More than 20% of lung cancer deaths could be prevented through early detection, yet California’s lung cancer screening rates are the worst in the nation—just 1%—according to a November report from the American Lung Association. The stigma associated with screening is partly responsible, said Sara Ghandehari, MD, director of the Centralized Lung Cancer Screening Program at Cedars-Sinai.
“To be screened, an individual has to share their history of tobacco use, and many people, especially if they used to smoke, don’t want to mention it,” Ghandehari said. “It’s really important that patients share their tobacco use history, even if it’s in the past, because it will help us decide whether or not screening is appropriate for them. Being upfront with their care team may ultimately save their life.”
The streamlined screening process at Cedars-Sinai aims to ease the minds of patients. The first step is referral by the patient’s primary care provider. Then, a dedicated nurse practitioner conducts a virtual or in-person visit to determine whether the patient meets the criteria for lung cancer screening, which include individuals who:
- Are age 50-80
- Have at least a 20 pack-year smoking history, determined by multiplying the number of packs per day by the number of years the person has smoked
- Currently smoke or have quit within the past 15 years
- Have no signs or symptoms of lung cancer
“During this visit, a nurse practitioner also evaluates the patient’s family history and any environmental or occupational exposures that increase the risk for lung cancer,” Ghandehari said. “The nurse practitioner discusses the risks and benefits of lung cancer screening and what the test might detect.”
If the patient qualifies for screening and wants to move ahead, the nurse practitioner obtains insurance authorization, orders the test, and the patient receives a call to schedule the screening. The test itself is a low-dose CT scan that is completely noninvasive, involves minimal radiation exposure and takes less than five minutes to perform.
Results are usually ready within three to five days, and the screening team reviews the findings before the patient’s follow-up visit—and coordinates everything with the patient’s primary care provider.
“If there is a small lung nodule, an abnormal growth that is rarely cancerous, we will share a recommendation from the radiologist with the patient,” Ghandehari said. “If it’s something larger or more concerning, we will review the findings with a group that includes radiologists, pulmonologists, oncologists and surgeons, so that when the patient learns the results of the CT scan, they also know what the next step is. They don’t have to wait for weeks to get the opinion of a specialist.”
Karen Reckamp, MD, director of Medical Oncology in Cedars-Sinai Cancer, said the team helps the patient through every step of what could be a frightening process.
“Some patients are afraid to be screened because they think that a lung cancer diagnosis is a death sentence, but that isn’t true,” said Reckamp. “We have made tremendous inroads against even the most aggressive forms of lung cancer and treatment options continue to expand. And through screening, we can identify lung cancer early, which allows for the best chance of survival for patients.”
The clinician sharing results with the patient can also discuss any additional findings.
“There are lots of things that can be spotted with a low-dose CT scan,” Ghandehari said. “So if we find something on the thyroid, low bone density, calcium in the vessels of the heart or something else, we share that information with the patient and their primary care provider for follow-up.”
The team also contacts at-risk patients for annual follow-up screenings.
The program launched in the spring and more than tripled previous years’ screening rates in 2022. The team is also working to expand community access to the program by bringing CT scanners accredited for low-dose screening to additional locations and eventually launching a mobile lung cancer screening unit to visit underserved areas.
“This program is only part of a larger effort by the cancer center to improve equity by bringing care and research opportunities to the underserved and vulnerable patients in our community,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Distinguished Chair.
Cedars-Sinai Cancer serves one of the most diverse regions in the world, home to Latino, Asian-American, Black and LGBTQ communities that are at especially high risk for lung cancer.
“Our cancer outreach network continues to form partnerships with community leaders and organizations, healthcare providers and cancer survivorship and advocacy groups,” said Robert Figlin, MD, deputy director of Cedars-Sinai Cancer and the Steven Spielberg Family Chair in Hematology-Oncology. “Our Lung Cancer Screening Program is an important way to bring preventive care to these underserved groups.”
Ghandehari urges everyone who might qualify for lung cancer screening to talk with their primary care provider and to be honest about their smoking history, if any.
“It’s important for patients to share their pack-year smoking history and their quit date if they have quit,” Ghandehari said. “We know that we’re lacking that information for about 70% of our patient population, and it is information that could save a life.”
Read more on the Cedars-Sinai Blog: An Underused Tool for Preventing Lung Cancer Death