Q&A with Katrina Steiling, MD, M.Sc.
Lung cancer is the leading cause of cancer-related death in both men and women. It often goes undetected for long periods, and therefore is diagnosed at an advanced stage when treatments are less likely to cure the cancer. Katrina Steiling, MD, a physician in pulmonary, allergy, sleep and critical care medicine at BMC, provides details on how the hospital is advancing the early detection of lung cancer.
Q. How did the Lung Cancer Screening and Lung Nodule Evaluation Program come about?
A. Lung cancer screening aims to detect lung cancer at an early and potentially curable stage when a patient does not have symptoms. The National Lung Screening Trial compared annual low-dose CT scans (LDCT) to chest x-ray for lung cancer screening. This trial showed a 20 percent decrease in mortality from lung cancer using LDCT.
With the trial results in mind, BMC radiologists, pulmonologists, and thoracic surgeons collaborated to develop the Lung Cancer Screening and Lung Nodule Evaluation Program for patients at risk for lung cancer, and patients with CT findings such as a lung nodule that could turn out to be lung cancer.
Q. What happens during a lung cancer screening? Who should be tested?
A. Lung cancer screening is done using a LDCT scan, which is a CT scan that does not require intravenous contrast and uses a lower dose of radiation. The dose of radiation from an LDCT scan is similar to a mammogram.
The United States Preventive Services Task Force has recommended lung cancer screening for the following high-risk patients: age 55-80; current smoker or former smokers who have quit within the last 15 years; and those with at least 30 pack-years of cumulative cigarette smoke exposure. Patients undergoing lung cancer screening should have no symptoms of lung cancer, such as weight loss or coughing up blood. Patients should also be willing to undergo diagnostic testing and treatment for any abnormal findings detected by LDCT, and understand the importance of adhering to annual screening.
"The most important way for patients to reduce their risk for lung cancer is to not smoke or use any form of tobacco."
Q. What is a lung nodule and how common is it? Is it cancerous?
A. A lung nodule is an abnormal, solid area of tissue in the lung. Lung nodules look like "shadows" or "spots" on chest x-ray or CT scan. About one-quarter (25 percent) of LDCT scans to screen for lung cancer will detect a lung nodule. Lung nodules also can be detected by a chest x-ray or CT scan performed for a different reason. On average, less than 5 percent of lung nodules turn out to be lung cancer. Lung nodules that are larger than one centimeter or that grow over time are more likely to be cancerous.
Q. If a lung nodule is discovered, what's the next step? Can it be treated?
A. The treatment for a small lung nodule depends on how it changes over time. When a lung nodule is found, the next step is usually to get another CT scan in a few months to see if it has changed in size. If the lung nodule stays the same size, it is monitored using CT scans. If it is large, or if it changes over time, biopsy or removal of the nodule may be suggested.
Q. Can lung cancer and lung nodules be prevented?
A. The most important way for patients to reduce their risk for lung cancer is to not smoke or use any form of tobacco. As part of lung cancer screening, all patients should be counseled about the importance of not smoking. We can help patients quit smoking by seeing them in our Tobacco Treatment Center.
To learn more about the program, visit their webpage.