9,443 viewsSep 13, 2018, 03:38pm
Demand A Scan: Luck Is Not An Option
Bonnie J. AddarioContributori
Lung cancer chest X-rayGETTY
There’s a lucky few who get an accidental early cancer detection.
As if lucky and cancer belong in the same sentence. But as the story of Evy Schiffman shows, they do. And why an early diagnosis is the key to surviving lung cancer. There is a catch though. Early screenings are not a routine part of health care.
This year, Evy Schiffman read in her local paper about a not-so-well-known scan which detects calcium in the arteries to the heart and can assess stroke risk. She was concerned about her stroke risk, so she saved the article and five months later at her physical, she asked her primary care doctor for the Coronary Artery Calcium CT scan. He ordered it for her. Thankfully the scan showed Evy had a healthy heart and no risk of stroke. But it revealed a mass in her lung.
She was diagnosed with Stage 1 lung cancer that was EGFR mutation-positive, the same type that took her husband three years earlier. After a lengthy surgery to remove the mass, Evy was declared free of cancer and her five-year prognosis is good. Her accidental diagnosis did mean the difference between life and death. She calls herself “the luckiest person in the world.”
Early detection is more common for many diseases, including breast, colon or prostate cancer. Massive advocacy and funding efforts have helped the public understand that with early detection, a cancer diagnosis doesn’t mean an absolute death sentence.
Unfortunately, however, for the country’s deadliest cancer, lung cancer, early detection still only happens as a rare or accidental occurrence, even though lung cancer kills more Americans every single year than these other cancers combined.
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Thankfully, Evy’s doctor ordered the calcium scan. His willingness to do so saved her life, probably due in part to being 67 years old, among other factors. But would he have been so compliant had she been much younger? What happens when patients don’t fit the demographic?
Taylor Bell Duck was a 19-year-old collegiate soccer player. She was in the best shape of her life, but for some reason could not pass her school’s fitness exam. After numerous doctor visits with no results, the discouraged athlete assumed her best times were over and quit the team. After a spate of respiratory illnesses and numerous prescriptions of antibiotics from her campus’ student health services clinic, Taylor’s mother called the clinic and begged for her daughter to receive a chest x-ray.
The clinic gave into the pressure, the x-ray showed a mass, but it was quickly dismissed, and neither Taylor nor her family were told about it – simply because she was a 21-year-old student. A few months later, stomach pain and suspected appendicitis landed her in the ER. A CT scan of her abdomen and pelvisshowed she had a lung mass, a collapsed left lung and early signs of cancer. Taylor’s life was saved, but by an accidental discovery revealed by an CT scan ordered for unrelated concerns.
Neither of these women fit the traditional picture of what lung cancer “looks like,” given they were never-smokers, athletic, and active.
Their cases beg the question: What if early detection did not have to be a random occurrence, or a byproduct of another health inquiry? Perhaps hundreds of thousands of men, women, moms, dads, sons, daughters, sisters, brothers, and friends could be saved.
Physicians and others may allow themselves to assume that early detection, and survival, of lung cancer is akin to the leprechaun: a mythical hope that simply doesn’t exist. The lung cancer community, patients, families, doctors, researchers and advocates, battle that assumption every day, on top of the stigma that lung cancer is a smokers’ disease.
Evy and Taylor are living proof of this foolhardy view. And are now sharing their stories to advocate for early detection.
I asked both women what they hoped to accomplish by speaking out. They both answered unequivocally they wanted to see early detection for lung cancer with low-dose CT to become a standard for care, in the same way mammograms, prostate exams, and colonoscopies have become routine.
Right now, the only patients who get a CT scan for early detection are people considered high risk, including current and former smokers. That’s despite proof that 80% of new lung cancer patients have either never smoked or quit decades prior. Up to half of new female lung cancer patients are never-smokers, a number that is growing for reasons researchers have yet to understand, but we desperately need to find the reason. We all know that early detection is the single most important way to reduce all cancer, yet non-smokers don’t have the same access to early scans.
Evy and Taylor’s stories remind us how important it is to reject the stereotypes assigned to lung cancer. They also underscore the critical role physicians play in early screening. Advocates know that education aimed at the public, healthcare, and insurance industries is needed to stem the alarming increase in lung cancer cases.
Once early screening becomes routine, perhaps then we can turn a ravaging cancer into a manageable disease, and luck will no longer need to be a factor in our approach to this public menace.