Lung cancer is the third most common cancer in the United States. (Skin cancer is the most common, followed by breast cancer for women and prostate cancer for men.) However, lung cancer has been the leading cause of cancer death among men since the early 1950s. In 1987, it surpassed breast cancer to become the leading cause of cancer death among women.
Early screening and detection are critical to start treatment before the disease spreads. Unfortunately, doctors diagnose most cases of lung cancer in the advanced stages of the disease when there aren't as many treatment options.
Being aware of lung cancer screening guidelines is key to detecting the disease early. Julian Guitron, MD, David Long, MD, and Brian Mannion, MD, discuss current screening recommendations and treatment options.
What do doctors recommend for current lung cancer screenings?
Lung cancer screening is relatively new compared to other screenings, such as colonoscopies and mammograms, says Dr. Guitron. The U.S. Preventive Services Task Force (USPTF), an independent panel of disease prevention experts, issued its initial lung cancer screening recommendations in 2013.
“Initially the concern was that the health system would get overwhelmed by the number of patients who would qualify for screening, but the opposite has actually happened," Dr. Guitron says. “We have a significant underutilization of the lung cancer screening."
Screenings are intended for patients with a moderate to high risk of lung cancer. These include patients who:
- Are 50-77 years of age
- Have no symptoms of lung cancer
- Have a tobacco-smoking history of at least 20 pack-years (the equivalent of smoking a pack a day for 20 years or two packs a day for 10 years, etc.)
- Are a current smoker or quit smoking less than 15 years before getting screened
In 2021, the USPTF updated its guidelines to include a larger population. The guidelines went from one pack per day for 30 years to one pack per day for 20 years.
Patients who don't fit the criteria can still receive lung screening, but it may not be covered by insurance. However, Dr. Guitron says, people who have a first-degree relative who had lung cancer and died young should talk to their primary care doctor or call The Christ Hospital's screening program to discuss screenings.
"Lung cancer is usually found 45% or less of the time in stages I and II. We can potentially cure the cancer in those stages," Dr. Guitron says. Through The Christ Hospital's screening program and Lung Nodule Clinic, stage I and II lung cancer diagnoses have increased to between 80% and 85%.
“That makes everything we do worth it when we get these kinds of results," he says. “And we're striving to improve these numbers even more."
How do doctors diagnose and stage lung cancer?
Screening lays the foundation for diagnosing and staging lung cancer. Low-dose CT scan is the only recommended screening test for lung cancer. During a low-dose CT scan, you lie on a table and an X-ray machine uses low doses of radiation to take detailed images of your lungs.
If the CT scan shows areas of concern, the next step is to examine the area more closely. As a thoracic surgeon, one of Dr. Guitron's responsibilities is to make a diagnosis by testing a small piece of the lung (biopsy). One of the newest technologies that The Christ Hospital uses is robotic bronchoscopy, which helps surgeons reach areas of the lung that were previously unreachable.
The goal of surgery for early-stage lung cancer is to remove the entire tumor and surrounding tissue. This allows the pathologist—a healthcare professional who examines tissue samples—to thoroughly assess the tumor. The tissue can also be sent for genetic analysis to look for mutations. Surgery also helps monitor whether the tumor is growing slowly and whether it has spread.
How do doctors treat lung cancer?
Surgery isn't the only way to treat lung cancer. Radiation therapy and medicine can also treat the disease. Doctors may use the treatment options together, based on the stage of the disease.
Radiation therapy can play a role in any stage of lung cancer, Dr. Long says. It's more common when surgery isn't recommended and is often used with medicine to treat advanced lung cancer.
Patients usually receive radiation therapy five days a week over several weeks. However, advances in technology have made it possible for patients to receive higher doses of radiation over a shorter time.
“Radiation is not like money," Dr. Long says. “If I gave somebody a dollar and gave somebody else four quarters, those are not the same in terms of radiation. Giving somebody a dollar would be more radiation."
Stereotactic body radiation therapy (SBRT) and stereotactic ablative radiation (SABR) allow doctors to deliver radiation to a small area in five or fewer treatments. These forms of radiation therapy are helpful for patients who can't have surgery or who have poor lung function.
If doctors detect cancer in advanced stages, they will often combine treatments, such as chemotherapy, immunotherapy and radiation therapy. If the cancer has spread outside of the lungs, radiation therapy can treat symptoms such as pain, shortness of breath or bleeding.
For people with stage I to III lung cancer, doctors may add medicines to radiation or surgery to improve cure rates. Medicines are the main treatment for stage IV lung cancer that has spread to other parts of the body. The goal of medicine is to control the disease for as long as possible, although at some point, the cancer cells will begin to resist the medicine.
Medicines for lung cancer often fall into three categories:
- Chemotherapy—Uses drugs to destroy cancer cells
- Immunotherapy—Helps your immune system figure out the best way to attack cancer
- Targeted therapy—Uses drugs to find and attack certain types of cancer cells
Medicines aren't used for stage IA lung cancer since doing so does not improve survival rates. Doctors use medicines on a case-by-case basis for stage IB lung cancer.
For stages II and III lung cancers, doctors often combine chemotherapy and immunotherapy. Chemotherapy usually consists of a 12-week program, while immunotherapy is a one-year program.
Some people get lung cancer from damage (mutations) to a single gene. These mutations are known as driver mutations. There are more than 20 known driver mutations. If you can block the driver mutation, you can block the cancer, says Dr. Mannion.
Doctors use targeted therapies when there is a driver mutation present. Targeted therapies are the result of 20 years of research from around the world, Dr. Mannion says.
“There are nine different driver mutations that we have drugs for," he says. “Before we had treatments for these driver mutations, I would tell patients they might live for months with their stage IV lung cancer. If they have one of these driver mutations now, most of the time they will live for many years."
What are the next steps after a lung cancer diagnosis?
Receiving any cancer diagnosis can be scary. Sometimes patients want to make sure they have covered all their bases by getting a second opinion. The Christ Hospital is the first and only hospital in Ohio, and outside the Northeast, to become a collaborative partner of the Dana-Farber Brigham Cancer Center in Boston. That partnership gives patients access to individualized treatments and best-in-class clinical trials, as well as access to a virtual second opinion, if needed and/or desired. The Christ Hospital can also fast-track an in-person consultation for patients who want to see a doctor at Dana-Farber.
To speak with a Lung Nurse Navigator about screening, a second opinion, or smoking cessation, call 513-327-5985 or click here to request a call back.