How Siteman approaches lung cancer tests for eligible patients

Lung cancer is the second most common cancer in both men and women in the U.S. It is also the leading cause of cancer death, accounting for almost 25% of all cancer deaths. While these statistics are daunting, the good news is that lung cancer deaths are rapidly decreasing as more people quit smoking. Additionally, lung cancer testing is becoming more advanced, which is essential for early detection and treatment.

Lung cancer screening

Today, providers perform lung cancer testing using a low-dose computed tomography (LDCT) scan, which provides 3-D images of the lungs and can detect lung cancers before they become visible on chest x-rays. Several studies have shown that getting screened can reduce the risk of dying from lung cancer.

Early lung cancer testing and eligibility requirements

Because most lung cancers don’t cause symptoms in their early stages, early lung cancer testing is crucial to catching cancer before it progresses. In order to be a candidate for lung cancer screening at Siteman, you must meet all of the following eligibility requirements according to current lung cancer screening guidelines:

• Be aged 50-80
• Be a current smoker or a person who has quit smoking in the last 15 years
• Have a smoking history of 20 pack-years or more (one pack year is equal to smoking one pack of cigarettes a day for one year, or two packs a day for 10 years)

Screening costs may differ based on your specific benefit and coverage information, as well as the specific services you receive. Please contact your insurance provider to ask about your expected out-of-pocket costs.

If you meet these requirements, it is recommended that you get a lung cancer test every year. You’ll need a referral from your primary care provider for a lung cancer screening.

Your lung cancer test: benefits, risks and what to expect

The main benefit of lung cancer screening is preventing or lowering the chance of dying from lung cancer. However, false-negative and false-positive test results can occur. It’s important to keep in mind that not everyone who undergoes lung cancer testing will benefit from it. LDCT screening doesn’t find all lung cancers, and those that LDCT screening does find will not always be in their early stages.

During an LDCT exam, the technologist will position you on your back on the CT exam table and will likely ask you to raise your arms above your head. You will need to remain very still to ensure clear images are taken. Next, the table will move quickly through the scanner to determine the correct starting positions for the scan. Finally, the table will move slowly through the machine while you hold your breath for each five- to ten-second scan. The entire scanning process takes less than a minute and involves no needles or injections.

What do your lung cancer test results mean?

There are several possible results you may receive after a lung cancer test:

• No abnormalities found: the test did not detect any cancer. Current guidelines recommend that you undergo another scan in a year if you are still eligible for screening.
• False-negative result: while uncommon, you may receive a negative result when cancer is actually present but went undetected during the test.
• False-positive result: you may receive a positive result when there is, in fact, no cancer present. This can happen when the scan finds a nodule in the lung; however, most of these nodules are benign and will not lead to cancer.
• Small nodules: if the test detected small nodules, they likely will not require immediate action and will be monitored at your next annual lung cancer screening. But sometimes, the results may suggest a need for further testing in several months to see if the nodules have grown. Growing nodules are more likely to be cancerous.
• Large nodules: large nodules are also more likely to be cancerous. If the test detected a large nodule, your provider may refer you to a pulmonologist or thoracic surgeon for further testing, including biopsy and additional imaging tests, such as the positron emission tomography (PET) scan.
• Incidental findings: your lung cancer screening may detect something unexpected (such as cardiovascular or gastrointestinal issues). Incidental findings are common during lung cancer screenings. In a small percentage of cases, they may lead to additional testing.

Something abnormal was found during your lung cancer test. Now what?

If your lung cancer test results were abnormal, your doctor may recommend further testing to determine if you have lung cancer and, if you do, how far it has progressed. Typically, abnormal test results are followed up with:

PET-CT scan: this test uses a radioactive substance (called a tracer) to identify cancer in the lungs. The radiologist will administer the tracer through an IV and it will travel through your blood, collecting in organs and tissues. The tracer helps the radiologist see certain areas and diseases more clearly. It takes about 1 hour for your body to absorb the tracer. Then, you will lie on a table that slides into the PET scanner, which detects signals from the tracer. The scanner takes 3-D pictures that are displayed on a monitor for the radiologist to read. The entire process takes about 90 minutes.

Biopsy: in this test, your doctor removes cells from your lungs and examines them under a microscope to check for cancer. There are several types of biopsy that your doctor may perform:

• Needle biopsy/aspiration: your doctor will numb your skin and use a needle to remove a tissue sample.
• Bronchoscopy: your doctor will insert a thin tube into your lungs to remove a tissue sample.
• Open biopsy: for this test, a surgeon will put you under anesthesia in a hospital operating room. They will remove tissue through a cut in your chest to be examined at a lab.

Meeting with your thoracic surgeon

Before your thoracic surgeon meets with you to discuss your condition, they will have reviewed your medical history as well as radiology studies. If surgery is necessary, your surgeon will discuss the type of surgery you’ll be having, the risks and benefits of the operation, and the recovery process. If your surgeon believes you are eligible, you may have the opportunity to participate in a clinical study.

Our care team

The lung cancer treatment program at Siteman comprises a wide range of specialists, including medical oncologists, radiation oncologists, surgeons/thoracic surgeons, pulmonologists, radiologists/interventional radiologists and psychologists. The diverse expertise of our collaborative team is what allows our specialists to create personalized and compassionate treatment plans for each and every patient.

Meet some of the doctors on our team:

Ramaswamy Govindan, MD

Dr. Govindan is Professor of Medicine and the Anheuser Busch Endowed Chair and Director of the Section of Medical Oncology at Washington University School of Medicine. His clinical expertise is esophageal, thoracic and lung cancers. Dr. Govindan is widely recognized for his innovative research aimed at developing better lung cancer therapies and improving patient outcomes.

Ruben Nava, MD

Dr. Nava is Assistant Professor of Surgery in the Division of Cardiothoracic Surgery at Washington University School of Medicine. His clinical expertise is esophageal cancer, lung cancer and lung transplantation. Dr. Nava has more than 21 years of thoracic surgery experience and is the principal thoracic surgeon involved with Siteman’s lung cancer screening program.

Getting tested is crucial. Siteman is here to help

The Centers for Disease Control and Prevention estimates that cigarette smoking causes 80 to 90 percent of lung cancer deaths in the U.S. The most important thing you can do to prevent lung cancer is to not start smoking, or to quit smoking if you do. Lung cancer is highly preventable when detected early. If you are at high risk of developing lung cancer, it is crucial to follow screening guidelines because the earlier you catch lung cancer, the easier it is to prevent or treat.

If you have received a lung cancer diagnosis, or you’re at high risk for developing lung cancer, you may be experiencing a wave of emotions including fear, anger and sadness. We are here to support you every step of the way throughout your cancer journey. Siteman is renowned for its exceptional physicians, psychological services and survivorship care. As a patient of ours, you can take comfort in knowing that we are committed to caring for your body, mind and wellness, even after treatment ends.

Siteman offers lung cancer screenings at various locations, with dedicated nurse navigators to assist patients and healthcare providers through the screening and follow-up process. Our nurse navigators are available to answer any questions and to help patients understand their results.

• Anne Stilinovic, RN, BSN, 314-574-1124,for Barnes-Jewish Hospital, Barnes-Jewish West County Hospital and Siteman – South County
• Ellen Brennan, RN, BSN, 636-916-7098,for Barnes-Jewish St. Peters Hospital and Progress West Hospital
• Karmen Fugate, RN, MSN, OCN, 314-653-4529, for Christian Hospital and Northwest Healthcare

To schedule a lung cancer screening, please contact Siteman’s Patient Care Coordination Center at 314-788-3731. If you already had a screening exam that detected cancer cells and you wish to schedule a follow-up appointment with a lung cancer specialist at Siteman, please call 800-600-3606.