By Linda Dowling, RN
Lung cancer accounts for 25% of cancer deaths — more than colon, breast and prostate cancers combined. Lung cancer has been referred to as a “silent killer” because patients often do not develop symptoms until later stages of this disease, when treatment options are limited.
My perspective on lung cancer and early detection is personal and heartfelt. In 2004, my mother, a life-long tobacco user, was diagnosed with advanced small-cell lung cancer. During this time, lung cancer screening was still being researched, as were other exciting, recent developments in treatment, including immunotherapies.
Following my mother’s death in 2006, I made a mid-career change from marketing to nursing with the intention of focusing my career in cancer. As an oncology nurse, I first learned about lung cancer screening and knew that I wanted to work in this emerging field focused on early detection.
Coverage for lung cancer screening by both private insurers and Medicare coincided with my beginning to work at Rush in 2015. Since this time, I’ve had the pleasure and honor of working on a program that has the ability to save lives by identifying lung cancers that otherwise would go undetected.
So, I want to share my observations not only as a lung cancer screening navigator, but also as an advocate for this underutilized tool for the detection of lung cancer.
A simple, annual exam
Patients considering lung cancer screening must meet specific criteria based on their age and tobacco history. And if you meet the criteria, your provider will discuss risks and benefits of the exam before ordering lung cancer screening.
Lung cancer screening uses a low-dose CT scan. You will lay down while the CT machine takes multiple pictures of your lungs. The test is simple, fast and does not hurt. No preparation is needed, and you may eat, drink and take medications before your exam. This test does not require injections or an IV.
At Rush, a specially trained thoracic radiologist will review your exam and provide a follow-up recommendation. Over 90% of our lung cancer screening patients have negative exams. In this case, we then recommend that you complete your lung cancer screening annually until you are over 77 years old, quit smoking more than 15 years ago or develop a condition preventing you from adhering to recommendations after your exam result. If you have a positive exam, we may recommend additional imaging or we’ll direct you to a specialist for further evaluation.
We understand that a potential diagnosis of lung cancer can be frightening and anxiety provoking. That’s why our lung cancer screening program helps connect you to our multidisciplinary lung cancer team, and quickly.
The original National Lung Cancer Screening Trial said that a high number of patients needed to be scanned to find one lung cancer. And I am proud to report that within the past five years, we’re able to more effectively and efficiently detect lung cancer in our patients.
A key objective of lung cancer screening is early detection. Over 60% of patients at Rush with lung cancer were diagnosed at an early stage. Since their cancers had not spread, they were able to have minimally invasive surgical techniques, which allowed them to recover quickly from their procedure and be monitored with periodic CT scans.
Irony of lung cancer screening
In 20202, the American Lung Association reported just under 6% of those eligible in the U.S. participated in lung cancer screening. In contrast, within the past two years, 65% of eligible people in the U.S. had a mammogram, and 69% of eligible people in the U.S. had a colonoscopy.
Cancer screenings are a vitally important tool for early detection of disease, but I find it ironic that an exam that is so straightforward and minimally invasive, is the least used cancer screening. Additionally, lung cancer screening has the capability to provide the greatest benefit in addressing a disease with historically poor outcomes.
As a nurse advocate, I wonder what can be done on everyone’s part to inform and increase the lung cancer screening among those eligible? I believe it starts with education, and I will continue to spread the message about the role of lung cancer screening in early detection. And it is my sincerest desire that if you meet screening criteria, you will speak to your provider about getting this exam. And if you do not meet the screening criteria, please share your knowledge and encourage your loved ones to do the same.
One patient said to me, “You have a wonderful job.” I do, and I know my experience as the daughter of a lung cancer patient greatly contributes to my dedication and mission to increase awareness and usage of lung cancer screening. I promise you that I will not stop until more people know about and, therefore, benefit from lung cancer screening.
Lung cancer screening criteria:
- Age: 55-80 (private insurance) or 55-77 (Medicare)
- Current or former smoker who quit within the past 15 years
- 30+ pack-year smoking history (number of packs per day times number of years smoking)
- Asymptomatic of lung cancer (e.g., weight loss)
- Have not had a CT of the chest in the past 12 months
- Must be in reasonably good health and able to abide by treatment recommendations
Linda Dowling, RN, is the nurse manager for the lung cancer screening program at Rush University Medical Center.