Lung cancer kills more people than breast, prostate, colon and pancreatic cancer combined. Why? Doctors haven’t been able to detect lung cancer in time to effectively treat it. By the time symptoms presented, the cancer had spread so far that surgical options were not beneficial. But now there is a simple screening, a CT scan of the lungs. As of early 2015, the Affordable Care Act mandated that insurance companies and Medicare cover the cost of these scans. One hitch remains: only certain people qualify. As per the United States Preventative Task Force’s guidelines, the screening is approved for people ages 55 to 80, with histories of heavy smoking—defined as half a pack a day over 60 years, or one pack a day for 30 years. Former smokers who quit less than 15 years ago also qualify.
While those parameters don’t include many people who would benefit from the screening, Patti Hollenback is thrilled with even this amount of progress. A nurse navigator for the Crozer-Keystone Lung Screening Program, Hollenback wants everyone at risk to get CTs. She quotes research from the National Lung Cancer Screening Trial proving that patients who got CTs had 20 percent lower mortality rates than those who got X-rays. “It should be as routine as getting mammograms,” she says. “As with a mammogram, if we catch a tumor early enough, we can remove it and most likely prevent the cancer from proceeding.”
As Hollenback describes it, the CT scan is completely painless and does not require an injection of contrast dye. Patients don’t even have to change clothes. The CTs are available at Crozer hospitals and the imaging centers at Brinton Lake and in Media. These CT screenings are available through other healthcare systems, as well, like Main Line Health and Penn Medicine. Prescriptions are required and Hollenback says that Crozer’s primary care doctors are being encouraged to issue them for patients who meet the screening criteria.
As with mammograms, people who meet the criteria are encouraged to get annual CTs so that doctors can monitor potential changes in the lungs. “Cancers grow over time and we’ll see that when we compare the different pictures,” she explains.
What happens if something suspicious is discovered? Patients undergo a PET scan so doctors can get a better look at the mass. If it is determined to be cancerous and small enough, doctors remove it via needle biopsies or by using a device that is inserted orally. Both procedures are relatively simple and akin to lumpectomies for breast cancer. “The biopsies are diagnostic and curative,” Hollenback explains. “The surgeon takes the mass out and a pathologist is right there to test it. If appropriate, the surgeon will take out whole lobe or lump, depending on its size and location.”
Even if patients don’t need biopsies, they go home with information about Crozer’s smoking cessation programs. “We don’t want people to think this is a get out of jail free card,” Hollenback says. “It’s not, ‘I don’t have cancer so I can keep smoking.’”
Nor should the mentality be that doctors will catch tumors in time to remove them. Hollenback reiterates that by the time symptoms present, patients’ treatment options are usually limited, making screening essential. It’s a message that’s all the more significant for Hollenback, whose aunt and two uncles died of lung cancer, as did her best friend. Her husband died of colon cancer. “It’s terribly sad, but I’ve made my passion my career,” she says. “Now, it’s all about saving lives.”