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Saving lives by screening smokers

September 13, 2017


Saving lives by screening smokers

Though effective screening techniques for breast cancer and colon cancer have been widely used for many years, screening for lung cancer had never been proven effective.

That changed when the results of a large trial designed to evaluate a lung-cancer screening program were published in the New England Journal of Medicine in 2011. The trial involved more than 53,000 patients, and the results were promising: Lung cancer deaths were reduced by 20 percent in high-risk patients.

"The magnitude of this benefit is greater than the benefit of any other intervention for lung cancer, with the sole exception of smoking cessation," says Dr. Peter M. Jablin, a pulmonologist at Summit Pulmonary & Sleep Medicine in Chambersburg.

Last year, 224,000 Americans were found to have lung cancer. It is one of the most common types of cancer in both men and women--and one of the most deadly. The screening program uses yearly low-dose computerized tomography (CT) scans to monitor changes to a patient's lungs. CT scans, a specialized type of X-ray that combines multiple images from different angles, help save lives by enabling doctors to detect lung cancers when they are smaller and potentially curable.

"A CT scan of the chest allows the detection of X-ray abnormalities that are very small--less than 6 mm (1/4 inch)," says Dr. Jablin. "Even abnormalities as small as 2-3 mm can be detected reliably. Abnormalities in this size range are not detectable with a standard chest X-ray. Even if very small abnormalities are evident on a chest X-ray, they cannot be measured with dependable precision in order to determine whether the abnormality is remaining stable or growing."

Many people have small nodules in their lungs, which are aftereffects of infections earlier in life. That's why it's important to do the annual screening. One of the things doctors look for is not simply whether there is a nodule, but how big it is and whether it shows any evidence of growth.

Lung cancer is strongly related to cigarette smoking: Only about 10 percent of all lung cancers occur in nonsmokers. Cigarette smoking also is associated with a dramatically increased risk of cancers of the mouth, esophagus, stomach, kidneys, ovaries, and bladder.

"Smoking cessation dramatically drives down the risk of many of the deadliest cancers," says Dr. Jablin. "It also dramatically reduces the risk for heart attack, stroke, and the development of a destructive lung disease, COPD." Medical studies have shown that 25 percent of smokers who participate in a lung-cancer-screening program are able to quit, compared to the national average of 5 to 7 percent.

The lung-cancer-detection rate from Summit Health's low-dose CT program is consistent with the rates at large university centers. Since it began in 2014, Summit Health's screening program has found 11 lung cancers and one esophageal cancer. None of the patients were experiencing symptoms.

"All of these patients would have become aware of their cancer at a later date when they had symptoms," says Dr. Jablin. "But because most of the symptoms related to lung cancer are the result of progression of the cancer to other crucial structures of the body, the detection of lung cancer when it is not causing symptoms is the detection of cancer at an earlier stage when the likelihood of cure is much higher."

Tips for quitting

When it comes to smoking, the opposite of the old adage is true: Quitters always win. If you want to quit smoking and make it stick, keep these simple but powerful tips in mind.

  • Find your motiviation. Define a concrete reason to quit, whether it's to improve your health, be a good example for your children, or save money.
  • Be accountable to someone. Let friends and loved ones know that you're trying to kick the habit. It will help to keep you honest and on-track, and allow them to lend support along the way.
  • Don't make deals with yourself. Letting yourself sneak a cigarette today will only make it harder for you to get through tomorrow.
  • Do something else. Find stress-relief alternatives: taking walks, biking, talking to friends, knitting--whatever works for you.
  • Find strength in numbers. Support groups foster a sense of solidarity and let you know you're not in it alone.
  • Don't latch onto lapses. There's no shame in stumbling. If you fall off the wagon, don't beat yourself up, just climb back on.