Low-dose computed tomography (LDCT) screening for lung cancer represents a vital new opportunity – to more frequently catch tumors early, when they often can be cured with surgery.
Increased early detection alone could make a difference in survival rates, says Dr. Joan Schiller, Deputy Director of the Simmons Cancer Center. Results of the National Lung Screening Trial, published in 2011, found that participants had a 20 percent lower risk of dying of lung cancer if they were screened with low-dose helical CT scans, rather than chest X-rays. Before that, Dr. Schiller says, “We didn’t have any proven screening method. Now we do.”
At UT Southwestern, the LDCT screening program is led by Dr. Muhanned Abu-Hijleh, who is one of the interventional pulmonary and critical care physicians at the Pulmonary Specialty Clinic, serving patients with suspected pulmonary malignancy and pulmonary nodules. Screening is available to anyone in the targeted population (see box) even if they can’t afford to pay. Vouchers are provided by the Roger Williams Fund for CT Screenings for Lung Cancer. The fund aims to spare as many people as possible from the devastation of a diagnosis of advanced lung cancer by promoting early detection.
Roger Williams was a prominent Dallas trial lawyer who died of lung cancer in 2013. “His family wants screening to be barrier-free – if you think this is an issue for you, just do it,” says oncology certified nurse Maria Grabowski, Program Manager for Patient Education and Community Outreach. “Peace of mind or early detection is priceless. Based on the Williams fund, this opportunity is now available to everyone.”
At UT Southwestern, patients also benefit from cutting-edge technology and faculty expertise. “We have the latest-generation multidetector CT scanners and are continually adding the newest flagship scanners from major vendors,” says Dr. Suhny Abbara, Chief of Cardiothoracic Imaging. Meanwhile, radiologists at the university are meticulous about radiation dose (typical dose is about 1.2 to 1.5 mSV for LDCT, compared with 6 mSV or more for a standard chest CT). “We minimize the doses to as low as reasonably achievable clinically,” Dr. Abbara says, “and we do research to further push the limits.”
The targeted population for LDCT screening has been carefully defined to ensure benefits outweigh any harm, adds lung cancer specialist Dr. David Gerber. “When you compare it to breast, prostate, colon, or cervical cancer screening, the number needed to screen to save a life is best for lung cancer,” he says. “This reflects the lethality of lung cancer and the high risk of the targeted population.”
Any center providing screening should offer a full range of follow-up care, he notes. “Screening needs to be done at a place that can guide patients through all the subsequent processes, counsel patients on what a radiographic abnormalities may mean, and have an aggressive, comprehensive nicotine cessation program,” tailored to meet individual needs—all services available at the Simmons Cancer Center.
Lung Cancer Screening Guidelines
Since UT Southwestern's program was launched in 2013, about 60 patients have undergone low-dose CT screening for lung cancer – almost all of them with support from the Williams Family Fund. One malignancy has been detected.
The U.S. Preventive Services Task Force recommends annual screening with low-dose computed tomography for asymptomatic patients who are:
- 55 through 80 years old
- Have a 30-pack-year history of smoking*
- Now smoke, or quit within the past 15 years
Screening should be discontinued when the patient:
- Has not smoked for 15 years
- Has developed a health problem likely to significantly limit life expectancy or ability/willingness to undergo curative lung surgery
*Pack-year history is calculated by multiplying the number of packs of cigarettes a person smoked per day by the number of years the person has smoked.