Meet our doctors: Surgeon Dan Raz on lung cancer screening
Lung cancer – by far the most common cause of cancer death in men and women in the United States and worldwide – shows no symptoms until it has progressed to advanced stages, when it's very difficult to treat. But it doesn't have to be this way. For the first time, the U.S. Preventive Services Task Force is proposing annual lung cancer screening using low-dose computed tomography (CT) scans for people at high risk of developing the disease. That would allow lung cancer to be found at earlier stages, when it's more likely treatable.
Dan Raz, M.D., co-director and surgical director of City of Hope’s Lung Cancer and Thoracic Oncology Program, discusses the benefits and risks of screening for lung cancer and who would qualify. Why screen for lung cancer? Lung cancer screening with low-dose radiation chest computed tomography scans (LDCT) saves lives. About 80 percent of lung cancers detected in lung cancer screening programs are detected at stage 1, and the cure rate for these patients can be as high as 85 percent. Who qualifies for lung cancer screening? Current guidelines recommend that people who are 55 years or older and are current or former smokers who smoked one pack per day for 30 years, or two packs per day for 15 years, be screened. People who smoked less but have a history of another cancer, such as breast cancer or head and neck cancer or certain occupational exposures, may also be eligible. Aren’t chest X-rays a good test for lung cancer screening? No. Several studies have been done to look at this question. But no study has conclusively shown a benefit to lung cancer screening with chest X-ray. Are there any risks to lung cancer screening? First, it is clear that the benefits of lung cancer screening far outweigh risks in people at high risk for lung cancer. With that said, the risks associated with lung cancer screening include radiation exposure, possible invasive procedures to investigate positive findings and the anxiety one may experience as part of a screening program. While we don't know what the precise risks of radiation exposure may be, the radiation dose used in an LDCT is about the same as a diagnostic mammogram and is less than the amount of atmospheric radiation one is exposed to in a year’s time. At City of Hope, we minimize the number of biopsies and other procedures by adhering to a management protocol that is evidence-based to reduce false positives.
How does one get screened for lung cancer? It is critical to be screened in a lung cancer screening program, preferably one that is a designated Center of Excellence by the Lung Cancer Alliance. City of Hope is one of the busiest lung cancer screening programs in California and one of only three centers of excellence for screening in Los Angeles County. Ours is the only such center in the San Gabriel Valley. Being screened in a program ensures that you will receive low-dose radiation, that a protocol is followed that reduces the number of false positives and that tobacco-cessation services are offered if you still smoke.
If a lung cancer screening reveals something suspicious, what’s next? Most of the time, we order a repeat CT scan three months later. Other times, treatment with antibiotics and a repeat scan using a different scan called a PET scan, or a needle biopsy, may be ordered. We will communicate these results with you and your primary care physician, and you will see a health-care provider after your follow up scan.
How much does a lung cancer screening cost? Some insurances cover lung cancer screening using LDCT, while others still do not. If your insurance plan does not, the fee at City of Hope is $150.
Describe the patient experience when undergoing lung cancer screening. You will first speak by telephone with our tobacco exposure program nurse practitioner, Rachel Dunham, about the scan beforehand. You don't need to have an IV started or receive any kind of injection for the scan. The scan is done in a single breath hold. It is extremely quick.
Are there other benefits to lung cancer screening? Getting screened for lung cancer is not an alternative to quitting smoking. But screening high-risk smokers can prevent a significant number of lung cancer deaths because cancer may be found early enough to be treated. In addition to identifying lung cancers, we can also identify emphysema before a patient knows it and coronary artery calcifications (heart disease). Since heart disease and emphysema are also major causes of death in current or former smokers, identifying these earlier may allow for lifesaving medical intervention.
Can nonsmokers who have been exposed to a lot of secondhand smoke get screened for lung cancer? Not under the current guidelines. However, we will soon be opening a research study sponsored by the Flight Attendants Medical Research Institute, involving free screening using LDCT for nonsmokers exposed to secondhand smoke. Please contact us if you are interested.
Why did you choose thoracic oncology? What inspires you to do the work you do? I am a surgeon and feel gratification when I operate to remove a cancer. I am equally inspired by the women and men who have battled lung cancer. For such a common disease, we have not made a lot of progress in years past. At City of Hope, we believe lung cancer screening has the potential to completely change the face of lung cancer from a disease that is cured in some patients, to a disease that is cured in most patients. Do the benefits of lung cancer screening far outweigh its potential risks? Let us know your thoughts by commenting below. For more information about lung cancer screening at City of Hope, visit cityofhope.org/lung-cancer-screening.