every chest society in the United States has encouraged Medicare to do so. Even for patients not covered by insurance, the price has decreased and, in most centers, is less than $200. Low Dose Screening Chest CT—early detection—a chance to survive lung cancer.
Patricia Shapiro is a practicing diagnostic radiology doctor at Island Imaging Center in Savannah, Georgia.
After this article was published, MediCare approved screening chest CT for reimbursement.