Lung cancer remains the most lethal type of cancer in the United States — in part, because once its tumors are large enough to cause symptoms, it’s frequently too late to save patients.
But a new approach to screening high-risk patients has shown enough promise that some New Jersey hospitals are doing the testing at a reduced price.
The tests make it possible to detect cancers at an early stage, allowing tumors to be removed sooner and patients to live longer, according to hospital officials.
The approach has a downside, however: It may generate a large number of false positives, leading to unnecessary tests and surgeries performed as a result of harmless growths that the screenings detect.
Currently, most insurers aren’t paying for the computerized tomography (CT) scans, but that’s expected to change once a panel established by the federal government recommends the use of annual screenings for older, long-time smokers.
The Steeplechase Cancer Center at Somerset Medical Center and Robert Wood Johnson University Hospital Hamilton are both offering the screenings — which normally cost $300 to $500 — for $99.
Katrina Losa, Steeplechase’s director of cancer services, said she worked to launch the program after the National Cancer Institute released results in 2011 from its National Lung Screening Trial. This clinical trial found that low-dose CT scans could reduce the mortality rate for patients when compared with those who receive X-ray screenings.
“We thought it was important to offer this to the community because we have a strong lung cancer program here and screening is important for that,” said Losa, a registered nurse.
Losa emphasized that Steeplechase offers “comprehensive” screenings — after the initial scan, hospital staff review the findings with patients and recommend one of three paths: If the test results are benign, they recommend no action; if the results indicate a problem, they take immediate action, such as surgery; and if the results are inconclusive, they follow up with further tests.
This approach has paid off, according to Losa: since the screenings began in 2012, the center has detected seven lung cancer cases at an early stage. In addition, there have been several cases where the CT scans have detected issues with patients’ hearts that led to early treatment, Losa said.
The U.S. Preventive Services Task Force has issued a draft recommendation to conduct the screenings for a specific group of patients. Under the 2010 Affordable Care Act, insurers will be required to cover treatments recommended by the task force.
The CT screening is recommended for people between the 55 and 79, with a history of smoking for 30 “pack years,” which are defined as the average number of packs of cigarettes smoked per day multiplied by the number of years the person smoked. Therefore, a person who smoked two packs a day for 15 years would be eligible. In addition, eligible patients must currently smoke or have quit within the past 15 years.
Dr. Jean-Philippe Bocage, a thoracic surgeon and chairman of the lung cancer committee at Steeplechase, said the national trial showed landmark results after previous studies failed to find effective screening techniques.
Bocage said the reviews of the screenings involve several specialists, including pulmonologists, who specialize in treating respiratory conditions; radiologists; and cancer specialists.
“You don’t just go in, get a screening, it shows a little spot and [ask] ‘What do I do?’ ” Bocage said.
Bocage acknowledged that there have been criticisms of the screenings, focused on the fact that the tests will find nodules — small lumps of cells — that aren’t cancerous. A Mayo Clinic study found that 96 percent of nodules found in CT scans are false positives and aren’t cancerous. While most of those are determined to be benign before surgery, some result in unnecessary operations.
But Bocage said that despite the possibility of unnecessary surgery, the screenings have a positive overall effect.
“You don’t know what’s going to turn into a cancer before you take it out,” Bocage said. He added that advances in chest surgery have made most procedures to remove nodules noninvasive. Patients go home the day after the surgery and are back at work in two or three weeks, he said.
“Lung cancer is the No. 1 killer” among cancers, Bocage said. “We need to make progress and we have” made progress.
Both Steeplechase and RWJ Hamilton officials emphasized the importance of making the screenings available to residents.
“Our goal is to get more people screened and make the screening more accessible to our community,” said Dr. Biren Saraiya, medical director at the Rutgers Cancer Institute of New Jersey Hamilton, RWJ Hamilton’s cancer center, and a lung cancer specialist, in a statement.
RWJ Hamilton President and CEO Anthony “Skip” Cimino, in announcing the launch of the hospital’s screening program, noted in August that a hospital community health assessment found that lung cancer was the leading local cause of cancer deaths.
“Lung cancer is an ugly disease, so if this screening can give someone with a history of smoking a better chance at beating it then this investment is more than worthwhile,” Cimino said.