Routine lung cancer screening recommended for more current, former smokers
Tom Collier found out he has stage 1 lung cancer after a routine chest scan. Because the cancer was caught early, his doctors are optimistic about radiation treatment. More than 15 million Americans who are current and former smokers are recommended to get routine chest scans.
DULUTH — What started as a routine physical in early January became a life-changing day for Tom Collier.
The Duluth man's physician, Kelly McKinnon, asked him about his medical history — including smoking. Even though 73-year-old Collier had quit smoking cigarettes more than a decade ago, McKinnon suggested he get a chest X-ray. Sure enough, the scan came back with a spot that caused concern because of its star-like edges, called spiculation.
After an additional PET scan and a biopsy, it was determined that Collier has stage 1-A, non-small cell carcinoma in the lower left lobe of his lung.
“I had no way of knowing," Collier said of his cancer. "I wasn’t feeling any differently in this early stage. That’s one of the insidious things about cancers, is in their early stages you don’t have a lot of obvious symptoms so the way you discover them early on is through screening and testing.”
His doctors and specialists are optimistic that stereotactic body radiation therapy, which finely focuses radiation on the tumor, will be a successful treatment for Collier.
Collier is just one of an estimated 15 million Americans who are recommended to have regular lung cancer screenings. Last year, the U.S. Preventive Services Task Force expanded its guidelines for screenings to include individuals ages 50-80 who have a 20-pack-year smoking history. Earlier this year, the Centers for Medicare & Medicaid Services announced it is also expanding its screening eligibility for Medicare recipients to include people age 50-77 with 20-pack-year smoking histories.
A "pack-year" is defined as one year of smoking a pack of cigarettes a day, or its equivalent — such as a half a pack a day for two years, or two packs a day for six months. The expanded guidelines, which lowered the required number of pack-years and the minimum age, have nearly doubled the number of eligible Americans.
The screening itself, a low-dose computed tomography (CT) scan, is non-invasive and only takes a few minutes to complete. Scott Studden, director of diagnostic imaging at St. Luke's hospital in Duluth, said the actual scan itself is only seconds long.
“It actually takes longer to have you come into the facility and find CT than it does to actually have the pictures taken,” he said.
However, Studden said St. Luke's is not performing nearly as many screenings as it could be, which he believes is because many people do not know they are eligible. According to the American Lung Association, only 5.7% of eligible people have been screened.
“If we can get people in to see their doctor and talk about smoking, talk about stopping smoking and talk about screening, we’ll save more and more lives,” Studden said.
Collier said that McKinnon had not asked him, and if Collier hadn't disclosed that he was indeed a former smoker, his doctor wouldn't have known that he was overdue for a screening.
“It had not really occurred to me. I have to give Dr. McKinnon a whole lot of credit for being thorough where that’s concerned,” Collier said. “We needed to take a look, and thank God and thank (McKinnon) that we did. Otherwise, I would’ve been just happily trotting through life while this thing was growing and possibly moving on.”
Collier, who worked as a graphic artist and photographer, began smoking at age 21 when he was in the Navy. His smoking habit became heavier during his work, where he said he would chain-smoke one or two packs a day.
“You have a bad day, you smoke a cigarette. You have a good day, you smoke two cigarettes," he said. "You kind of start relating everything socially in your life to smoking.”
He quit in 2010, which was the same year his father died of chronic obstructive pulmonary disease.
Collier believes that if he wouldn't have gotten his chest X-ray when he did, he would likely not have the same optimistic diagnosis. The tumor, which was 1.5 centimeters during his PET scan, grew nearly a half-centimeter in diameter in the next month. The cancer is still early stage and has not yet spread to surrounding tissue or lymph nodes, but it may have if Collier did not know it was there.
“This is a good time to catch it before it’s spread anywhere else," McKinnon said. "I think that if he wouldn’t have agreed to this scan and it would've been later and would’ve had the opportunity to spread, this specific treatment that he’s likely to tolerate wouldn’t have been an option that securable for him."
McKinnon said that, on the bright side, patients are scheduling more routine exams after there was a sharp decrease at the beginning of the coronavirus pandemic. However, many people who are coming in now for screenings are discovering health concerns in later stages because of the postponement.
Lung cancer is the leading cause of cancer death, accounting for 25% of all cancer deaths — more than colon, breast and prostate cancers combined. According to the American Cancer Society, an estimated 236,740 new cases of lung cancer and 130,180 deaths from lung cancer will occur in 2022.