More People Should Get This Test to Detect a Deadly Cancer
Summary
- More people at risk are having CT scans to help catch lung cancer early
There is a test that could diminish the toll of the nation’s top cancer killer—if people would use it. Doctors are pushing harder to make that happen.
Lung cancer kills upward of 127,000 people in the U.S. each year. The toll has waned in recent years thanks to declining smoking rates and new treatments, but it remains the deadliest cancer for Americans by far.
A CT scan can catch the disease early to help save lives. The five-year survival rate when lung cancer is caught early is about 60%, compared with around 7% if it is caught after disease has spread, according to the American Lung Association. Medical groups recommend annual, low-dose scans starting at 50 for people who smoke heavily or recently quit. Insurers often cover the test.
“It’s low-hanging fruit for the country," said Dr. Patrick Hwu, president and chief executive officer of the Moffitt Cancer Center in Tampa, Fla. “It would save the most lives immediately."
Only 6% of eligible people are screened, according to a 2022 report from the American Lung Association, compared with more than 60% of people eligible for breast and colorectal cancer screenings.
Doctors have debated whether CT lung screening is worth the risk of false positives and the invasive procedures that result. Some eligible people have said they didn’t know the test existed or would rather not know the results because a lung-cancer diagnosis was long considered a death sentence.
Now some doctors and advocates are pushing harder to expand lung-cancer screening and take advantage of newer treatments that have changed the disease’s outlook. They are outfitting vans with CT equipment, imploring family doctors to recommend the scans and working to instill hope in patients who are often blamed for developing the disease.
“Most of them don’t even know that if we catch these things early, they’re curable," said Dr. Robert Winn, director of the Virginia Commonwealth University Massey Cancer Center.
In Kentucky, where more than one in five adults smoke, the screening rate has risen to some 13%, more than double the national average. Medical centers in the state have worked together to raise awareness and swap best practices, prompting Kentucky lawmakers last year to establish a statewide screening program.
Glenna Courtney, a 73-year old retiree in Sanders, Ky., was screened in 2020 at her doctor’s recommendation. Cancer terrified her. Her mother died three days after being diagnosed with lung cancer at age 75 in 2008.
Courtney’s scan revealed a spot too small to biopsy. After it grew, surgeons removed it. Tests showed it had been cancerous. But it was gone, and she didn’t need chemotherapy or radiation, just regular follow-up scans. “It was such a big sigh of relief," Courtney said.
She urges friends and family to ask their doctors if they should be scanned. Relatives have told her they didn’t know about the test, she said. “We need to get the information out there about how much of a life-saver this test is," Courtney said.
St. Elizabeth Healthcare in northern Kentucky, where Courtney is a patient, was screening around 700 patients a month in 2022, up from seven in all of 2013, when a U.S. government-backed panel first recommended the test. More than two-thirds of lung cancers the scans identified at St. Elizabeth in 2022 were in the earliest stage.
Dr. Michael Gieske hadn’t heard of the test before St. Elizabeth assigned him in 2016 to encourage more eligible people to get it. He started writing thank-you notes to doctors who got their patients scanned and helped implement software that identifies eligible patients based on their medical records. He climbed Mount Everest with a large white ribbon fashioned from wood, inspired by the pink ribbon for breast-cancer awareness, to spread the word.
“I’ve seen a lot of lung cancer, and I’ve found for the first time, there was really something that can make a difference," Gieske said.
Pam Perin, 65, smoked for decades beginning as a teenager. “There was a part of me that just did not want to know," she said.
A snap decision in 2017 to get the test after seeing a poster in her doctor’s office led to the removal of a marble-size tumor. She quit smoking and tells everyone she knows about the scan, sometimes handing fliers about it to people she sees smoking.
Though studies show an annual low-dose CT scan can prevent lung-cancer deaths, the scan was first recommended based on limited data and flags false positives that can lead to unnecessary, invasive biopsies and costly follow-up.
“I was definitely hesitant to implement it in my own practice," said Dr. Kenny Lin, a family physician in Lancaster, Pa. More data and better methods for reducing false alarms have made him more confident in the test, he said.
The American Academy of Family Physicians, which first recommended against the scan, endorsed itin 2021 on the strength of the new data. The academy called for more research on the risks of the scan and for work to address barriers to screening among communities of color.
Moffitt Cancer Center in Tampa and Ohio State University Comprehensive Cancer Center in Columbus, Ohio, are planning to use mobile-screening vans to reach more patients, after efforts were derailed during the Covid-19 pandemic. Mount Sinai Health System in New York said it more than doubled the number of people it screened between 2017 and 2022.
The Veterans Health Administration increased its screening rate by nearly 80% in a similar time period, said Dr. Nichole Tanner, a pulmonary and critical-care physician at the Ralph H. Johnson VA Healthcare System in Charleston, S.C. “We’re moving in the right direction," she said.
Write to Brianna Abbott at brianna.abbott@wsj.com
