ACR Bulletin

Covering topics relevant to the practice of radiology

With Lung Cancer, Is Awareness Enough?

By combining awareness and action, the radiology community can offer hope in the fight against the leading cause of cancer in the U.S.
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Photo: Eric M. Hart, MD

Eric M. Hart, MD

Guest Columnist

October 23, 2023

“You have lung cancer” are four words that strike fear in the hearts of nearly everyone who hears them. Patients, loved ones, family members and friends all share that fear. My oldest sister, Lisa, heard those words in September of 2010 at age 48. She was stage IV at diagnosis. Sadly, she passed away on May 7, 2011. At age 49, she left a husband, children, mother and siblings to piece together lives fractured by her premature death. In this she was not alone, then or now. Lung cancer continues to be the leading cause of cancer death in the United States.

However, over the last 12-plus years, there has been a revolution in lung cancer diagnosis and treatment. The National Lung Screening Trial (NLST) primary result, published in 2011, documented a 20% lung cancer-specific mortality reduction in high-risk patients screened for lung cancer with low-dose CT. Subsequent studies have confirmed or extended the mortality reduction in other populations.

Lung cancer screening, limited in availability in 2010, is now widely available in the United States, although it remains underutilized. On the treatment front, genetic tumor testing, in its infancy in 2010, has become a linchpin of modern lung cancer care, guiding medical oncologists as they deliver individualized patient treatment regimens using an ever-increasing arsenal of immunologic and tumor targeted therapies.

In thoracic surgery, parenchymal sparing operations (such as segmentectomy, sometimes performed as a same-day surgery) have fast become the standard of care in large institutions. In radiation oncology, stereotactic ablative radiotherapy (SART) used with curative intent has become a widely used alternative to traditional radiotherapy for many patients, including those with early-stage disease who might not be able or willing to undergo curative intent surgery.

We practice radiology in an amazing era, when, thanks to targeted therapies, many patients with stage IV lung cancer can live with their disease as a chronic health condition for 5-plus years — and in some cases, a decade or more — something that was vanishingly rare at the time of my sister’s diagnosis. Yet even those of us in medicine rarely hear these achievements loudly trumpeted.

Stigma surrounding lung cancer and cigarette smoking, medical nihilism, patient nihilism and fear all contribute to keeping these remarkable accomplishments too low in profile, both within the house of medicine and in the wider world in which we (and our patients) live.

The revolution has been far too quiet. Stigma surrounding lung cancer and cigarette smoking, medical nihilism, patient nihilism and fear all contribute to keeping these remarkable accomplishments too low in profile, both within the house of medicine and in the wider world in which we (and our patients) live.

As a chest radiologist, I am grateful to have played a small role in the NLST, the study that provided the ultimate impetus for payer acceptance of lung cancer screening in this country. And I am thankful for the opportunity every day to be able to provide low-dose CT lung cancer screening as a service to my eligible high-risk patients — those age 50 to 80; 20 pack-year smoking history; and current or former cigarette smokers who quit within 15 years. Yet not enough of my eligible patients take advantage of this opportunity.

I’d wager that my practice is no different in this respect than most practices elsewhere in the United States. And so, as we observe Lung Cancer Awareness Month in November, we should ask ourselves, “Is it time to take a different tack?”

Raising awareness of the opportunity for lung cancer screening among our patients and referring physicians is necessary to make a difference, but is it enough?

I would argue not and encourage you to consider how you can translate awareness into action.

The 2nd National Lung Cancer Screening Day (Saturday, Nov. 11, 2023) is an excellent opportunity for all radiology practices to showcase their ability to serve this segment of their population. Smoking history correlates strongly with lower socioeconomic status in this country. Many of our patients who might most benefit from screening may find it difficult or impossible to get screened on a typical weekday. For them, having a weekend alternative could literally be lifesaving.

And if your practice can’t be ready by Nov. 11, perhaps you can be ready later. National Lung Cancer Screening Day should be our starting point, not our destination, as we work to meet our patients where the need exists.

The ACR has numerous educational and practice-based resources to help you perform high-quality lung cancer screening, and I encourage everyone to take full advantage of them. In so doing, you help ensure that our lung cancer screening patients receive the highest quality of care and have the greatest opportunity to be diagnosed at a low stage, in the unfortunate event they have lung cancer.

While my sister’s story is one of sadness, our lung cancer screening message should be quite the opposite. Working together with our patients and medical colleagues, we can make a tremendous positive difference. Awareness + Action = Hope in the fight against lung cancer.

Author Eric M. Hart, MD,  co-chair of the ACR Patient- and Family-Centered Care Commission's Lung Cancer Screening 2.0 Committee of the ACR Commission on Patient- and Family-Centered Care; associate professor of radiology, Northwestern University Feinberg School of Medicine; and clinical director, Northwestern Medicine Lung Cancer Screening Program