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During the COVID-19 pandemic, routine doctor’s visits and preventative care often had to take the back burner, so over the next few months, the Health & Wealth will be speaking with experts about how you can get back on track with your preventative health care.Have a pressing question? Reach out and let us know at smithbecky@missouri.edu or aspidel@missouri.edu.

Checking Up on Lung Cancer Screenings: 'Catching it earlier, you have a higher probability of getting a cure.'

A plastic diagram of lungs.
A person who spends a year smoking one pack of cigarettes a day has experienced one "pack year."

This month, the American Cancer Society expanded their lung cancer screening recommendations to yearly, low-dose CT scans for those aged 50 to 80 who formerly or currently smoke and have a 20 or greater "pack year" history.

KBIA’s Rebecca Smith spoke with Dr. Sebastian Wiesemann and Dr. Vipul Bhanderi from Ellis Fischel Cancer Center about these new recommendations.

University of Missouri Health Care

Rebecca Smith: We've seen lung cancer rates go down and decrease steadily as people either stop smoking or prevent, you know, the start of smoking. How much of an issue is lung cancer for our population? How common is it? How deadly is it?

Dr. Vipul Bhanderi: You know, lung cancer is still one of the top leading cancer deaths, as far as overall statistics are concerned, and so, even with the decrease in new smoking rates, it’s still fairly prevalent.

Catching it earlier, you have a higher probability of getting a cure versus if you're able to catch it later stage like three, four, and that's where the screening comes in because by the time – especially for lung cancer, you know, once you have symptoms, it's likely more advanced already. And then if you're a more advanced disease, when you're diagnosed, then the likelihood of cure is lower.

"Lung cancer screening is so important because it gives us the chance – and the patients the chance – to diagnose a lung cancer because it causes damage and at a stage that we can still intervene and, for example, cut that lung cancer out and cure the patient."
Dr. Sebastian Wiesemann

Dr. Sebastian Wiesemann: I just wanted to add that, you know, in Missouri, there are, on average, more smokers than if you compare to the average of the USA. It's still the most lethal cancer in the USA, so the cancer diagnosis that has the highest probability of dying from cancer – that's lung cancer.

Only on average 25% –so just 1/4 of all patients diagnosed with lung cancer are still alive five years after their diagnosis.So, it's a pretty terrible disease, and what the lung cancer screening can do is it can increase their chances of survival by around 20%.

Unfortunately, only, you know, even less than 10% of all patients who should get the lung cancer screening – those high-risk patients that have been smoking for, you know, more than 20 years, a pack per day on average – less than 10% currently are getting the lung cancer screening.

So, much, much more patients should get the screening in order to try to get those numbers up, you know, those numbers – those survival rates.

Rebecca Smith: Now, you guys mentioned this screening – we're talking about a low dose CT scan, and, so I'm wondering, for someone who's maybe apprehensive, they've been smoking a long time or they had that pack-year history? What can they kind of expect walking in for this procedure?

Dr. Sebastian Wiesemann: So, that's very easy to answer because it's not invasive at all. I mean, the CT scan is very quickly done, and because it's a low dose CT scan, the radiation that you're exposed to is very low, as well. It’s a little bit more than a regular chest X-ray., but it's not as much as a regular CT scan.

Rebecca Smith: So, how can folks go about accessing this screening?

Dr. Sebastian Wiesemann: The first person to talk to would be the primary care physician, and the primary care physician can then order the screening test.

Rebecca Smith: Why is this something that someone who is high risk should consider an important part of their preventative health measures every year?

"The new guideline recommends yearly screening for lung cancer for people aged 50 to 80 years old who smoke or formerly smoked and have a 20-year or greater pack-year history. The recommended annual screening test for lung cancer is a low-dose computed tomography scan (also called a low-dose CT scan, or LDCT)."
American Cancer Society

Dr. Sebastian Wiesemann: The problem with lung cancer is that you cannot feel it until it's too late, usually. You don't feel any growth inside your lung, and so, the cancer keeps growing and growing and spreading and you're still not aware that you're having a lung cancer.

So, there is no good way that your own body can tell you that something's wrong with you in the early stages of the lung cancer, and most of the time, if the lung cancer is so advanced that it causes symptoms, then it's too late to cure it.

And that's why the lung cancer screening is so important because it gives us the chance – and the patients the chance – to diagnose a lung cancer because it causes damage. And at a stage that we can still intervene and, for example, cut that lung cancer out and cure the patient.

Rebecca Smith: So, what has changed with the recommendations? And what exactly is a “pack year?”

Dr. Sebastian Wiesemann: So, I mean, there haven't been any major changes. They changed the age of the patients who should get the lung cancer screening from 55 to 50 years — starting at 50 years, and then from 74 up to 80 years.

So, now the recommendation is to get lung cancer screening if you're belong to a higher risk population, and you have an age between 50 and 80 years.

And the definition of high-risk population has also changed a little bit. It used to be patients who have smoked for more than 30 pack years and haven't quit before 15 years ago.

This means, you know – the definition of “pack year” is if you smoke one pack per day for one year, then you smoke one pack year. And if you smoke, let's say two packs for one year, then you have smoked two pack years in that one year.

Or if you smoke just half a pack per day for one year, then you had a half pack year. And if you smoked half a pack per day for two years, then you have smoked one pack year.

So, that's the definition of “pack year,” and that has changed from 30 to now 20 pack years.

So, let's say a patient who smoked on average, one pack per day, started at an age of, let's say, 15, and smoked until the age of 35, then he would have 20 pack years. And even if he has quit smoking for 20 years, he would still be eligible, you know, for the lung cancer screening now.

So those have been the changes, but of course, the kind of the goal is the same – and that is to screen the high-risk population, which is, you know, patients who have smoked for some times in their lives, and to screen them with a yearly low dose CT scan.

And then to look for lung nodules that might be lung cancer – the earliest stage lung cancer are the stages that we can cure, as opposed to the stage four lung cancer stages, which can rarely be cured.

You can calculate your pack year history —here.

Rebecca Smith is a reporter and producer for the KBIA Health & Wealth desk. She was born and raised in Rolla, Missouri, and graduated with degrees in Journalism and Chemistry from Truman State University in May 2014. Rebecca comes to KBIA from St. Louis Public Radio, where she worked as the news intern and covered religion, neighborhood growth and the continued unrest in Ferguson, MO.
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