Susan B. Allen Memorial Hospital is Bringing Healthcare to You with the newest addition to the SBA Cancer Center programs. Lung Cancer Screenings are now being offered as Susan B. Allen continues to expand the care it provides to the community.
“Most lung cancers are caught in later stages which are more difficult to treat,” said Jamie Richards, Radiation Oncology Manger at Susan B. Allen. “If we catch it sooner it is easier to treat.”
These screenings will help doctors do just that.
“We do this non-invasive screening because we are looking for cancer before it is so big you can’t treat it anymore,” said Dr. Paige Dodson, Chief Medical Officer. “This is something special to me. My second specialty is preventive medicine and when I was training in Oregon, one of my professors was doing this study at the VA.”
According to the National Lung Screening Trial, participants who received low-dose helical CT scans had a 15 to 20 percent lower risk of dying from lung cancer than patients who received standard chest x-rays.
These scans also have another benefit. While technology continues to improve for CT scans, which look at cross-sectional slices through a patient anatomy, this also means increases in radiation exposure for each additional slice provided in the scan. The lung cancer scan uses a lower dose of radiation due to ability of the technologists to cone down the x-rays around the lungs.
“This is fewer slices with intentionally low-quality pictures so we can only see the big ‘scary’ things and there is less radiation exposure,” explained Dr. Dodson. “This is all about the amount.”
Because it has less slices than a typical diagnostic chest CT scan, it doesn’t take as long and the patient doesn’t have to hold his or her breath as long, but other than that it is similar to other scans a person would get.
“For patients, it is quick and easy,” Richards said, explaining there is no contrast and no patient prep needed.
People coming in for the scan will check into the Cancer Center like they would for other scans or lab work. It takes about 10 minutes from the time a patient walks into the Cancer Center to when they walk out. Initially, most scans will be scheduled on Wednesdays.
“We want to let our patients know that we can find it here and treat it here,” Richards said.
How to qualify
This screening has strict eligibility requirements, being limited to those who have much higher risk factors.
Dr. Dodson said those who qualify will typically be males who have smoked their whole lives. The patient has to be age 55 to 77, with few exceptions, based on insurance. Patients also have to be asymptomatic, meaning no symptoms such as fever, chest pain, new shortness of breath, new or changing cough, coughing up blood, or unexplained significant weight loss.
“The model is all based on risk-benefit,” explained Dr. Dodson. “The criteria is very specific. Everyone has agreed on it.”
A person had to have smoked at least one pack of cigarettes a day for 30 years to be eligible. If a person has stopped smoking within the past 15 years and they meet the pack year criteria, they will still qualify.
“The risk of a lot of things gets better when you quit smoking, but the risk of lung cancer doesn’t go down to zero,” Dr. Dodson said. “People qualify even if they don’t smoke now.”
Getting the test
People have to be referred for this scan by their physician, who must sign an order form.
“When a physician is going to order it, they need to have a shared decision making with their patient,” Dr. Dodson said. “There has to be an informed consent conversation with the patient.”
Required information will include date of birth, smoking history including pack years, current smoking status or the number of years since quitting and a statement the patient is asymptomatic (no signs or symptoms of lung cancer). For smokers, coughing is not a sign of lung cancer.
Physicians also will offer counseling on the importance of being screened each year and the impact of other possible causes of death with lung cancer, as well as counseling on the importance of quitting smoking and resources available such as Medicare-covered tobacco cessation counseling services, if applicable.
Dr. Dodson said because the requirements are set, there are only a certain number of people in this area who will be eligible for the screening. Eventually, everyone in the area who qualifies will get the scan as they continue their checkups with their primary care physicians (PCP) and are referred for the test. There will be a registry of patients so it can be used throughout the county on the effectiveness of screenings.
What is the risk?
The Lung Cancer Screening uses low-dose computed tomography (CT), which reduces the medical radiation dose by up to 60 percent.
“This is an extremely low-dose scan compared to typical diagnostic scans,” explained Richards, saying the exposure is similar to that from a mammogram.
“This program is really interesting because most of the time when you are doing something that exposes people to this much radiation, you have to balance the risk with the benefit,” Dr. Dodson said. “Radiation exposure puts you at risk of developing cancer. That’s why we want to avoid as many unnecessary tests as possible.”
The study determined the benefit of finding a treatable cancer in a smoker or former smoker outweighs the risks associated with radiation exposure.
Other risks include impact on quality of life due to the anxiety of watching and waiting in some instances, as well as false-positive biopsies, although any x-ray has that possibility.
The benefits include decreased lung cancer mortality, as well as a reduction in disease-related morbidity and treatment-related morbidity, improvement in healthy lifestyles and reduction in anxiety burden. It also can lead to the discovery of other significant occult health risks such as thyroid nodule(s) and coronary artery disease.
After the screening
From the initial screening there is a structured protocol.
Once a person receives the screening, the images will be reviewed by a radiologist and the provider will get a report and any next steps there might be. Richards said the patient will also get a letter to either come back in a year to continue routine screenings or to see their PCP for follow up of any findings.
To help with the process, Dr. Larry Graham, II, the medical director for the radiologists, is doing some continuing education related to this protocol and some of his partners also have experience with it.
Dr. Dodson said if they find a lone nodule, it is not always bad, rather they will follow them over time.
“The next steps depend on the size of the lesion they find,” Dr. Dodson said.
Upon diagnosis of lung cancer, patients will be offered state of the art treatment close to home as well. The full service SBA Cancer Center offers chemotherapy and radiation therapy, including stereotactic radiation, which dramatically decreases the number of treatments for those patients who qualify.
About Susan B. Allen Memorial Hospital
Susan B. Allen Memorial Hospital is a not-for-profit, general acute care hospital that includes a 24-hour physician staffed emergency department, family birth center, home health agency, dialysis center, cancer center, and a family medical care facility in Augusta. The Hospital is governed by a local board of citizens, and is accredited by the Joint Commission.