Lung cancer is the leading cause of cancer deaths, accounting for around 1 in 5. And cases are on the rise – especially among nonsmokers. But current practices that physicians rely on to determine who should be screened for lung cancer and how are thought by some to be outdated, and they often miss cases until cancers have metastasized and are no longer curable.
In a November study, Northwestern Medicine found that only 35% of around 1,000 patients being treated for lung cancer would have qualified for screening based on the current criteria.
So it expanded upon the current recommendations by adopting universal age-based screening for those 40-85 years old and launched its comprehensive Lung Health Center to provide low-dose CT scans that detect lung, heart and bone conditions as early as possible to a wider selection of patients.
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The Blind Spot in Current Screenings
Lung cancer is widely considered one of the deadliest cancers because nearly 80% of cases aren’t discovered until they’ve reached advanced stages.
Dr. Ankit Bharat, chief of thoracic surgery and executive director of the Northwestern Medicine Canning Thoracic Institute, says that, unlike breast and colon cancers, for which screening is conducted based on the age of a patient, lung cancer screening is still recommended based on the risk a patient is perceived to face.
He says the current guidelines are outdated because they were created on the false assumption from decades ago that smoking was the only cause of lung cancer. The guidelines focused on heavy smokers who smoked for over 20 years and hadn’t quit within the last 15 years.
“They assumed that if you quit over 15 years ago, your risk of smoking-associated cancer goes down dramatically and you don’t need screening. But over 30% of lung cancer patients are never smokers. And in our study, we found that the population is increasing to over 40%,” he says.
The Low-Dose Solution
At the newly formed Lung Health Center, approved patients undergo a low-dose CT screening that captures images of the chest, stomach, esophagus, neck and bones. The scan takes less than 10 seconds and does not require an intravenous contrast dye, like the standard scan. And while colonoscopies can cost up to $6,000 and mammograms can run over $1,000 without insurance, the low-dose CT scan is often less than $300.
Bharat says patients first complete a phone assessment so physicians can understand their lifestyles and their current health conditions. Physicians evaluate whether they meet the current criteria for screening. If they do, they are given the standard CT scans of the lungs only. But if they don’t, they are given the low-dose CT scan that captures a bigger picture.
He says the benefit of being able to capture images of more than the lungs is that other illnesses – like pulmonary fibrosis, bone issues and COVID-related respiratory issues – can be detected earlier and treated.
A ‘No-Brainer’ for Early Detection
The new form of detection has proved to be successful for patients and doctors alike at Northwestern.
Around 300 patients have since been selected for the new screening, and two patients have been diagnosed with Stage 1 lung cancer. Other ailments that have been identified via the scans include several types of benign and nonmalignant lung conditions, blockages in heart vessels and two breast problems.
Bharat calls the new screening a “no-brainer,” not just because of the results but also because of its cost-effectiveness. He notes that early detection means less invasive and expensive treatments and scans.
He says his biggest hope is that regulators will consider this new option to make screenings more accessible.
“We’ll continue to offer this because we believe in it, and we are seeing the results. But unless there is a widespread regulatory allowance, this cannot get widely adopted.”
