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Maine Docs Embracing C-T Screenings for Lung Cancer
08/12/2013   Reported By: Patty B. Wight

Lung cancer is the top cancer killer in the U.S., and Maine has a higher-than-average mortality rate. The search for an effective screening tool has proved elusive for years. But recently, physicians have started to embrace a method once considered controversial. C-T scans are now being used to screen those most at risk for lung cancer, with the goal of detecting the disease in its early stages. Patty Wight reports.

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Doctors are bound to get frustrated when trying to cure a patient of a tenacious disease like cancer. But Dr. Chris Kuhn - a radiologist at Mercy Hospital in Portland - says lung cancer is particularly frustrating.

"It's not unusual to have just a random chest x-ray come across the desk for a cough or something, and you see a three-and-a-half centimeter cancer that's metastasized to bone," he says. "And then the conversation has changed, of course, from, 'Well, let's cure this,' to, 'You've got a few months and these are the things we can offer you to improve your quality of life.'"

Lung cancer accounts for more deaths in the U.S. than breast, colon, and prostate cancers combined. One of the reasons mortality is so high, says Dr. Seth Blank of Mercy Portland Thoracic Surgery, is that it's difficult to detect the disease early.
"In the early stages, lung cancer is highly treatable, usually curable. In the later stages, it's not," he says. "And the problem with lung cancer is, early stages don't have symptoms."

But if doctors can get a good picture of someone's lungs, they have a chance of catching it early. This is where a C-T scan delivers - it takes a series of x-rays to create detailed images of organs, tissues and bone.

But it also delivers radiation to the patient, and in the past, the risk of that exposure outweighed the potential benefits. But Dr. David Langdon of Mercy says that's changed.

"Advances in technology now allow us to do very good images with much lower dose, so it's an acceptable amount of radiation to administer to the public," he says.

Doctors also have a much better understanding of who is most at risk for developing lung cancer, and can target those patients specifically. Generally, those at highest risk are 55 to 79 years old, with a 30- or more- so-called "pack-year" history of smoking. In other words - an average of a pack a day for 30 years, or it could also mean two packs a day for 15 years.

The profile fits a guy like 56-year old Dan Wilson, who says he smoked one to two packs a day, "since I was 10 years old, 11 years old. I always smoked when I was a kid, and right up through."

Wilson, a self-employed roofer in Westbrook, says he quit five years ago. But he can't shake the lingering fear that he'll one day develop lung cancer, just as his late father did. So when Wilson felt shortness of breath a few months ago, he headed to the doctor's office.

"So I just - I don't have the insurance. I don't take a lot of - I don't go to the doctor's - I have a physical every eight to 10 years, something like that," he says. "So I just figured it was time to do it and have the whole nine yards done so I could find out if there was anything wrong."

Wilson's C-T scan revealed a spot on his lung, so doctors ordered a more intensive PET scan to find out if it was cancerous. To his relief, it wasn't. The entire process set Wilson back nearly $3,000. He's paying in monthly installments and says it's worth it. Just a small portion of his bill was for the C-T scan - Mercy charges a maximum of $275 for uninsured patients like Wilson.

Even if he was insured, insurance companies aren't required to cover the C-T scan - yet. That may change, thanks to the U.S. Preventive Services Task Force's recent recommendation that those at high risk for lung cancer receive annual C-T scans. The recommendation still needs final approval, but Dr. Dave Langdon of Mercy says given recent research, there's no question the scans should be used for high-risk patients.

"It decreases the mortality 20 percent, so it's a huge decrease in mortality," Langdon says. "And for the citizens of Maine, I think, those people have a chance now to really change their life."

Mercy started offering lung cancer screenings in March. Other hospitals, such as Central Maine Medical Center and Sebasticook Valley Health, also offer C-T scans to screen for lung cancer. Both Maine Medical Center and Eastern Maine Medical Center say they are considering their use in the future.



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