Ms. Alexis Paulson, Radiology Nurse Practitioner and the Clinical Coordinator of the Vanderbilt Lung Screening Program, discusses lung cancer screening recommendations and eligibility.
Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today, we are speaking with Ms. Alexis Paulson, Radiology Nurse Practitioner, Clinical Coordinator of the Vanderbilt Lung Screening Program and a tobacco treatment specialist. Alexis, thanks so much for joining us today.
Alexis Paulson, N.P.: Thank you.
Shaina Farfel: When most of us think about cancer prevention, screenings for breast, colon, and cervical cancer are probably some of the first things to come to mind. However, for a big segment of our population, there is another cancer prevention strategy that we want to bring awareness to today and that is lung cancer screening. Can you tell us why lung cancer screening is so important and also how it is performed?
Alexis Paulson, N.P.: I think it is important for everyone to realize the prevalence of lung cancer and the burden of lung cancer deaths on Americans. Lung cancer kills more Americans than breast, colorectal, cervical and ovarian cancers combined. While breast has the highest incidence of cancer detection in our country, lung cancer has the highest number of people who pass away from cancer. Unfortunately, that has a lot to do with how late lung cancer is typically detected. Like all cancers, it is much easier to treat when the disease has not metastasized or spread into the tissues around the lungs. We have found over decades of research that chest x-ray and other sputum cytology tests have not been shown to reduce the risk of dying from cancer because they do not catch lung cancer in that early, early stage. Annual lung cancer screening CT scans have been shown to reduce lung cancer deaths by 20% in a population of high-risk individuals and that is done by performing a low-dose CT scan of the lungs which gives us a highly detailed image that can be compared over time from year to year to see what is new or changing, that way we can catch lung cancers at its earliest stage, stage I or II. If we catch a lung cancer at the earliest stage before any symptoms arise, patients have a 60 to 90 percent five-year survival rate rather than a 10 to 36 percent survival rate when caught in later stages.
Shaina Farfel: That is really significant there. Are there any risks associated with the lung cancer screening, this low-dose CT scan that patients may need to be aware of?
Alexis Paulson, N.P.: Yeah, so, there are risks with all cancer screenings and lung cancer screening is similar to other cancer screenings in that the biggest real risk of lung cancer screening is that we may see abnormalities on the scan that are not actually cancer, but do require additional testing. So, most of the time we can rule out cancer with additional imaging, but sometimes we have to do invasive lung biopsies or surgeries to rule out cancer. Most people are relieved when a lung cancer is not detected with these additional tests, but we have to consider all of that additional time, energy and sometimes expense that comes along with additional testing and we have to call that a potential harm of screening. Like with all tests there is always a chance of missing something on the scan too which would be really hard to do, but coming every year is the best defense against that because, again, we are comparing those images over time to see what is new or changing. There is also a low dose of radiation given with lung cancer screening CTs. This is more radiation than with a chest x-ray, but it is about a quarter of the typical chest CT scan. We keep those doses as low as possible so we can safely give them very year.
Shaina Farfel: Thanks for clarifying that. Who would be eligible for screening? I know that there may have been a recent change in some of the guidance and if so, how has that changed recently in terms of eligibly?
Alexis Paulson, N.P.: Again, lung cancer screening is just recommended at this point for people who are considered higher risk for lung cancer. The current recommendations define that as anyone who is 50 to 80 years old with a 20-pack-year smoking history and who has smoked in the past 15 years. Now, pack years are calculated by the packs per day a person smokes and the number of years that they have smoked. So, a pack a day for 20 years or more would qualify you as a 20-pack-year history or two packs a day for 10 years would also quality as a 20-pack-year history. The age recommendation recently went down from 55 to 50 and the pack-year recommendations went from 30 to 20 and these changes were intended to capture more patients at high risk for developing lung cancer based on newer research showing the benefit from lower risk individuals.
Shaina Farfel: How can patients access lung cancer screening here at Vanderbilt and is it something that is typically covered by insurance?
Alexis Paulson, N.P.: Medicare and Vanderbilt insurance, and private insurances currently cover lung cancer screening in full for all individuals who qualify as high risk and this is always determined and documented by one of our nurse practitioners prior to the lung screening CT. So, you would have a conversation with one of the N.P.s prior to the scan to confirm that you meet the criteria and make sure you understand all the risks and benefits. Like I said, most private insurances cover the screenings in full, but some plans have not adopted the new criteria that we were discussing about the new ages and pack-year history. So, some people still have to be 55 and have a 30-pack-year history rather than 50 with a 20-pack-year history. Now to get screened at Vanderbilt, you can call our program navigator at 615-322-0580 for assistance or speak with your provider and ask if they think that lung screening would be beneficial to you. If you do not quality as high risk by the current criteria but would still like to be screened, we do offer a 145.00-dollar self-pay option as well.
Shaina Farfel: Okay. That is wonderful. Thank you so much Alexis for sharing your expertise and for continuing to bring awareness to this important issue. We hope to have you back again soon.
Alexis Paulson, N.P.: Thank you so much.
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