Lung cancer scans are done with a CT scan machine like this one. (Credit: Liz West)
Only 14.5% of At-Risk Vermonters Are Screened for the Disease
Unlike screenings for breast, prostate, and other cancers, which have a long history and are routine procedures, examining non-symptomatic patients for signs of lung cancer is relatively new. Lung cancer screening for at-risk patients became a standard recommendation covered by insurance only in 2013, after research showed it saved lives, and is still much less utilized than screening for other cancers.
The discrepancy comes at a high price. Absent a regular screening protocol, lung cancer is often detected late, after it has spread, and is the number one cause of cancer death in Vermont and the country. Lung cancer kills more Vermonters, and more Americans, than breast, prostate, and colorectal cancers combined.
A new community education program, spearheaded by the Dartmouth Cancer Center and the University of Vermont Cancer Center in partnership with Vermont’s state cancer coalition, Vermonters Taking Action Against Cancer, aims to make lung cancer screening for eligible patients—those over 50 who have smoked a pack of cigarettes a day for 20 or more years, including those who quit no more than 15 years ago—much more prevalent in Vermont. The project is funded by the National Cancer Institute.
“The goal of this program is to significantly widen awareness among eligible Vermonters of the proven life-saving benefits of lung cancer screening,” said Dr. Rian M. Hasson, assistant professor of Surgery at Dartmouth’s Geisel School of Medicine and a co-leader of the lung cancer screening project.
“We are also working closely with health care teams to make sure conversations about these screenings are a regular and routine part of healthcare in Vermont, and patients can get them in a timely fashion” added Dr. John King, a professor of Family Medicine at UVM’s Larner College of Medicine, also a co-leader of the lung cancer screening project.
Missing Over 50% of Eligible Vermonters
Lung cancer screening is much needed in Vermont. Only 14.5% of eligible Vermonters are currently screened, according to the Journal of the National Cancer Institute.
“Vermont is above the national average of 5%,” said Dr. Beth Zigmund, director of Lung Cancer Screening at the UVM Medical Center and an associate professor of Radiology in the Larner College Medicine. “But that number is still low; we miss well over half of Vermont’s eligible population.”
The impact on mortality is significant.
- Vermonters with lung cancer currently have, on average, a five-year survival rate of 26%, close to the national average of 24%, according to the American Lung Association.
- However, for those whose cancer has metastasized widely—a group that includes nearly half of all those screened in Vermont—five-year survival is just 6%. The number grows to 60% for Vermonters whose cancer is detected when localized at the original site, only about one quarter of those screened, according to the ALA.
“If they’re detected early, local tumors can be removed surgically, and that can be curative for many lung cancer patients,” said Dr. Randall Holcombe, director of the UVM Cancer Center. “By the time you have symptoms, like pain or coughing blood, the cancer may have spread, and the outlook is much less positive.”
Campaign Launches in July; Virtual Community Meetings on July 11
The community education campaign launched in July.
Consisting of posters, social media posts, web advertising, op-eds, and outreach to media, the campaign stresses:
- the life-extending benefits of early detection of lung cancer;
- that it is safe, quick, and covered by Medicare, Medicaid, and private insurance;
- that the procedure takes only a few minutes in a CT scan machine, not in a claustrophobia-inducing MRI scanner, and that it uses a low-radiation-dose technique;
- that patients need to meet with their primary care providers to engage in a joint discussion about the screening, a process called shared decision-making. The provider will then refer the patient to the nearest lung cancer screening facility. There are seven American College of Radiology-accredited lung cancer screening facilities in the state.
- that gas cards are available to eligible Vermonters to defray the costs of driving to a lung cancer screening center.
The public education program will also feature free virtual community meetings from 12 to 1 p.m. and from 6 to 7 p.m. on July 11. Dartmouth’s Dr. Rian Hanson will present and UVM’s Dr. John King will be on hand to answer questions. Registration information is available on the Vermonters Taking Action Against Cancer website.
Statewide, with special focus on Rutland, Milton areas, Northeast Kingdom
To ensure its statewide impact, the program held two continuing education sessions for doctors across Vermont, underscoring the importance of lung cancer screening, highlighting recent changes in patient eligibility, and suggesting that doctors and other health care providers add lung cancer screening prompts to their patient checklists, including in their electronic medical records.
The program will also focus some communications on three target communities: the Rutland area and Northeast Kingdom, which have among Vermont’s highest smoking rates, and the Milton region which, due to the area’s larger population, has a high number of people eligible for lung cancer screening.
Vermont’s seven American College of Radiology-accredited lung cancer screening sites are at the following locations:
- UVM Medical Center in Burlington
- Mt. Ascutney Hospital and Health Center in Windsor
- North Country Hospital in Newport
- Northeastern Vermont Regional Hospital in St. Johnsbury
- Northwestern Medical Center in St. Albans
- Rutland Regional Medical Center in Rutland
- UVM Medical Center, Fanny Allen Campus
The efficacy of lung cancer screening in extending life is based on two large clinical trials. The National Lung Cancer Screening Trials found that patients who were screened for lung cancer saw a 20% mortality rate reduction. A Dutch/Belgian screening trial with the acronym NELSON saw a 24% mortality benefit for men and a 33% mortality benefit for women.
The Dartmouth Cancer Center Dartmouth Cancer Center is one of the nation's premier facilities for cancer treatment and research. It is one of only 52 National Cancer Institute-designated comprehensive cancer centers in the United States. For more details about, refer to the center’s Fact Sheet (PDF).
The University of Vermont Cancer Center is Vermont’s only not-for-profit comprehensive clinical and research cancer center. Founded in 1974, the organization is located within the University of Vermont Larner College of Medicine and has a clinical partnership with the University of Vermont Medical Center.
Vermonters Taking Action Against Cancer Vermonters Taking Action Against Cancer (VTAAC) offers the power of collaboration to what otherwise might be a lonely fight. Created in 2005, VTAAC is responsible for putting the Vermont Cancer Plan into action by preventing overlap and directing resources to where they matter most in our state. VTAAC activities are focused on reducing the burden of cancer for all Vermonters.