Screening Detects Lung Cancer Before Physical Symptoms

Think of a cancer that is the deadliest around, leading to more deaths than the second, third and fourth place finishers combined.

Then consider the disturbing fact that only 4 percent of the people who qualify for screening actually do so. You might then understand the fervor — and frustration — of physicians, such as Dr. Nestor Villamizar from Sylvester Comprehensive Cancer Center, who want to make sure people know there is a way to detect lung cancer before symptoms show up.

As in other cancers, early detection is critical because smaller cancers are more readily treated and cured. Studies show that as many as 80 percent of patients with a pulmonary nodule (or spot) one centimeter or smaller live at least five years past the diagnosis. In comparison, that rate of survival plummets to less than 20 percent when all patients with lung cancer, including those with larger, fast-growing nodules, are accounted for.

“There’s not a lot of publicity around the screening, so people don’t know about it,” explains Dr. Villamizar, a thoracic surgeon and lung expert at Sylvester. “Our goal is hopefully to get it as well-known as a mammography or a colonoscopy.”

Lung cancer screening is done with a low-dose computerized tomography scan (LDCT). Sylvester’s lung cancer screening program, launched in 2011 by Dr. Richard J. Thurer, was recently designated an American College of Radiology (ACR) Lung Cancer Screening Center, signifying the program meets the requirements of the ACR’s lung cancer screening committee. The designation is awarded only to those providers who offer effective and safe diagnostic care. To receive the designation, Dr. Villamizar adds, the program had to undergo “a rigorous assessment” of the lung cancer screening protocol as well as demonstrate Sylvester had procedures in place for follow-up patient care, from counseling to smoking cessation programs.

In addition to being a seal of approval, the ACR’s special designation enables Sylvester to receive Medicare CT lung cancer screening payments, an important factor as many potential patients tend to be older.

About 234,030 new cases of lung cancer are expected to be diagnosed in 2018, according to American Cancer Society estimates, with about 154,050 deaths this year alone. It is the second most common cancer after breast in women and prostrate in men. Yet lung cancer has beat out breast cancer as the deadliest cause of cancer-related deaths in men and women, and more people die of lung cancer each year than of colon, breast, and prostate cancers combined.

“Part of the issue,” Dr. Villamizar, says, “is that it’s hard to detect. It also tends to be quite aggressive and metastasize faster [than other cancers].”

By the time patients show up to their doctors complaining of chest pain and shortness of breath, “it is usually in an advanced stage,” making treatment more difficult. Though lung cancer has no symptoms in its early stages, signs of advanced disease can include a chronic, hacking cough with bloody mucus, recurring respiratory infections such as bronchitis or pneumonia,  hoarseness, fatigue, loss of weight and appetite, trouble swallowing, even swelling of the neck and face.

“Smoking is the number one risk factor,” Dr. Villamizar adds, “and while there are others, like environmental exposure, they don’t play as big a role. I can’t stress enough the importance of not smoking.”

Smokers are 10 to 20 times more likely to develop lung cancer or die from the disease than non-smokers.
The number of cigarettes and the number of years spent smoking also ups that risk. But it’s never too late to quit. Lung tissue can slowly repair itself if you stop smoking before cancer develops, Dr. Villamizar says.

Smoking is so dangerous that it plays an outsized part in determining who should be screened for lung cancer. In fact, screening is reserved for those who are at the greatest risk of developing lung cancer, namely current heavy smokers and former heavy smokers who have quit within the past 15 years. Heavy smokers are those with a smoking history of smoking a pack a day for at least 30 years, or two packs a day for 15 years, or three-quarters of a pack a day for 40 years.

Both Medicare and private insurers pay for current and former smokers 55 and older to be screened. The only difference between the two is that Medicare will pay for annual screenings up until the patient turns 77 years old, while private insurance extends the cutoff to 80 years of age. The U.S. Preventive Services Task Force recommends that screening should continue until age 80 or until a patient develops a serious health condition that limits the benefit of screening.

People who have been exposed to environmental factors or suffer from chronic obstructive pulmonary disease (COPD) are also good candidates for lung screening. Dangerous environmental exposure includes secondhand smoke and radon gas or asbestos, as well as arsenic and some kinds of silica and chromium. A family history of lung cancer, particularly if parents or siblings have had it, should also be regarded as a red flag.

If a scan shows a spot, the steps to be taken can vary depending on the size and characteristics of the nodule. A physician may opt for monitoring or order more tests. Some studies have shown that as many as half the people who undergo screening have one or more nodules, but those spots can also point to other health problems typical of long-time smokers, such as emphysema and hardening of the arteries in the heart. The nodules may also be scars from lung infections or benign growths. (However, it’s also important to note that about 40 percent of these spots, or pulmonary nodules, turn out to be cancerous.)

If the spot is small, Dr. Villamizar usually suggest another CT scan in a few months to detect any lung nodule growth, which usually signals cancer. On the other hand, a large nodule (1 to 2 cm, for instance) is more likely to indicate cancer. This then requires other procedures for confirmation, including a biopsy or a PET (positron emission tomography) scan.

“A scan is pretty accurate in detecting an abnormality,” Dr. Villamizar says, “even if it doesn’t let you know if it’s cancer. It’s the best place to start. ”

Find out if you qualify for lung cancer screening TODAY.


Ana Veciana Suarez
Ana Vecina-Suarez, Guest Columnist
Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.