For 35 years, Lorna Kruse felt soothed by Marlboro cigarettes, smoking two packs a day.
When she developed a nagging cough, the 58-year-old Billings woman decided she’d had enough.
That was seven years ago.
On Aug. 25, Kruse, a nurse, gave herself a gift — a low-dose CT lung cancer screening, also called a low-dose CT scan, or LDCT — at St. Vincent Healthcare. The St. Vincent Healthcare CT Department is now considered an American College of Radiology-designated lung cancer screening center. The hospital began offering the scans on the first of the year, and so far has done about 20 of them.
“I’ve taken care of a lot of people who died of lung cancer in my day, and it’s not pretty to watch,” she said. “There is always a fear of getting lung cancer when you smoke.”
Her scan was negative.
The 10-second scan, which she had while wearing her street clothes, provided her peace of mind.
“I didn’t realize it would be so quick and easy,” she said.
Lung cancer is the second most common cancer in the United States and represents 14 percent of newly diagnosed cancers. In 2013, it is estimated that there were approximately 228,000 new cases of lung cancer and 160,000 deaths from the disease, said Dr. Kathleen Ryan, a radiologist at St. Vincent Healthcare. It represents 27 percent of all cancer-related deaths in the United States.
Some 50 to 60 percent of lung cancers are diagnosed at an advanced stage and have dismal survival statistics, incurring costly treatment with little or no survival benefits, Ryan said.
But unlike mammography for breast cancer or colonoscopy for colon cancer, a widely accepted screening tool for early stage cancer has not been available until recently. Until now, one of the only ways to screen for lung cancer was with a chest X-ray, which is not reliable enough to find lung tumors in their earliest stages, when many doctors believe the tumors are in their smallest and most curable state.
The only recommended screening test for lung cancer is the LDCT. In this test, an X-ray machine scans the body and uses low doses of radiation to make detailed pictures of the lungs.
“Our hope is to reduce death from lung cancer because so many are found too late,” Ryan said.
The U.S. Preventive Services Task Force has recommended yearly lung cancer screening with LDCT for people who have a history of heavy smoking, smoke now or have quit within the past 15 years, and are between 55 and 80 years old.
Heavy smoking means a smoking history of 30 “pack years” or more. A pack year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 30 pack-year history by smoking one pack a day for 30 years or two packs a day for 15 years.
Most lung cancers are first diagnosed based on symptoms. Symptoms of lung cancer are not very specific and generally reflect damage to the lungs’ ability to function normally. The most common symptoms are a worsening cough that will not go away and chest discomfort. Other symptoms include shortness of breath, spitting up small amounts of blood, unexplained weight loss, back pain, loss of appetite and general fatigue.
The American Society of Clinical Oncologists suggests annual screening with LDCT for smokers and former smokers at high risk for developing lung cancer. At this time, yearly screening with LDCT is recommended for high-risk individuals after careful discussion with their physicians.
As with all screening tests, there are controversies, Ryan said, adding that some people are concerned about radiation.
“The dose is very small, the equivalent of a few months of background radiation,” Ryan said.
There are also concerns about overdiagnosis of small lesions that may never have become symptomatic, she said. Incidental findings and managing small nodules will pose challenges. And, of course, the cost-effectiveness of the procedure will raise questions in this age of cost containment.
“Turns out, smoking cessation is actually twice as effective as CT screening, so smoking cessation counseling is a very important component in controlling lung cancer deaths and the high cost to society for treating late-stage lung cancer,” Ryan said.
St. Vincent Healthcare is working to establish a multidisciplinary Pulmonary Nodule Clinic complete with a navigator to help patients and their primary care providers understand the pros and cons of the procedure, the CT findings and follow-up recommendations.