MedStar Georgetown Puts National Study Findings Into Practice
The National Cancer Institute announced a stunning first in the long-running battle against lung cancer last summer: Low-dose helical computed tomography identifies early malignancies more often than standard chest X-rays, resulting in interventions that are more successful and a 20 percent reduction in mortality.
Georgetown University Medical Center is one of 33 major medical centers that participated in the National Lung Screening Trial (NLST) — which is the source of the news. Armed with this clinical data, MedStar Georgetown University Hospital launched a large and comprehensive lung cancer CT screening program in the region — one of the first of its kind in the country. Under MedStar Georgetown’s direction, the program is also available at MedStar Washington Hospital Center, MedStar Montgomery Medical Center and MedStar St. Mary’s Hospital.
“Historically, most lung cancers are not detected until an advanced state, resulting in a five-year survival rate of only 15 percent,” says Dr. Eric Anderson, MedStar Georgetown’s director of Interventional Pulmonology. “Yet that rate soars to nearly 90 percent over 10 years when the disease is treated in its earliest stages, making the NLST findings truly significant.”
Adds Dr. Claudine Isaacs, principal investigator for the NLST study at MedStar Georgetown, “It is now clear that CT screening of individuals at high risk of developing lung cancer can save lives.” Under Dr. Isaacs, MedStar Georgetown followed approximately 1,800 area residents during the trial through its Lombardi Comprehensive Cancer Center — the only NCI-designated comprehensive center in the area and one of only 41 nationwide.
Altogether, the NLST involved 53,454 current and former heavy smokers, randomly assigned to either CT or X-rays scanning, from 2002 until 2007. Primary research results were published in the New England Journal of Medicine in June 2011.
Since then, the American Society of Clinical Oncology, the American Thoracic Society and the American College of Chest Physicians have been developing clinical practice guidelines for lung cancer screening based upon the study. Public health observers expect the U.S. Preventive Services Task Force, other nationally recognized health societies and Centers for Medicare and Medicaid Services (CMS) to follow suit.
Oncology leadership at MedStar Georgetown, however, did not want to wait for policy to catch up with science and their own experience with NLST to make screenings available.
“We believe it’s only a matter of time before this becomes the recognized standard of care,” says Dr. John Deeken, medical director for the MedStar Cancer Network’s Lung Screening Program. “Until then, we’re running our new program ‘strictly by the book.’”
Following NLST’s data and parameters, MedStar Georgetown’s lung screening program restricts participants to current and former heavy smokers 55 years and older. Heavy smokers are defined as those with a 30-pack-year history, determined by multiplying the number of years smoked by the average number of packs per day. Former smokers must have quit within the last 15 years to be eligible.
Standardized across four MedStar hospitals, the protocol includes a team of radiologists, pulmonologists, thoracic surgeons and a nurse navigator at each institution. Eligible patients receive an initial CT screen and, if findings are negative, a repeat scan over each of the next two years. Those with positive results or suspicious or inconclusive findings are referred back to their primary physician with recommendations based upon established pulmonary and/or surgical standards. In addition, all smokers and former smokers at risk of relapse may participate in a MedStar research study to evaluate the effectiveness of various smoking cessation approaches.
While individuals can call a centralized number to get more information about the program, authorization for the actual CT requires a referring physician’s order.
“Our goal is to partner with primary care physicians to screen those who could benefit the most, while assuring that ultimate decisions on follow-up and care remain with the patient and their personal physician,” Dr. Deeken says.
Dr. Anderson concurs.
“This is a valuable new service for area physicians and their patients,” he says, “Thanks to CT screening, we can now detect lung cancer at its earliest stages, when we have the best chance for a cure.”
NOTE: At the time of this writing, CT screening for lung cancer is not covered by Medicare or most private insurance.