Advanced screening devices have contributed to a decline in cancer death rates in recent years. Dr. Mark Parker, director of a lung cancer screening program at VCU, uses specialized low-radiation machines that can catch lung cancer early.
Reviewing a scan, he says, “When we have spots that are this big, we have concerns. We want to catch that lung cancer at its smallest size at its earliest stage."
The program at VCU is open to patients who qualify as "high risk" like Scott Bradon, a 55-year-old who smokes heavily.
Parker says, “If we wait until a patient presents to his doctor with signs and symptoms of lung cancer, from coughing up a little bit of blood, losing weight, ... a new cough that developed. The vast majority of those patients already have advanced lung cancer at that point in time when they very first see their doctor and early detection will not have a role in increasing their survivability.”
Dr. Patrick Nana-Sinkam is chair of Pulmonary and Critical Care Medicine at VCU Health says most of the spots are false alarms. “Over 90% of the spots we detect are non-cancer. This is very important for patients to understand prior to their scan. Because it allows them to be more at ease when we have a conversation about the results," he says.
The American Cancer Society says the low-dose CT scan is safer.
The patient may have to get extra scans, but it's safer than traditional CT scans because the scans only emit “about ten percent of the radiation of a standard CT," Nana-Sinkam says.
Although he says many people are concerned about long-term radiation risks from scans, “The reality is most studies have demonstrated that the risks of radiation-induced disease is minimal to almost zero, even after you have had 10,15,20 scans.”
Bradon has had four, and he'll be back in 6 months for another scan. He, like most of the patients here, is a smoker who wants to quit. He says, “Main thing, I need to quit smoking."
Parker says, "Yeah, I know that's difficult." According to a 2008 study by the U.S. Department of Health and Human Services, giving up nicotine takes multiple attempts.
Although smoking-related diseases are serious and common among smokers, many screens are poorly performed - millions according to a 2020 American Cancer Society report. They report found that physicians needed to be alerted to a “shared decision-making conversation” required by the Centers for Medicaid and Medicare Services so they could give patients realistic expectations.
Michelle Futrelle is the Nurse Coordinator for the Lung Cancer Screening Program and she says, “There is a whole process in terms of people coming in, getting assessed because they have to meet certain criteria for insurance and all that.”
And clinics must meet stringent American College of Radiation guidelines.
This clinic and at least three dozen others in the area qualify. The American Cancer Society says the low-dose CT scans have reduced mortality rates by 20% over chest radiography.
And Dr. Parker says, “The American Cancer Society estimates that by, in Virginia alone, that by the end of this year over 5900 Virginians will be diagnosed with lung cancer. And by the end of the year over 34 hundred will die from lung cancer.”
Dr. Nana-Sinkam says if every high-risk person were screened, it could save 12 thousand lives a year nationally. “We’ve diagnosed many individuals with lung cancer. A large percentage of those patients are early-early stage lung cancers and there is nothing more gratifying than seeing that patient in my clinic a month or six months or even two years after they have had their tumor resected and we look at each other and we recognize that if it were not for early detection, their outcome may have been very different.”
He says lung cancer is not a death sentence. “Not at all, in fact I am telling many of my patients we are moving closer and closer to a point we consider lung cancer a chronic disease," instead of a terminal one.
