Lung cancer is a potentially fatal disease. According to the American Cancer Society, it is the No. 1 cause of cancer death in the United States for both men and women with about 155,000 deaths per year. Approximately 70 percent of patients with lung cancer are diagnosed in Stage 3 or Stage 4 — its latest stages — when the average five-year survival rate is just 16 percent.
If lung cancer is diagnosed in its earliest stage — Stage 1A — the five-year survival rate jumps to between 77 and 92 percent. This difference in survival rate makes the goal of early detection of lung cancer particularly urgent for patients.
Before the availability of screening for lung cancer, most patients were diagnosed after developing symptoms, by which time the cancer was most likely to be quite advanced. Screening tests are meant to find cancer in people in its earliest stages, before they even notice symptoms. Effective screening tests have been developed for many cancers.
For lung cancer, however, until recently, there was no reliable screening exam. That situation changed in 2011 when the National Lung Screening Trial (NLST) study, published in the New England Journal of Medicine, showed that low-dose CT (LDCT) screening of certain individuals resulted in a 20 percent reduction in lung cancer mortality. Guidelines were established, and LDCT became an approved screening test for lung cancer.
Screenings at Augusta Health
Augusta Health started its Lung Cancer Screening Program in 2014. During the program’s first year, 37 LDCT exams were performed and one lung cancer was detected. To date, more than 1,600 LDCT exams have been performed and 30 lung cancers have been detected. That detection rate is twice what was expected when the program began.
The LDCT exams are conducted by radiologist Matthew Shapiro, MD. Pulmonologist Laura Gonzales, MD, can add further diagnosis and information through navigational bronchoscopy procedures.
Before the program started, 15 percent of the lung cancers diagnosed at Augusta Health were Stage 1A and 73 percent were Stage 3 or Stage 4. The Lung Cancer Screening Program seems to have had the desired result of shifting lung cancer diagnosis to earlier stages. In 2017, about three years into the program, 27 percent of lung cancer diagnoses at Augusta Health were Stage 1A and 58 percent were Stage 3 or Stage 4.
“The 27 percent of Stage 1A lung cancer diagnoses, while significant, is for all patients and includes patients diagnosed with screening as well as those diagnosed without screening,” adds Dr. Shapiro. “When we look at only those patients diagnosed with lung cancer through screening, we see an even greater benefit with 53 percent in Stage 1A and only 7 percent Stage 4. This suggests to me that there are probably more patients in our area who are at high risk for lung cancer but are not being screened.”
Treatment of lung cancer at Augusta Health
After a lung cancer diagnosis, the medical team that treats lung cancer begins its work. Thoracic surgeon Miguel Aguinaga, MD; medical oncologists Kelvin Raybon, MD, Raymond Cruz, MD, Reshma Khetpal, MD, and Naheed Velji, MD; radiation oncologists Robert Kyler, MD, and David Morgan, MD; and lung cancer navigator Megan Howell, RN, BSN, all can become part of the team.
“We’ve seen a dramatic increase in the diagnosis of Stage 1 lung cancer at Augusta Health,” says Dr. Kyler, “and the earlier the stage, the more treatment options we have to offer the patient. Cancer care is very individualized medicine. Each cancer is unique, and its treatment needs to be tailored to the patient. The ability to diagnose patients earlier, combined with the robust medical team we have developed, results in better outcomes for our patients.”
Dr. Raybon agrees that the multidisciplinary care available at Augusta Health is a great advantage for lung cancer patients. “Lung cancer is complex and often requires the involvement of many different doctors,” he adds. “For diagnosis, we have imaging and radiologists, pathologists and pulmonologists. As we begin to treat, we could have surgery, radiation and medical oncology. Depending on the stage of the cancer and the patient, we may have these modalities running simultaneously. The key is that, since we are all here in the same location, we can meet regularly to discuss each patient’s unique needs and situation. The ability to work together so closely is a huge advantage to the patient.”
“For us all to be in the same building, where conversations can be immediate and patients’ appointments can be in one convenient location, is a great benefit for our patients,” continues Dr. Kyler. “We can easily discuss options with each other and with our patients. Megan Howell, our lung cancer navigator, is available to go with the patient wherever he or she needs to go, help set up the physician visits and provide any information needed. It’s a much better approach for patients. They aren’t alone in this journey; they have a coordinated team working with them and for them every step of the way.”
In addition to a strong team of providers, lung cancer patients at Augusta Health have access to new and advanced treatments that have not been available until recently, including:
- Less invasive surgical options, including laparoscopic and robotic surgery;
- Stereotactic Body Radiation Therapy (SBRT), a non-invasive alternative to surgery that precisely targets tumors in just three to five outpatient treatments;
- Immune Therapy, which can be combined with chemotherapy for better effectiveness and response; and
- National Clinical Trials, open to patients of Augusta Health Cancer Center through our affiliation with the Duke Oncology Network.
“For decades, there were very few advances in the treatment of lung cancer,” says Dr. Raybon, “but what has happened in the last three years has turned lung cancer treatment upside down with advancement. That is particularly encouraging for patients.”
Adds Dr. Kyler, “Our capacity to diagnose and treat lung cancer at Augusta Health has expanded. The last thing you want to do when you’re sick is travel for care, and that’s clearly not necessary now.”
For more information about Augusta Health’s cancer care programs, please call (540) 332-5960.