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Published on November 26, 2019

This under-utilized test could save your life

Lung Cancer Screen

If you live on Cape Cod and are at high risk for lung cancer, you can receive specialized screening that could save your life.

Cape Cod Hospital was recently named a lung cancer Screening Center of Excellence by a leading patient advocacy organization. The GO2 Foundation for Lung Cancer, a nationwide organization founded by lung cancer patients and survivors, awarded the designation to Cape Cod Hospital.

The hospital’s commitment to high-quality screening practices is good news for patients, said Laurie Fenton Ambrose, GO2 Foundation co-founder, president and CEO.

“Cape Cod Hospital’s commitment to practice responsible lung cancer screening will lead to many lives saved,” she said. “They are an example to follow.”

The achievement was a team effort, said Alexander Adduci, MD, PhD, chief of radiology at Cape Cod Hospital.

“We’re very proud to be recognized,” he said. “We’re doing excellent work, and I think that people should know about it.”

Screening allows the detection of smaller, earlier stage lung cancers and that translates into a better prognosis, he said.

“If you catch a lung cancer at stage 1, there’s a five-year survival of 68 to 92 percent. But if you wait until the later stage, if you’re stage 4, there's only a zero to 10 percent five-year survival rate. Catching it early makes a huge difference, so it’s really important that we get the high-risk people in.”

An Under-Utilized Test

Lung cancer screening is an under-utilized weapon in the battle against cancer, said Dr. Adduci.

“People are very familiar with mammography, prostate screening and colonoscopies,” he said. “The cancer screening rates for appropriate patients are 50% for breast, 35 percent for prostate and 63 percent for colorectal – but a study in 2016 estimated that only 2 percent of eligible high-risk patients in the U.S. get lung cancer screening. We need to get more people in.”

The high-risk category is people who are 55 to 80 (Medicare guidelines cover ages 55 to 77) who are still smoking or quit within the past 15 years and smoked for 30 pack years (a pack a day for 30 years, for example, or two packs a day for 15 years).

“We scanned over a thousand patients at Cape Cod Hospital and Falmouth Hospital last year, but we estimate that that’s only 20 to 25% of what we should be screening,” he said.

Cape Cod Hospital earned the GO2 Foundation recognition by meeting the following criteria:

Providing clear information on the risks and benefits of CT screening

Complying with standards based on the most up-to-date best published practices for managing screening quality, radiation dose and diagnostic procedures

Working collectively as a multidisciplinary team or referring patients as appropriate to a multidisciplinary team to carry out the process of screening, diagnosis and the continuum of care

Referring patients who still smoke to a tobacco cessation program

Providing results of the screening scans to the patient or referring physician, as appropriate, in a timely manner.

How Screening Works

The procedure for lung cancer screening – a CT scan of the chest – is simple, according to Dr. Adduci.

“You’re in the room for about 10 minutes, and that includes getting you settled on the table and talking to you about what’s going to happen,” he said. “The scan itself is about 20 seconds. There are no intravenous lines or injections involved, and no prep beforehand.”

Patients usually have the results in a few days.

“We’re looking for anything suspicious in the lungs, a nodule or a mass,” he said. “The majority of the studies are negative, which is good for the patient.

“Even those that do have findings, a lot of them are just small nodules that we follow-up on in six or 12 months.

Patients whose nodules are more suspicious get further testing, including a PET-CT scan or a biopsy, he added.

Early Detection, Better Outcomes

Over the past year, Cape Cod Hospital has worked hard to improve multi-disciplinary care for lung cancer patients.

“We have people from radiation oncology, thoracic surgery, pulmonology, respiratory therapy and administration all working together to get people plugged into the right care,” said Dr. Adduci. “We’re trying to remove any time lags in the process.”

The American Lung Association recently released its first “State of Lung Cancer” report. The report showed that the U.S. lung cancer survival rate has improved by 26% in the past 10 years. The five-year survival rate is now around 22%.

Nationwide, more than 228,000 people will be diagnosed with lung cancer this year.

There was good and bad news for Massachusetts residents. The rate of new cases (62.0 out of 100,000 people) was slightly higher than the national average (59.6), but 26.7 percent of cases were caught at an early stage (the second-best rate in the nation).

“Most lung cancer cases are diagnosed at later stages when the cancer has spread to other organs, treatment options are less likely to be curative, and survival is lower, according to the ALA web site.