National push for screening, research as more non-smokers are diagnosed Rabih Bechara, MD, says the most difficult part of his job is telling patients, “You’ve got lung cancer.” Unfortunately, chances are three of four patients with lung cancer will be diagnosed at a late stage, when cure isn’t an option.“Once you tell patients they have cancer, no matter the stage, they’re usually very distraught,” said Bechara, chief of the pulmonary division at Cancer Treatment Centers of America at Southeastern Regional Medical Center (CTA at Southeastern) and professor of medicine at Georgia Regents University. “The beauty is, if we catch it early, we can cure them.” Bechara is a staunch supporter of the national push for lung cancer screening, hoping to see it join the ranks of the mammogram for breast cancer or colonoscopy for colon cancer. The trend of more non-smokers being diagnosed with late-stage lung cancer has expedited the movement.“More people will die from lung cancer this year than any other type of cancer, including breast, prostate, colorectal and colon cancers combined,” said Bechara. “Unlike other types of cancers that are prominent among certain genders and ethnicities, lung cancer doesn’t discriminate and remains the leading cause of cancer deaths, regardless of sex or race.”According to the most recent data from the National Cancer Institute (NCI), roughly two-thirds of all new lung cancer diagnoses are among patients who have never smoked. Some are former smokers who quit decades ago. “Despite the harsh realities of lung cancer, it simply doesn’t grab the headlines of more popular forms of cancers,” said Bechara. “It also doesn’t get near the research funding as other cancers.”Lung Cancer ScreeningsIn 2012, the American Lung Association (ALA) released guidelines on low-dose lung cancer screenings, based on the NCI’s National Lung Cancer Screening Trial. The U.S. Preventive Services Task Force recently issued draft recommendations for annual low-dose CT screenings for patients at high risk for lung cancer, which translates to an estimated 7 million Americans, including smokers ages 55 to 79 who have consumed the equivalent of a pack a day for 30 years. “We’re excited about launching this tool and the low-dose screenings,” said ALA president and CEO Harold P. Wimmer. “It’s a big step in the fight against lung cancer. We created this online tool to help people understand quickly whether they’re candidates for low-dose CT screening.”The upside of lung cancer screening was discussed in the Sept. 5, 2013 edition of the New England Journal of Medicine. “Probability of Cancer in Pulmonary Nodules Detected on First Screening CT” showed how the percentage of patients dying from lung cancer could be cut by 20 percent via a low-dose CT scan versus regular x-rays. The summary: “Predictive tools based on patient and nodule characteristics can be used to accurately estimate the probability that lung nodules detected on baseline screening low-dose CT scans are malignant.”“Catching lung cancer early requires a very streamlined and collaborative process between PCPs (primary care providers) and interventional pulmonologists,” said Bechara. “Getting the CT scan results in a timely manner and discussing the results between specialists and subspecialists is vital so that patients have a ready plan when they receive a diagnosis.”Determining who will pay for lung cancer screening remains a question mark, said Bechara, noting that a low-dose CT scan may cost up to $400. Most insurers don’t automatically cover lung cancer screening costs, as they do other cancer screenings like mammography. “Most screening isn’t paid for. Different institutions have taken it upon themselves to start a screening program for the benefit of patients at a reduced rate. Some offer free screenings. At Emory, we were working on (offering it free to patients) but couldn’t because of logistics and other obstacles,” said Bechara, who completed training, internship, residency and a fellowship in pulmonary and critical care at Emory University School of Medicine, and also founded and directed the institution’s interventional pulmonology program, focusing on new endoscopic techniques for lung cancer. “Because (CTCA at Southeastern) is only 14 months old, we would probably start screening with stakeholders and their families to make sure the process is streamlined before we offer it to the general public. If there’s a fee-for-service, it will be amazingly cheap.” Front Line Assistance“PCPs are at the forefront and play a major role in identifying or at least raising the knowledge of patients with lung cancer,” said Bechara. “Unfortunately, there are no specific symptoms for lung cancer. Patients may cough and be short of breath sometimes, but that can happen to anyone with sinus issues or allergies. I urge PCPs to recommend screening for high-risk patients. They should at least be aware of the screening recommendation if patients come to them with non-specific symptoms they can’t explain. We can refer them to a low-dose CT scan of the chest, which identifies patients with lung problems and hopefully catches lung cancer in an early stage.”Until recently, lung cancer was considered a man’s disease; statistics show it’s now the leader of cancer deaths in both genders, said Bechara.“The rate of smoking for the subsection of young females is on the rise,” said the father of two adolescent daughters. “They may start smoking as young as 12 or 13, mainly because nicotine is an appetite suppressant and being thin is the main goal. PCPs may tell them there are many other healthier ways to keep their bodies in shape. If we can reach them at an early age, and bring awareness to the younger generation of the consequences of choices they make early on, imagine how much cancer we can prevent down the road.”Bechara is optimistic about curbing lung cancer. “We’re collaborating with multiple institutions and new technology,” he said. “Our aim is to look at new ways to kill lung cancer via multidisciplinary approach which includes endoscopy. It’s still in research mode, and the findings need to be validated. Definitely, more research is needed.”