Screenings up, but lung cancer still #1 killer

screening for lung cancer at UVM Medical Center. The low dose scans take only 15 minutes, with no preparation, IV, or clothing changes. Screenings are a powerful tool in reducing lung cancer death. (Photo credit: UVM Health Network)

Vermont Business Magazine Lung cancer screens are on pace to increase by over 27% in 2023 in the UVM Cancer Center’s lung screening program over the previous year, after a multi-faceted public education campaign publicizing new guidelines for screening eligibility was implemented in the summer and fall of 2022.

In 2022, the UVM Medical Center screened 1,634 patients, from both Vermont and northern New York. It is on track to screen 2,081 in 2023. Other sites in Vermont the campaign reached have also seen increases.

The increase is good news for November, which the White House has designated Lung Cancer Awareness Month, said Dr. Beth Zigmund, the director of UVM Cancer Center’s Lung Screening Program.

But even with the increase, screening rates remain much too low, she said.

“We’re seeing an uptick this year, and that’s a great development. But to prevent more needless lung cancer deaths, we need to see many more screenings,” she said.

The most recent data from the American Lung Association shows that only 13.2% of eligible Vermonters are being screened. New York stands at 6%. Both are better than the national average of 5.8% but still much too low.

“We’re missing well over half of the eligible population,” Zigmund said.

Fewer screens mean more lung cancer deaths

Low screening rates translate directly to more lung cancer deaths, said Zigmund.

Unlike other cancers, which have established screening protocols that developed over decades, lung screening for at-risk patients became a standard recommendation covered by insurance only in 2013, after research showed it saved lives, and is still much less utilized than screening for other cancers[BZ2] . 

As a result, lung cancer is the number one cause of cancer death in Vermont, New York and the U.S., killing more people than breast, prostate, and colon cancers combined. 

If lung cancer is caught early via a screen, when it is confined to one spot, Vermonters have a five-year survival rate of 60%, compared with just 10% for patients whose cancer is caught late, after it has spread widely, according to the American Lung Association. 

Of the patients Zigmund’s program screened in 2021 and 2022, only 18% and 10%, respectively, had late-stage cancer. For UVM Medical Center patients who were diagnosed with lung cancer outside the screening program in 2020 and 2021, 42% and 52% had late-stage cancer. 

The screening is quick and low-impact, said Randall F. Holcombe, MD, MBA, director of the UVM Cancer Center.

“It’s done with a low-dose CT scan and takes only 15 minutes with no preparation, IV, or clothing changes,” he said.

For New Haven Resident Diana Clark, a lifesaving intervention

For Diana Clark of New Haven, Vt., a 76-year-old retired nurse who smoked a pack of cigarettes a day for 50 years before quitting 11 years ago, a painful autoimmune disease affecting her lungs and kidneys may have saved her life.

A CT scan designed to show the impact of the autoimmune disease on her lungs detected a non-cancerous lesion. To be safe, and because of her smoking history, her doctor scheduled an annual regimen of low-dose CT scans.

Five years later, though she was experiencing no symptoms, one of these routine screens found a cancerous lesion in her lower left lung. 

In five pain-free sessions that lasted only a few minutes each, she had the tumor treated with radiotherapy at the UVM Medical Center by Dr. Nathaniel Lester-Coll. She been cancer free for three years. 

“My advice is to have the screen,” she says. “It’s comparable to a mammogram but easier. It can seem scary, but it’s better to know than not to know. And lung cancer is not a death sentence anymore if it’s caught early.”

Screening Would Have Saved His Father’s Life 

William Staub, MS, PA-C, a physician assistant with the University of Vermont Health Network-Champlain Valley Physicians Hospital (CVPH) who cares for many patients diagnosed with lung cancer through the screening process, knows the danger of catching lung cancer too late.

“My father, who smoked for more than 40 years, was diagnosed with stage three lung cancer in the early 1990s, before a screening program was in place. Had he been able to get screened and catch the cancer earlier, he may have survived, and I would have had more time with him,” he said.

“This is a serious fight for people, and every tool we can get into the toolbox for the patient and care team is giving that person a better chance at beating lung cancer,” Staub said. “When it’s caught early, we have more options available to treat that patient.”

Regular screening is essential

Zigmund says that getting screened regularly — once a year — is vitally important.

“It's key to continue coming back each year for that screening, or you're not getting the full benefit of the process,” she said. “If you skip a year or two, you could end up missing cancer that could have been caught early.”

Eligibility requirements expanded last year — and again this year

The objective of last year’s public education program was to publicize the new federal guidelines that decreased the age and smoking history requirements for lung screening. Screening is covered by both public and private insurance.

To be eligible for screening, you must now be over 50, have smoked a pack of cigarettes a day for 20 or more years, and quit no fewer than 15 years ago. Patients who fit that profile should meet with their primary care provider, who will then refer them to the nearest lung screening facility. 

This month, the American Cancer Society released even broader criteria, recommending screening for older Americans who have smoked no matter how long ago they quit, which could expand the screening population by 5 million Americans. 

The federal guidelines haven’t changed yet, which means that, at this time, Medicare and Medicaid won’t extend coverage for screenings to the larger group, and private insurance companies are unlikely to. However, this represents the first step in a long process to expand coverage to a new group of at-risk individuals.

Last year’s public education campaign, which included educational materials, social media posts, web advertising, op-eds, and outreach to media, was sponsored by the UVM Cancer Center, the Dartmouth Cancer Center, and Vermonters Taking Action Against Cancer.

Lung Cancer Facts for Vermont, Northern New York, and the U.S.*

Vermont

  • New lung cancer cases in 2020: 448.
  • Lung cancer deaths in 2020: 303.
  • Age-adjusted incidence rate for lung cancer from 2016-2020: 56.3 cases per 100,000 people.
  • Age-adjusted mortality rate for lung cancer from 2016-2020: 36.3 deaths per 100,000 people.

Northern New York (St. Lawrence, Franklin, Clinton, Essex, Washington and Warren counties)

  • New lung cancer cases in 2020: 411.
  • Annual lung cancer deaths on average between 2016 and 2020: 258.
  • Age-adjusted incidence rate for lung cancer from 2016-2020: 76.7 cases per 100,000 people.
  • Age-adjusted mortality rate for lung cancer from 2016-2020: 43.7 deaths per 100,000 people.

U.S.

  • Age-adjusted incidence rate for lung cancer from 2016-2020: 54.2 cases per 100,000 people.
  • Age-adjusted mortality rate for lung cancer from 2016-2020: 35 deaths per 100,000 people.

*Data sources:

  • Incidence data is from the US CDC National Program of Cancer Registries (NPCR) and National Cancer Institute Surveillance, Epidemiology and End Results (SEER) programs.
  • Mortality data is from the US CDC National Vital Statistics System (NVSS).

5-Year Relative Survival Rates, U.S.*

  • Lung cancer: 22.9%
  • Breast cancer: 89.6%
  • Cancer any site: 68.1%
  • Colon cancer: 64.5%

*Data source: U.S. Cancer Statistics Working Group, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, 2022

Efficacy of Lung Screening

The efficacy of lung screening in extending life is based on two large clinical trials.

  • The National Lung Cancer Screening Trials found that patients who were screened for lung cancer saw a 20% mortality rate reduction.
  • A Dutch/Belgian screening trial with the acronym NELSON saw a 24% mortality benefit for men and a 33% mortality benefit for women.


Source: 11.9.2023. University of Vermont Cancer Center