TriStar Centennial thoracic surgeon explains increasing treatment options and importance of early diagnosis
By Denis Gilmore, MD
Lung cancer in Tennessee
Tennessee ranks as one of the worst states in the nation for the rate of new lung cancer cases, according to the American Lung Association. Currently, Tennessee has the third highest rate in the nation for lung cancer diagnoses and fourth in deaths related to the disease. It’s a sobering reality attributed in part to stigmatism surrounding outdated screening, treatment options and traditional outcomes. The good news is lung cancer screening has now been simplified with new guidelines posted this month. Current screening guidelines include patients ages 50-80 with a 20 pack-year smoking history.
The need for early diagnosis
Lung cancer kills more patients than breast, colon and prostate cancers combined, yet people don’t discuss lung cancer screening as frequently as other cancers. Lung cancer screening continues to be only offered to 6% of eligible patients nationwide, which is significantly lower than screening rates for breast cancer (70%) and cervical cancer (80%), according to a study published in the State of Lung Cancer 2022. When lung cancer screening is performed, nodules are often found in early stage which corresponds with increased treatment options and survival rates. Lung cancer does not often have signs or symptoms until advanced stage, which is why early state diagnosis is so important.
Through low dose CT scans, specialists are diagnosing more cancers in their earliest, most treatable stages. Patients with a nodule one centimeter or less have a 90% five-year survival rate, which drops roughly an additional 10-15% with every centimeter of growth. Historically, the five-year survival for all lung cancer patients is 18%, driven by advanced disease at diagnosis. Stage for stage, lung cancer has worse outcomes compared to all solid tumors. However, we are changing this through screening.
If lung cancer can be found early, those survival rates will be greater than 70%.
A game changer
Low dose CT scans offer decreased radiation exposure (equivalent to two round-trip flights) than traditional CT scans, and far greater image quality than a plain chest x-ray. Treatment has also progressed in all phases from a surgical perspective and now includes medical oncology and radiation oncology options.
The evolution in treatment has resulted in less invasive surgery by utilizing minimally invasive, robotic approaches, which leads to faster recovery, less pain and down time, and increased survival. If patients are not surgical candidates, patients may receive stereotactic body radiation therapy (SBRT) which utilizes high intensity beams over four to six treatments and is completed in less than two weeks, compared to contemporary radiation.
Chemotherapy protocols have also changed, with molecular markers allowing for more targeted treatments, including immunotherapy. Immunotherapy utilizes the body’s own immune system to identify cancer as an intruder. Each of these advancements has made a significant impact. We continue to see an increase in patients who are now able to have surgery for their cancer. This results in the best chance for cancer free survival.
Today, lung cancer screening is recommended for those ages 50 to 80 who have smoked an average of one pack a day for 20 years. The guidelines have been changed to encompass a larger targeted population to include more women and minorities, who tend to get lung cancer at an earlier age than white men with less smoking history. A surprising 20% of lung cancer patients have never smoked, while 60% are former smokers. The average age of diagnosis is 69, and women are at higher risk.
Challenges to providers
As awareness for screening grows, overcoming the stigmatism of lung cancer along with easing requirements needed to obtain insurance approval for low dose lung cancer screening remain the biggest roadblocks for many patients and providers. To qualify for low dose CT scans, doctors often have to document they’ve recommended smoking cessation, smoking history in packs per day and discussed health benefits, but the logistics can be worked out and impact the survival of lung cancer patients.
Lung cancer screenings are a quick process involving no need for invasive bowel prep, IV access, blood draws, undressing or uncomfortable exams. This is surprising but welcoming news to most patients. It’s by far the easiest screening of any you can get in local communities throughout Middle Tennessee.
The Sarah Cannon Cancer Institute at TriStar Health utilizes a multidisciplinary approach involving surgeons, pulmonologists, radiologists, interventional pulmonologists, radiation oncologists, medical oncologists and nurse navigators to obtain diverse input and to ensure each patient has a personalized plan that will give them the best chance of living a cancer free life. This team is focused on moving patients from diagnosis to first course of treatment as quickly as possible.
Hearing the word cancer is devasting, but a lung cancer diagnosis shouldn’t be considered a death sentence. Today, our lung cancer survival rates are improving 5% per year thanks to screenings and evolving treatment options on all fronts. Screening can save lives, but only when screening is performed. Through advocacy and a multidisciplinary approach, we are making a difference in lung cancer.
Denis Gilmore, MD is a Thoracic Surgeon with TriStar Medical Group’s Centennial Thoracic Surgical Associates and provides care at The Sarah Cannon Cancer Institute at TriStar Centennial. To learn more about lung cancer screenings and treatments offered, please visit TriStarHealth.com.