Lung Cancer Screening Program Saving Lives

Each year, 132,000 Americans die from lung cancer. Why is lung cancer the number one cancer killer in the United States? A key factor is that symptoms typically don't emerge until the disease has reached an advanced stage. UMass Memorial Health's Low-Dose CT Lung Cancer Screening Program aims to detect lung cancers earlier — before they cause symptoms and when they can still be treated successfully. 

The Lung Cancer Screening Program, which is part of the Department of Radiology, provides regular low-dose CT screenings for patients at risk for developing lung cancer. These patients include adults aged 50 to 80 years who currently smoke or have stopped smoking within the past 15 years, and have smoked at least the equivalent of one pack a day for 20 years.

A patient must be referred by their primary care doctor, pulmonologist or other doctor to be enrolled in the program. The CT scans are available at entities throughout the system. Through the program, all scans are reviewed, communications are managed with the patient and referring doctor, and any necessary follow-up visits or tests are scheduled. 

"To provide the advantages of academic subspecialized readings and efficient patient management, we've centralized the program's work at UMass Memorial Medical Center's University Campus,” said radiologist Alexander Bankier, MD, PhD, Program Director and Chief of Cardiothoracic Imaging. "And patients from all of our member entities can access this critical service." 

Shared decision making between the patient and referring doctor using at least one decision aid is required prior to enrollment in the program. For example, patients must be: 

• Aware of not only the potential benefits but also the potential harms that come with low-dose CT lung cancer screenings, such as the risks of a false-positive diagnosis, over-diagnosis and radiation exposure

• Willing to have screenings moving forward, usually once a year

• Willing and able to undergo follow-up examinations, lung biopsies and treatment if necessary

"Lung cancer screening is a commitment for the patient. The balance between the potential benefits and harms varies based on each patient's lung cancer risk and the effects of other medical conditions. They have to understand what they're signing up for," said Mayuko Ito Fukunaga, MD, a pulmonologist at the University Campus. "Just doing a one-time CT scan won't be beneficial. If the patient doesn't come back the next year, we may miss the lung cancer growing." 

According to Dr. Ito Fukunaga, studies have found that shared decision making: 

• Can help reduce a patient's stress if a scan finds an abnormality

• Is associated with better adherence for follow-up

Three program navigators (one nurse, two ambulatory service representatives) can assist referring doctors with enrolling patients in the program. They can also help with counseling on smoking cessation — a necessity for patients in the program. 

Roughly 3% of screenings uncover suspicious findings or detect lung cancer. These cases are discussed among specialists in radiology, pulmonology, interventional pulmonology, interventional radiology and thoracic surgery at a weekly multidisciplinary conference. Each patient's referring doctor is also invited to attend. Together, the doctors arrive at a recommendation on next steps tailored to each patient. 

About 6,000 screenings are completed each year via the Lung Cancer Screening Program — a figure that is growing by 15 to 20% a year. About 15,000 patients in the system are enrolled, which represents almost 23% of the eligible population. 

"That number is good considering the national average is around 10%," Dr. Bankier noted. "Still, we have a lot of room to grow." 

To learn more about our LDCT lung cancer screening program, or to get screened, visit ummhealth.org/lung or contact ctlungcancerscreening@umassmemorial.org with questions.