Mass General: Lung Cancer Screening Saves Lives

Jessie Mendizabal and Nathan Spry Blake 2 CT Techs./Photo courtesy of MGH

According to the American Cancer Society, lung cancer accounts for more deaths than any other cancer — nearly 27 percent. Rates have been declining since the 1980s for men and since the early 2000s for women, with more than 159,000 deaths from lung cancer annually. However, there’s a good chance those numbers can be reduced by approximately 20,000 per year with lung cancer screening.

“Lung cancer screening is important because the majority of lung cancer presents at a very late stage when patients are symptomatic,” says Dr. Jo-Anne Shepard, Director of Thoracic Imaging and Intervention Division at Mass General. She says that the best hope is an early diagnosis — something not always possible when relying on chest x-rays.

Mass General’s Cancer Center is at the forefront of the battle against lung cancer. The Department of Radiology at Massachusetts General Hospital uses low-dose CT scans (LDCTs) of the lungs on high-risk patients, a recommendation that comes from the U.S. Preventive Services Task Force (USPSTF) following a seminal study funded by the NCI (National Cancer Institute).

To be eligible for CT-based lung cancer screening, a person must meet several criteria: 1) Be between 55 and 80 years old (77 years old for Medicare patients); 2) Be a current smoker or former smoker who has quit within the past 15 years; 3) Have a 30-pack-year history, which means smoking the equivalent of one pack of cigarettes per day for 30 years or two packs a day for 15 years, etc.; 4) Must have no lung cancer symptoms; and 5) Must be well enough and willing to undergo treatment.

“What sets Mass General apart,” Dr. Shepard says, “is we have tremendous expertise here, readily accessed by the public.” Pulmonary nodule evaluation and lung cancer care is provided by a team made up of thoracic surgeons, thoracic oncologists, thoracic radiation medicine doctors, pulmonologists, interventional pulmonologists and thoracic radiologists and interventonalists. Together, they use the most advanced imaging and surgical techniques, and chemotherapy and drug therapy available to diagnose and treat lung cancer patients.

“It’s one thing to find a nodule and another to be in the hands of experts who know how to manage nodules with state-of-the-art care and good outcomes,” Dr. Shepard continues. For a research institution, Mass General is patient forward and focused on compassionate care. “We don’t isolate ourselves,” she adds. “We’re here to help patients.”

A colleague of Dr. Shepard’s at the Massachusetts General Cancer is Dr. Inga Lennes, a thoracic oncologist and Director of the Pulmonary Nodule Clinic. She started the clinic in 2012 to treat patients with high-risk nodules found on screening and diagnostic (non-screening) CT scans. “Patients’ radiographic imaging studies are reviewed by the team, and then the patient is seen by the most appropriate providers for them.” This alleviates the “ping-ponging” of patients from one specialist to another — perhaps in different locations — that can delay time-sensitive treatments.

Dr. Michael Lanuti, a thoracic surgeon and Director of Thoracic Oncology at Mass General, says that once patients undergo screening, lung nodules can be identified. Most are benign, but a small number will be lung cancer. He says, “We look at nodule size, radiographic characteristics or growth over time to make recommendations to the patient. Once there is enough suspicion raised by the radiographic imaging, thoracic surgeons can offer modalities for diagnosis and therapy.”

The lung cancer program at Mass General serves patients from diagnosis all the way through the cancer journey. “The seamless integration [of thoracic surgery, chest radiology, oncology, radiation medicine and pulmonology, along with a rich history in thoracic surgery and thriving lung cancer research (both clinical and translational) is what makes lung cancer care unique at Mass General,” Dr. Lanuti says.

“By creating the screening program and nodule clinic, we hope to build a research program around pulmonary nodule patients seeking answers to questions about the evolution of pulmonary nodules into invasive lung cancers,” Dr. Lennes says. She hopes that will result in new and improved methods for early detection and treatment — essential for good outcomes.

November is Lung Cancer Awareness Month. To reduce your chances of developing lung cancer, never start smoking — and try to avoid second-hand smoke. If you are a smoker, quit now. Avoid exposure to asbestos and radon, and know your family’s pulmonary history. “If you know what your risks are,” Dr. Shepard says, “you can avoid them or be screened.”

Talk to your doctor about your risk for lung cancer and find out if you are eligible for screening! If you are at risk for lung cancer or want more information, contact Mass General. Or access our patient FAQs!