David Franco, MD, a pulmonary specialist with Pulmonary Associates of the Southeast, is on a mission to prevent deaths from lung cancer through early detection by making screening a priority for patients at high-risk for the disease.
Through the use of low-dose computed tomographic scans (CT) at Grandview Cancer Center, lung cancer can be detected in its earliest stages, an intervention that is moving the needle in the battle against the number-one cancer killer. Franco's challenge is to ensure that people know they have the option of testing, which can mean the difference between life and death.
"Lung cancer is the leading cause of cancer deaths in men and women," Franco says. "As opposed to other cancers we actively screen for - breast cancer, prostate cancer - until recently, screening for lung cancer was uncommon. Now, screening for lung cancer with a low dose CT saves lives. For every 1,000 patients screened, we save three lives."
The low-dose scan is a marked improvement over previous diagnostic testing, such as chest radiography. Screening is approved for patients aged 25 to 78 and should be covered by health insurance.
"Since the 1970s, the survival rate for breast cancer patients has improved dramatically, while there has been almost no improvement with lung cancer," Franco says. "The five-year survival rate for lung cancer is now 17 percent, with about 150,000 deaths a year, and in the 1970s it was 15 percent."
Screening can result in a stage shift in diagnosis and survival rates. Franco cites smoking history, exposure to asbestos and silicosis as factors to be considered for recommending that patients get low-dose CT scans.
"You can find lung cancer in the early stage when it's the size of an eraser head rather than the size of an egg," Franco says. "Lung cancer in Stage One has an excellent prognosis. It's the asymptomatic patients we want to screen to catch this early enough to intervene."
Franco says he doesn't think scare tactics work in getting smokers to stop the habit or even to get screened. He's relying on outreach to the community and to physicians to promote the importance of scanning.
"Part of the problem in screening awareness could be attributed to a bias against lung cancer because it is viewed as a self-inflicted disease" Franco says. "In pulmonary medicine, smoking is a huge issue in many of our patients. In the National Lung Screening Trial of screening for lung cancer in older persons who were heavy smokers, mortality from lung cancer was lower with the use of three years of annual screening with low-dose CT than with chest radiography. The ability to screen for cancer along with new diagnostic tools that allow us to biopsy extremely small spots we see on the scan give us a better chance at saving lives."
"We want to let the public and primary care physicians know that technology has advanced so much in the pulmonary lab that we can make a difference," says Ramie Wesley, service line administrator for imaging and oncology at Grandview. "Patients can complete a risk assessment to see if they are candidates for the test. If the scan shows a nodule, they can get a biopsy."
High risk is determined by several factors from family history to the length of time a person has smoked. If a patient is diagnosed with cancer, the physician determines the treatment protocol, which might include chemotherapy, immunotherapy, radiation therapy or stereotactic body radiation therapy (SBRT). SBRT delivers precise doses of radiation to cancer cells and is effective in certain forms of lung cancer.
"We're passionate about the screening tools and improved patient outcome," Wesley says. "We have a great opportunity to do things a lot better right now. If we can detect cancer at Stage One instead of Stage Four, we are going to save lives."