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HEALTH MATTERS 1/8: Early Detection is Key in Treating Lung Cancer

 By John A. Heim, M.D.

Lung cancer is the leading cause of cancer deaths in both men and women in the United States, claiming more lives than colon, prostate, ovarian, and breast cancer combined, according the American Cancer Society.

And while there are several risk factors for lung cancer, the vast majority of lung cancer deaths are linked to smoking.

Screening, however, can help detect lung cancer in high-risk individuals before symptoms begin and when the disease is easier to treat successfully.

Penn Medicine Princeton Health offers no-cost lung cancer screening for qualified patients, enabling doctors to identify lung nodules as early as possible and helping to save lives.

Finding Cancer Before Symptoms Start

An estimated 229,000 new cases of lung cancer were diagnosed in the United States last year, according the American Cancer Society, and nearly 136,000 people died from the disease.

By far, smoking is the leading risk factor for lung cancer, and is behind at least 80 percent of all lung cancer deaths. Other less common risk factors include radon exposure, asbestos exposure, exposure to other cancer causing agents, and family history.

In most instances, by the time lung cancer causes symptoms – such as chronic cough or difficulty breathing – it is usually in an advanced stage when it is more difficult to treat.

That is why early detection is key. Treatment is most effective if cancer is found when it is small and before it has spread.

Screening Criteria

Based on results from the National Lung Cancer Screening Trial, lung cancer screening is recommended for people who:

• Are current or former smokers
• Are age 55 or older
• Have a smoking history of 30 or more pack years (one pack per day for 30 years or two packs per day for 15 years)
• Do not have a history of lung cancer

If you meet the above criteria and are concerned about your risk for lung cancer, talk with your doctor about low-dose CT screening.

With low-dose CT screening, spiral CT scans use low-dose radiation to make a series of detailed pictures of areas in the body. The pictures are made by a computer linked to an X-ray machine that scans the body in a spiral path. The scan takes just a few minutes and does not require any pre-operative lab work. Results are normally available within a matter of days.

Regular chest x-rays are not recommended for lung cancer screening. As the American Cancer Society notes, research has shown that using low-dose CT scans to screen people at higher risk for lung cancer has saved more lives compared to chest x-rays.

The American Cancer Society also notes that screening should only be done at facilities that have the right type of CT scanner and that have experience in low-dose CT scans for lung cancer screening. The facility should also have a team of specialists that can provide appropriate care and follow-up if there are abnormal test results.

For higher risk individuals, getting yearly low-dose CT scans before lung cancer symptoms start helps lower the risk of dying from the disease.

Treatment Varies

Usually, the earlier lung nodules can be found, the easier they are to treat.

If a lung nodule is found during screening, further testing will determine whether it is benign or malignant. In some cases, the abnormality will be monitored with additional tests throughout the year rather than being surgically removed.

Surgery for lung nodules can often be performed using a minimally invasive approach with patients benefiting from fewer complications, less blood loss, shorter hospital stay, less pain, and faster return to normal activities. Chemotherapy and/or radiation may or may not be necessary afterward.

Molecular testing can also help determine the genetic makeup of the mass and whether immunotherapy, which stimulates a person’s immune system to destroy cancer cells, is a treatment option.

Cancer Screening During COVID-19

Many people may have postponed lung cancer screenings and other routine exams last year due to the COVID-19 pandemic. However, screenings remain an important part of staying healthy and detecting disease in its early stages.

At Penn Medicine Princeton Health, multiple safety measures have been put in place to protect against COVID-19, including:

• Requiring all staff, providers, patients, and visitors to wear a protective masks
• Reconfiguring waiting rooms to allow for physical distancing
• Having hand sanitizer readily available
• Ensuring providers wear appropriate personal protective equipment
• Following rigorous sanitation and disinfection protocols

If you are a candidate for lung cancer screening or are due for other health exams, talk with your doctor to determine if the benefits outweigh the risks.

The Lung Cancer Screening Program at Penn Medicine Princeton Health is a collaborative effort involving radiologists, surgeons, pulmonologists, and oncologists who work together to detect and treat lung cancer.

Patients who meet the criteria need only a prescription from their primary care doctor or other physician for no-cost screening. All results and any necessary follow-up care will be discussed with your primary care physician and, if appropriate, a specialist who treats lung nodules.

To find a physician with Penn Medicine Princeton Health, call 888.742.7496 or visit www.princetonhcs.org.

John A. Heim, M.D., is board certified in general and thoracic surgery and is the chairman of the Department of Surgery at Penn Medicine Princeton Health.

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