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Medical professionals push for wider screening for lung cancer

Lung cancer might be going undetected because not all physicians are unaware of screenings that can save the lives of those between the ages of 50 and 80 years old with a history of smoking or being exposed to living conditions where smoking was a norm, according to medical professionals.

Even those who never smoked, but because of environmental or genetic conditions, could be candidates for lung cancer, the health experts said during recent interviews.

Alyse Yourist, of Sherman Oaks, learned she had lung cancer only because a breast cancer screening picked it up. (Photo by Michael Owen Baker, contributing photographer).

Alyse Yourist, 53, learned she had lung cancer in 2014 only because of a breast cancer screening.

That’s not always the case. A portion of the lung can be hidden by the heart and a normal chest X-ray might not pick up on a cancerous spot.

No one in her family had lung cancer, though her mother died after a long bout with breast cancer.

Yourist did not smoke. But her mother did at home until Yourist was 8 years old.

“My mom was first diagnosed with breast cancer at the age of 41,” said Yourist, a Sherman Oaks resident, a human resources manager and a mother of two adult children. “She passed away at 66 after a 25-year battle.”

Yourist was diagnosed with breast cancer at 45 years old.

“I knew I was going to be okay as I had an angel (my mother) looking after me,” Yourist recently said. “She was my hero and she showed me how to be strong during the hardest of times.”

Yourist was initially diagnosed with Hodgkin’s disease and treated with radiation from her belly button up to her earlobes.

Years later she discovered a lump in her breast despite having annual mammograms as recommended by medical experts.

“When they tested for breast cancer, they found something in my lung. I went through chemo and had a mastectomy. The doctors told me they wanted to take care of the breast cancer before they treated the lung cancer.”

Then the doctors recommended surgery on her lung, because they thought the site was small and she was told if she agreed to surgery most likely she would not need further treatment.

“I was told it was in my lower right lobe from the PET scan and they could remove it surgically, but once they went in they couldn’t find the cancer and so they ended up removing my entire right lower lobe of my lungs,” Yourist said.

Lungs are two sponge-like organs in your chest. The right lung has three sections, called lobes. The left lung has two lobes. The left lung is smaller because the heart takes up more room on that side of the body.

Yourist said the five-day hospital stay and the recovery days following it were horrific.

In 2014 based on various tests, her doctor attributed the breast and lung cancers to environmental factors.

“I was lucky I was being treated for breast cancer and they accidently discovered the cancer in my lungs,” Yourist said.

Dr. Tom Yadegar in his Tarzana office, Friday, Aug. 6, 2021. (Photo by Michael Owen Baker, contributing photographer).

Not everyone is as lucky, according to her doctor Thomas Yadegar, pulmonologist and critical care physician, medical director of intensive care unit and lead physician for COVID at Providence Cedars-Sinai Tarzana Medical Center.

And although there is a low-dose, CT screening available to clinicians, patients must meet certain criteria set out by the American Cancer Society or the United States Preservation Services Task Force, for example, and approved by a patient’s insurance carrier to avoid out-of-pocket expenses.

Yadegar believes the lung cancer screening procedure is underutilized. He says some physicians aren’t aware of guidelines.

“Techniques exist within our health system to screen and diagnose patients earlier,” Yadegar said. “Low-dose CT screening is the best technique available to detect early lung cancer. This modality deploys less radiation than a typical CT scan to protect patients from high radiation exposure and does not require any interventions (blood tests or intravenous contrast). It is also a modality that is readily available at imaging centers and health facilities throughout the country.”

Decades have passed since the link between smoking and lung cancers became clear. Smoking remains responsible for most lung cancer deaths. Researchers continue to look into other causes such as exposure to radon and diesel exhaust and ways to use vitamins or medicines to prevent lung cancer in people at high risk, but so far none have been shown to clearly reduce risk. Some studies have suggested a diet high in fruits and vegetables may offer some protection, but more research is needed to confirm this, according to the American Cancer Society.

In the United States in 2021, there will be an estimated 1,898,160 new cancer cases and 608,570 cancer deaths. That’s approximately four new cases and one death every minute, according to medical experts. The American Cancer Society estimated that in 2021, the will be 235,760 lung and bronchus cases in men and women and 131,880 deaths. While lung and bronchus cases are estimated to reach third place among the various cancers behind breast and prostate, they rank number 1 in deaths.

These estimates present the most current trends in cancer occurrences and survivals. Prevention offers the greatest opportunity to fight lung cancer.

The American Cancer Society recommends annual lung cancer screenings using low-dose CT scans in healthy patients between 55 to 74 years old who currently smoke or quit within the last 15 years and have at least a 30-pack-year smoking history.

Alyse Yourist, left, talks with Dr. Tom Yadegar in his Tarzana office, Friday, Aug. 6, 2021. Yourist, of Sherman Oaks, learned she had lung cancer only because a breast cancer screening picked it up. (Photo by Michael Owen Baker, contributing photographer).

A pack-year is used to describe how many cigarettes you have smoked in your lifetime with a pack equal to 20 cigarettes. If you have smoked a pack a day for the last 20 years, or two packs a day for the last 10 years, you have 20 pack-years.

The United States Preventive Services Task Force, an independent, volunteer panel of national experts in disease prevention and evidence-based medicine, works to improve health by making evidence-based recommendations about clinical preventive services.

The agency recommends annual screening for lung cancer with low-dose computed tomography in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

Lung cancer is the second most common cancer and the leading cause of cancer-related death in the U.S, according to the task force, and smoking is estimated to account for about 90 percent of all lung cancer cases with a relative risk of lung cancer approximately 20-fold higher in smokers than in nonsmokers. Increased age is also a risk factor for lung cancer. The median age of diagnosis of lung cancer is 70 years.

Lung cancer has a generally poor prognosis with an overall 5-year survival rate of 20.5 percent; however, early-stage lung cancer has a better prognosis and is more amenable to treatment. The task force’s recommendations are based on the balance of benefits and harms for a given preventive service. Clinicians should understand the evidence, but individualize decision-making to the specific patient or situation.

Dr. John Wong, a primary care physician at Tufts Medical Center in Boston and a member of the United States Preventive Services Task Force, said the goal of the agency is to improve the health or maintain good health by making evidence-based recommendations about preventative services and what prevents disease and what doesn’t.

“We hope that will facilitate discussions between clinicians and their patients to work together to make informed decisions about preventive health measures such as whether or not to undergo low-dose CT screening and prevent the most common cause of cancer related deaths in the U.S.,” Wong said.

The agency had recommended the lung screening for those 55 years old, similar to the American Cancer Society’s, but in 2013 they reduced it to 50 years old based on a European trial study called the Nelson Trial in which they enrolled individuals as young as 50 years old with a lower pack-year smoking history, according to Wong.

“When people don’t have any symptoms or signs of lung cancer, we can reduce the chance that they die from lung cancer by detecting lung cancer earlier when it’s in a more treatable form,” Wong said. “That’s what allowed us to change our recommendation from age 55 to 50.”

He couldn’t say when a change in age, for example, might occur next, but on average it’s about every five years that the agency reviews and perhaps reconsiders additional research if necessary.

“Sadly, only one in four people in the U.S. who would be eligible for lung cancer screening based on our older age group recommendation have actually gotten CT scans,” Wong said. “So, we called for more research to understand or to help clinicians and patients to come together to have a discussion about the benefits. For additional research looking at the incidents of lung cancer at younger ages, we routinely re-exam our recommendations.”

Smoking by far is the most common risk factor for developing lung cancer and in fact a person who smokes is 20 times more likely to develop lung cancer.

Alyse Yourist consults with Dr. Tom Yadegar in his Tarzana office, Friday, Aug. 6, 2021. Yourist, of Sherman Oaks, learned she had lung cancer only because a breast cancer screening picked it up. (Photo by Michael Owen Baker, contributing photographer).

“It’s important for patients and clinicians to recognize that there are other causes or risk factors to think about including radiation exposure related to cancers,” Wong said. “The task force makes recommendations for all people nationwide so we think very broadly about how do the benefits relate to the harms of screening and we just don’t have evidence in people with the other risk factors of lung cancer to make any scientific determination of the relative harms of doing such screenings versus the relative benefits.”

Wong couldn’t say how much an out-of-pocket lung cancer screening costs should a patient not have insurance or their insurance company wouldn’t pay.

“The task force makes the recommendations and we recognize, because of the Affordable Care Act, that most insurers will cover the screening at no out-of-pocket cost for the patient,” he added. “We base our recommendations, however, on the benefits versus the harms. We leave payment and coverage decisions solely up to the payors, the insurers and our focus is on getting preventive health measures to be a benefit relative to the harms and how do we think about the most appropriate population for that based on scientific evidence.”

Wong said it’s hard to predict the future and he had no idea if the lung cancer screening would become routine like a mammogram but hoped with the declining rates of smoking there would be a dramatic drop in lung cancer and the need for routine screenings would disappear.

“We are on the cusp of an amazing future with regard to health and medical care and it’s hard for me to think of all the possible ways of advancements and influence on cancer in both the development and treatment,” Wong said. “But I will say what’s important to remember is the most important risk for lung cancer is smoking and the best way for people to prevent lung cancer is to quit.”

Source: Orange County Register

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