Breathing Easier

Few former smokers are aware of recent changes in health insurance coverage to include potentially life-saving lung cancer screening

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My neighbor could find no relief.

He would cough. And cough. And cough. It had to hurt, and it seemed unending. He’d leave his house next to my parents’ home, trying to spare his family from hearing what he was going through, but he’d frequently end up in a side part of the yard, just outside my bedroom window.

And cough. And cough. And cough.

It was lung cancer.

And it was the sound of death.

I was 6.

Months of night terrors ensued not long after his death, but they faded away with time.

I’d like to say that it scared me from even thinking of smoking when I was older, but it didn’t. I was sneaking Winstons in the cemetery (an appropriate place, come to think of it) by ninth grade, and going through a pack of smokes a week by my senior year in high school. That escalated to a pack-a-day through college and into my late 20s before I finally quit.

Even though that was 30 years or so ago, I still have a greater chance of contracting lung cancer than someone who never smoked.

There are a lot of baby boomers out there like me, and many of them quit later in life. They know all about the recommendations for colon cancer and breast cancer screening, but most folks are unaware that there are now recommendation for yearly screenings for lung cancer for certain at-risk cohorts.

It’s covered by most insurance plans, and, crucially, it can lead to early detection of one of nature’s great killers.

Lung cancer is the leading cause of cancer deaths, and second behind heart disease in overall causes of death.

 It accounts for 27 percent of all cancer deaths, more than colorectal, breast and prostate cancer combined, according to the nonprofit American Lung Association. African American males have the lowest survival rates, and are 36 percent more likely to develop lung cancer than white males. Lung cancer rates are about equal in black and white women.

Smoking is a factor in 85 percent of lung cancers. Other risk factors include exposure to radon, asbestos or other agents, secondhand smoke, a family history of lung cancer, and whether you have had other lung diseases or some other types of cancer.

The statistics aren’t in your favor: The one-year survival rate is 44 percent, and the five-year rate is just 17 percent. The five-year survival rate with early detection is 54 percent, but the problem is that only 15 percent of cases are caught early. It’s especially deadly because often it has spread by the time it's found, and most patients are initially diagnosed when the cancer is a Stage III or Stage IV.

“It breaks our hearts all the time,” says Sridhar Neralla of Pulmonary Associates of Richmond.

More than half of people with lung cancer die within a year after diagnosis.

There’s a great primer on lung cancer, its detection and treatments, from the National Comprehensive Cancer Network here.

And there’s an effort afoot to turn those numbers around. A landmark 2011 study, the National Lung Screening Trial, found that screening people at high risk for lung cancer could reduce mortality by up to 20 percent. As of the current year, most insurance plans, including Medicare, now cover the screenings for at-risk individuals.

Neralla and Andrew Apostle, also with Richmond Pulmonary, are advocates of the screening, and want to raise awareness of its use. They met with me Monday at Bon Secours St. Mary’s to discuss the importance of early detection of lung cancer and to show off one of the hospital’s latest gadgets to help in detecting the disease.

Yearly screening is recommended (and will be paid for through Medicare Part B) for anyone who meets all of the following:

Age 55-77 who is

  • Either a current smoker or someone who quit smoking less than 15 years ago, and who
  • Has a smoking history equivalent to smoking at least a pack a day for 30 years, and who
  • Has written authorization from their doctor or qualified practitioner.

Your smoking history is determined in “pack years,” basically a measurement of your tobacco consumption in terms of the number of cigarettes you smoked each day, based on there being 20 cigarettes in a typical pack. So, if you smoked 20 cigarettes a day for a year, it equals one pack year. If you averaged 30 cigarettes a day, that’s 1 1/2 pack years.

If you consumed tobacco in a cigar, smoked a pipe, or used a water pipe, or smoked marijuana regularly, here’s a calculator from Nigel Masters and Catherine Tutt to help you determine your pack years.

I averaged a pack a day for 10 years, and quit 30 years ago, so no screening is recommended in my case.

For every 320 people screened, you’re likely to find one patient with lung cancer who’s curable, according to Neralla. That’s a rough equivalent to the gross number of breast cancer  screenings per cancers detected. “You have to screen a lot of people to pick up one,” he says.

The recommendations call for a yearly Low Dose Computed Tomography (LDCT) scan.  It’s quick and easy, provides a more detailed view and delivers a lower dose of radiation than a standard chest X-ray. The upside to LDCT is that it is more effective in screening for lung cancer than X-rays, but there’s a downside in that it results in false positive readings.

That’s where St. Mary’s SpinView Thoracic Navigating System comes in. It’s a diagnostic machine that uses a sort of GPS. The thoracic navigation system can provide a quick check and confirm an initial finding, or help rule out a false positive, and is useful in detecting spots outside the lungs.

 “This takes you right there,” says Apostle.

It’s easy to navigate, provides a 3-D view, and biopsies can be performed on the spot, offering peace of mind that comes from a faster turnaround on receiving results. It’s used on an outpatient basis. Recovery time is minimal.

Though the detection and cure rates are abysmal, Apostle is hopeful that increased awareness of the need for screening will lead to more cures.

“In the next 10 years, we’ll have better statistics,” he says.

Trend-wise, lung cancer cases have been in decline as fewer people smoke, with a 2.9 percent yearly decline for men, and a 1.9 percent yearly decline in lung cancer in women. Combine that with advances in multiple facets of treatment, prevention and detection, including chemotherapy, immunotherapy, targeted therapy and  surgery.

“That sense of nihilism in lung cancer is starting to fade,” says Neralla.