Lung cancer awareness month: Know your risk, get screened, follow up

By Vinay Patel, MD

Finding lung cancer early makes a difference

Lung cancer causes more cancer deaths in the United States than any other cancer. But there is good news. Fewer people are dying of lung cancer than in years past. And when it is found early, the outlook is much better.

When lung cancer is found before it spreads, about two out of three people are alive five years later. When it is found after it has spread to distant parts of the body, that drops to about one in ten. Unfortunately, only a minority of lung cancers are found at the earliest stage.

This November, during Lung Cancer Awareness Month, we want to help change that.

Who is at risk?

Smoking is the biggest cause of lung cancer. People who used to smoke can stay at higher risk for years after quitting. If you smoke or used to smoke, you are not alone, and it is never too late to take steps to protect your health.

Lung cancer can also happen to people who never smoked. Other causes include:

• Radon. This is a natural gas you cannot see or smell. It can build up in homes from the ground. Radon is the second leading cause of lung cancer, and the leading cause in people who never smoked. Testing your home is simple and low-cost.
• Secondhand smoke.
• Some workplace exposures, such as asbestos.
• A family history of lung cancer.

Lung cancer screening: who should get it?

Lung cancer screening uses a low-dose CT scan of the chest once a year. The scan is quick and painless and uses less radiation than a standard chest CT. Its goal is to find lung cancer early, before it causes symptoms.

Screening is for people who feel well but are at higher risk. The U.S. Preventive Services Task Force recommends a yearly screening scan if you:

• Are 50 to 80 years old, and
• Have smoked at least 20 pack-years, and
• Still smoke, or have quit within the past 15 years.

What is a pack-year? It is a way to measure how much you have smoked. One pack a day for one year equals one pack-year. So one pack a day for 20 years, or two packs a day for 10 years, both equal 20 pack-years.

The American Cancer Society does not use the 15-year cutoff, so some people who quit longer ago may also qualify. If you are not sure whether you qualify, talk with your clinician.

Screening is a choice you make with your clinician. Many scans find small spots that turn out not to be cancer, and some people need extra scans to be sure. Your clinician can help you weigh the benefits and the downsides. And screening does not replace quitting. If you smoke, quitting is the most important step you can take, and help is available.

Symptoms need a visit, not a screening scan

Screening is for people at higher risk who have no symptoms. If you have new symptoms, see your clinician for an evaluation instead of waiting for a screening scan. Call your clinician if you have:

• A cough that will not go away
• Coughing up blood
• New trouble breathing or chest pain
• Weight loss you cannot explain

These symptoms often have other causes, but they should be checked.

Good care is a team, not a single test

Good lung cancer care is not one test, one procedure, or one doctor. It is a series of steps, and each step needs to connect to the next. Mary Washington Healthcare is building a coordinated lung cancer pathway for patients in the Fredericksburg region. Our goal is to make the path from an abnormal scan to an answer as clear and coordinated as possible, while allowing patients to receive appropriate care close to home.

Here is how the steps fit together:

1. Screening. A yearly low-dose CT scan for people who qualify.
2. Nodule follow-up. When a patient with a spot on a scan is referred, our pulmonary team evaluates the finding and recommends the appropriate next step. For most people, that means watching it with future scans.
3. More imaging, if needed. Some spots need other scans to learn more.
4. Biopsy and staging, if needed. When a spot does need a sample, doctors can sometimes reach it through the airways with a thin, flexible tube, with no cuts on the chest. Robotic bronchoscopy helps doctors steer through the airways to some nodules deeper in the lung. EBUS, short for endobronchial ultrasound, uses ultrasound during this procedure to look at and sample lymph nodes in the chest. This helps show whether cancer has spread. These are important tools, but not every patient needs them, and sometimes other approaches work better.
5. Team review. When cancer is found, specialists can review the case together to plan care. This may include lung specialists, surgeons, cancer doctors, radiation doctors, radiologists, and pathologists. This kind of meeting is often called a tumor board.
6. Treatment. Depending on the cancer, this may include surgery, radiation, medicine, or a combination.
7. Long-term follow-up. Care continues after treatment, with check-ups, follow-up scans, and support.

Two things you can do this month

1. Get screened. Not sure if you should be screened? Talk with your primary care clinician. Bring your smoking history, even if you quit years ago.

2. Follow-up. Has a CT scan shown a nodule or "spot" that needs follow-up? Make sure the recommended follow-up happens. Ask your clinician whether a visit with a lung specialist is right for you.

To learn more or request an evaluation with Mary Washington Pulmonology, call 540-741-0500.

Vinay Patel, MD, is Medical Director of Pulmonology and Interventional Pulmonology at Mary Washington Healthcare.