Results spur doctors to push lung cancer screenings
Published: Wednesday, November 21, 2012 at 6:01 a.m.
Last Modified: Tuesday, November 20, 2012 at 1:19 p.m.
Three years ago, Deborah Shaw-Mirando had a cough that wouldn't go away. She thought it might be a cold, or allergies. Her doctor thought differently. Knowing Shaw-Mirando's family history of lung cancer — both her mother and grandmother had had the disease — Shaw-Mirando's doctor ordered an X-ray.
The X-ray revealed a suspicious spot behind Shaw-Mirando's clavicle. A CT scan sharpened the image, revealing a nodule that looked like lung cancer. A biopsy confirmed the disease.
"That scan saved my life," said Shaw-Mirando, of Gainesville, who three years later is cancer-free. "Had I just bought cough syrup, who knows where I would be today."
Lung cancer is the leading cause of cancer death in the U.S., causing more deaths than breast, prostate and colorectal cancer combined. It's also the disease that most often escapes attention because there are few symptoms apart from a cough that is often mistaken for something else.
Ironically, Shaw-Mirando's cough turned out to be acid reflux. But if the cough means lung cancer, the disease is usually too advanced to be cured.
Because of this dire situation, doctors are pushing for more lung cancer screenings, specifically with CT scans, which unlike X-rays, are 3-D and able to pick up more tumors in hard-to-see places.
"There's better visualization. You can see behind the heart and parts of the lung that sit behind the heart," said Dr. Manish Jani, a radiologist at Invision Imaging, which is part of North Florida Regional Medical Center. November is lung cancer awareness month, and Invision recently launched its lung cancer screening program.
Screening centers throughout the nation have stepped up lung cancer screenings after a major study called the National Lung Screening Trial in the summer of 2011 showed a 20 percent reduction in lung cancer mortality using CT scans compared with X-rays for smokers. The American Cancer Society developed interim guidance (not official guidelines) advising people ages 55-74 who have smoked at least one pack of cigarettes a day for 30 years, or two packs a day for 15, to consider screening.
Shaw-Mirando smoked 20 years ago, but less than a pack a day, and for about 10 years. But her family history put her at a higher risk of getting the disease, so her diagnosis was disappointing but not surprising, she said. She had her upper left lobe removed but was spared follow-up chemotherapy and radiation.
As a nurse, Shaw-Mirando also had worked with a lot of lung cancer patients who fared much worse. "Back in the ‘80s and ‘90s, when we had lung cancer patients, we knew that was a death sentence," Shaw-Mirando said. "It was very sad. They usually had six months."
Shaw-Mirando was also lucky to be diagnosed early, when the odds of survival are high: 50 percent to 60 percent of patients are alive five years after diagnosis, compared with 5 percent of patients diagnosed with advanced disease. Now, Shaw-Mirando gets a CT scan every six months and sees her oncologist every three months. She said she feels both lucky to be alive and humbled to life's uncertainties.
Shaw-Mirando said she hopes that increased screening efforts will save more lives. "There's no reason people have to die from lung cancer," she said.
She said she hopes lung cancer screening follows the path of breast cancer screening, where earlier and more frequent mammographic screenings are widely believed to have saved thousands of lives by catching breast cancer when it's early enough to be treated.
Doctors at Invision find lung cancer several times a week, if not every day, with CT scans, Jani said. The center recently reduced the price of a CT scan from about $255 to $150 to make the test more accessible.
"Cost is an issue, but because the data is so strong, we had to remove that barrier," said Jani, adding that the clinic prefers primary-care physician referrals to walk-ins.
Kristine Crane is a Gainesville Sun staff writer.