Lung Cancer Awareness Month: Low-dose CT Screening is Under-utilized in Florida

Despite a decade of data showing the value of low-dose CT screening for people at high risk of lung cancer, too few Floridians take advantage of the test. At Baptist MD Anderson Cancer Center, Carolyn Austin, RN, is working hard to change that.

Low-dose CT lung cancer screening involves taking periodic images of the lungs using a low-dose computed tomography (CT) scanner. The images are read by a radiologist to look for abnormalities that are suggestive of lung cancer. The test was first recommended in 2013 by the U.S. Preventive Services Task Force (USPSTF) based on data from multiple studies showing it can find lung cancer at early stages, when the disease is most curable.

“It takes about 60 seconds and is not invasive,” says Austin who has been overseeing the Lung Cancer Screening Program at Baptist MD Anderson for nine years. “If you are age 50-77 and have a smoking history, you could be eligible, so talk to your primary care doctor. Insurance covers it 100%. The goal is to find lung cancer before you have any symptoms; when it is curable.”

The screening criteria established by the USPSTF includes individuals who:

• are between 50 and 77 years old
• have a 20 pack-year or more history of smoking (this means one pack a day for 20 years, two packs a day for 10 years, etc.)
• are a current smoker or have quit within the last 15 years

The test takes only about 60 seconds, and the radiation dose does not pose a significant risk, even for people who have the test yearly, Austin says. The radiation from low-dose CT is far under a typical diagnostic CT. “It’s 75% less than a CT chest.”

Meanwhile, the upside of the test is considerable. Lung cancer is often detected at a later stage, when treatment is arduous, and the chances of a complete remission drop. People with non-small cell lung cancer (the most common type of lung cancer) diagnosed at the earliest stages have cure rates of up to 92%. However, stage IIB lung cancer has a five-year survival rate of 53% and late-stage disease has five-year survival rates of less than 10%, according to Go2 Foundation for Lung Cancer.

Austin says she has seen the benefits of the program.

“I was the lung cancer nurse navigator and helped lung cancer patients through their cancer journey, from diagnosis to treatment,” she says. “Unfortunately, most of my patients were diagnosed at stage 4, which has a very poor survival rate. By the time symptoms appear, lung cancer has typically advanced to stage 4. It was rare to meet a stage 1 patient. I was thrilled to develop the Lung Cancer Screening Program in 2015 and help find lung cancer at a curable stage.”

The program has conducted more than 26,000 screenings and found 342 lung cancers. People who have suspicious findings are referred for further testing. People who test negative are asked to return in a year for another test (for up to 15 years after quitting smoking). Sometimes, a radiologist will recommend a follow-up test in three months or six months, Austin says. The test can produce “false positives, findings that erroneously suggest cancer, but that is rare.”

Most of the positive findings include early-stage cancers that are highly treatable, she says.

“Almost 72% of the lung cancers we have found have been in the early stage,” she says. “Before screening, only 16% were found in early stage. It excites me to see we’re finding so many at an early stage. It means lung screening is working, and we will have more lung cancer survivors.”

However, a large swath of Americans who could benefit from screening do not appear to know about the test. In Florida, only an estimated 5% of individuals eligible for the test receive it, says Austin. Lung cancer is the leading cause of cancer deaths. It is the third most common cancer in the United States, according to the Centers for Disease Control and Prevention.

Smokers and former smokers should be proactive and discuss low-dose CT screening with their health care providers, Austin says. “Be your own advocate. Ask about it.”

While stopping smoking allows the lungs to heal, the risk from smoking remains high for many years. “Many patients who quit smoking think they are no longer at risk,” Austin says. “We follow individuals for 15 years after they quit smoking.”

For individuals who do not meet the criteria for insurance coverage and who still want the test, Baptist MD Anderson offers a self-pay rate of $170 ($110 for CT scan, $60 for radiologist).

“There is a stigma associated with smoking that makes people avoid lung screening,” Austin says. “People feel like they’ve done it to themselves. The truth is, smoking is a very addictive habit and no one deserves cancer. They deserve compassion, and we are here to offer support.”

To see if this screening is right for you, talk with your primary care physician or go to Baptist Health. For information on help with quitting, go to Tobacco Free Florida.