Lung cancer is the leading cause of cancer deaths. Historically, the public has focused on lung cancer less than other cancers and it's been called the silent killer. As a lung cancer oncologist, I see firsthand the toll lung cancer takes on the lives of patients and their families. How can this reality be overlooked?
The American Lung Association and its LUNG FORCE initiative—a national movement to take action against lung cancer—sought to address this very question. To learn more about women's perception and understanding of lung cancer, the LUNG FORCE surveyed 1,000 American adult women through its Women's Lung Health Barometer (LUNGFORCE.org/barometer). The barometer findings confirmed lung cancer awareness remains critically low. Despite being the No. 1 cancer killer of women and men, lung cancer is not a top-of-mind cancer concern for 98 percent of women.
While the 5-year survival rate for lung cancer is one of the lowest among leading cancers, three out of five women incorrectly believe, or are not sure, that lung cancer has a similar survival rate to other cancers. Lung cancer kills more than 400 people every day, with a new diagnosis occurring every 2.5 minutes. And the horrible fact remains that half of all women diagnosed with lung cancer will lose their lives within a year.
Screening Saves Lives
Despite the shocking statistics, according to the third annual Women's Lung Health Barometer, only half of women at high risk for lung cancer have spoken to their doctor about the disease. This is heartbreaking. If those at high risk for lung cancer aren't speaking with their doctors, they probably are not aware there is an option to be screened before they have any symptoms. Screening for this high-risk group can be lifesaving, leading to early detection of the disease. If lung cancer is caught before it spreads, the likelihood of survival more than triples. In fact, it's estimated that screening can reduce lung cancer mortality by up to 20 percent and, if only half of those at high risk were screened, more than 13,000 lung cancer deaths could be prevented.
Despite the life-saving benefits of early detection, currently only 16 percent of lung cancer cases are diagnosed at an early stage. This is due in part to the fact that many people with lung cancer don't have symptoms until the disease is in its later stages. This makes screening more urgent for those who are at high risk. I encourage you to help make everyone aware of lung cancer and its risk factors and to encourage them to speak to their doctor about screening options if they think they might be at risk.
The good news is that we are experiencing a historic moment in the battle against lung cancer. As of February 2015, people at high risk who are covered by Medicare have access to lung cancer screening. The Affordable Care Act requires most private health plans, including those sold on the exchange and Medicaid expansion plans, to have no-cost coverage for effective screening for people considered high-risk. Lung cancer screening for the high-risk population is more available now than ever before. Now is the time for patients to talk to their primary care physicians about screening options.
The American Lung Association supports low-dose CT screening for the recommended high-risk population. If a patient meets the following criteria, they are considered “high risk” for developing lung cancer and should talk to their doctor about screening:
* 55-80 years of age (55-77 years of age for Medicare);
* have a 30 pack year history of smoking (this means one pack a day for 30 years, two packs a day for 15 years, etc.); and
* are a current smoker or have quit within the past 15 years.
Access to screening is a game changer for the high-risk population, but do they know this is available? And do they know if they are eligible? While current smokers may realize they are at risk for lung cancer, for many former smokers, smoking is in their past and they may not consider asking their doctor about their risk or screening options. If screening can save more lives, we need to make sure we are communicating this to patients and that the doctors and healthcare workers who work with these patients can communicate about screening options.
Spreading the Word
Oncologists tend to meet patients after they have already been diagnosed, so what can we do to encourage lung cancer screening? The reality is that by the time I see patients, the cancer is usually incurable. How can we, as oncologists and others on cancer center care teams, help those considered “high risk” access lung cancer screening before they are diagnosed due to symptoms?
For your own cancer patients, encourage them to speak to their family about their risk, as smoking, secondhand smoke, radon gas, genetic factors, air pollution, and more might play a role. Hearing this from family members with a cancer diagnosis can encourage even reluctant patients to speak with their doctor about their risks. You can point them to Lungcancerscreeningsaveslives.org.
We need to educate those at high risk for lung cancer any chance we get. I would encourage you to visit a tobacco cessation clinic, such as a Freedom From Smoking clinic or lung health support groups, such as a Better Breathers Club, in your hospital to speak with patients and let them know about the criteria for screening and available services in the area.
A screening program should be established in every institution with trained professionals. Oncologists can be proactive and advocate for getting programs set up. These should be established by, or alongside, interdisciplinary care teams, including pulmonologists, oncologists, radiologists, thoracic surgeons, respiratory therapists, social workers, patient navigators, and more. Coordinating care can provide a comprehensive approach to support for patients.
Since the first Women's Lung Health Barometer in 2014, there have been positive shifts in women's perceptions of lung cancer. Over the past year, women have become 35 percent more likely to speak to their doctors about lung cancer. However, when patients speak to their doctor, they need the right information. So we must ensure they have the most recent guidelines and recommendations when it comes to lung cancer screening.
It's critical to update primary care physicians and pulmonologists on current screening guidelines and insurance coverage so they can ask patients the right questions and recommend and educate high-risk patients about their options.
A great opportunity to educate is through lectures and grand rounds at the department of medicine at your institution and at other local institutions. This is an important opportunity to educate those working directly with patients prior to a lung cancer diagnosis, and these are well attended since physicians can usually earn CME credits.
At Mount Sinai Hospital, we take this a step further and hold lung cancer screening seminars for the community. We provide a panel of oncologists, screening experts, thoracic surgeons and more, and we allow attendees to ask questions and learn directly from the source. By meeting with the community, we hope to raise awareness about screening options and spread the word.
For smaller institutions who may not have the budget for holding public seminars and panels, I encourage you to collaborate with other organizations, such as the American Lung Association. They have information about lung cancer screening at Lung.org/lcscreening, as well as videos, resources, and support communities for lung cancer patients and their caregivers at Lung.org/lung-cancer. They also host LUNG FORCE Walks and Expos, which serve as a great avenue to educate the public about lung cancer, its risk factors and screening options.
We know early detection and screening is key to saving lives. That's why I'm volunteering with the American Lung Association and its LUNG FORCE initiative, a nationwide movement to raise awareness about lung cancer and unite the nation against the No. 1 cancer killer. Through LUNG FORCE, those whose lives have been touched by lung cancer are raising their voices and sharing their stories. Together, we're bringing lung cancer out of the shadows and encouraging those at risk to speak with their doctor and get screened.
As a lung cancer oncologist, I serve patients and have had many hard conversations. I became a doctor because I want to help patients. To achieve this, as oncologists, we may need to reach them before they become our patients. By raising awareness about screening, the hope is that when they reach us, it will be early on, when curative treatment options are available. This is an important opportunity to save lives, which is at the heart of our profession.
JORGE E. GOMEZ, MD, is Assistant Professor of Medicine, Hematology and Medical Oncology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai in New York, N.Y., and Member of the American Lung Association Lung Cancer Expert Medical Advisory Panel.