March 3, 2020

Lung screenings are saving lives, and the research shows it

by

Yearly lung screenings have reduced cancer deaths. Find out if you need one in addition to your colonoscopy and mammogram.

The colonoscopy for colorectal cancer and the mammogram for breast cancer are talked about more often than screening for lung cancer. But a yearly lung screening with low-dose computed tomography is just as crucial for individuals who are at higher risk.

“Early-stage disease is very often curable — not for everyone, but for a lot of people and for far more people than who have metastatic disease,” said Kim Sandler, M.D., co-director of the Vanderbilt Lung Screening Program. The five-year survival rates for stage 1 lung cancer are above 60 percent, but they’re less than 10 percent for late-stage disease. “Survival is largely dependent on when your lung cancer is found,” Sandler added.

What the research says

The National Lung Screening Trial showed a 20 percent mortality rate reduction and an almost 7 percent decrease in all-cause mortality in individuals who had undergone low-dose computed tomography, when compared to people who had been screened via chest X-ray.

Additional studies have shown an even greater benefit. Sandler said mortality rate reductions are probably closer to 40 percent. “It’s been shown to be as high as 69 percent in women,” Sandler added, “because women tend to get a type of lung cancer that grows more slowly. So we actually have more time to catch it with lung screening.”

Who needs a lung screening?

The U.S. Preventive Services Task Force recommends yearly screenings for people age 55 to 80 who have a 30 pack-year history. That means they’ve smoked about a pack of cigarettes a day for 30 years or more. These guidelines apply to those who currently smoke or who have quit within the past 15 years. The task force says screenings can stop once a person has not smoked for 15 years, has developed a condition that limits their life expectancy, or is unwilling or unable to undergo surgery or treatment for lung cancer. “So, in terms of insurance reimbursement from Medicare and private insurers,” Sandler said, “that is the criteria they will use in determining when lung cancer screening is covered.”

Those guidelines may change in the future if studies show a benefit to screening younger patients. “We published an article in JAMA Oncology earlier this year,” Sandler explained, “showing that the screening recommendations are lacking for African Americans because they tend to develop lung cancer at younger ages and with less tobacco exposure.”

Sandler pointed out that lung cancer and related deaths are prevalent without tobacco use, as well. “People think only smokers get lung cancer, which is really not true,” she explained. “If you look at lung cancer, and you excluded all of the smoking-related lung cancers, lung cancer would still be the seventh leading cause of cancer-related mortality in non-smokers.”

If you have a family history of lung cancer, a personal history of other cancers, or a history of occupational exposure to carcinogens, talk to your health care provider to see if earlier screenings are right for you.

Raising awareness and empowering patients

“We have these huge efforts in October around breast cancer awareness,” Sandler said, “and then November is Lung Cancer Awareness Month, and no one seems to know that there’s anything going on. And so we’re working to change that.”

For any cancer, Sandler said patients should be empowered to talk to their health care providers about the potential need for earlier screenings. “I think it’s important to know as much as you can about your history and also how your risk changes based on exposures,” she explained.

If you meet the criteria for lung screening, ask your primary care provider to refer you for lung screening. If you do not currently have a healthcare provider, Vanderbilt’s program can help you. For more information, visit www.VanderbiltLungScreening.com or call 615-936-3606.

Kim L. Sandler, M.D.

Kim L. Sandler, M.D., is assistant professor of radiology and radiological sciences at Vanderbilt University Medical Center and co-director of the Vanderbilt Lung Screening Program. Her research focuses on outreach for lung screening, particularly for women and minorities, and improving our ability to differentiate benign and malignant lung nodules by combining CT imaging with blood-based biomarkers, machine learning, and radiomic evaluation of pulmonary nodules.