September, 2009
By Shannon Wilder
In Georgia alone, according to figures from the Georgia Cancer Coalition, every year between 1992 and 2002, some 5,200 lung cancers were reported. During that same period, 4,000 Georgians died from lung cancer.
“The problem with lung cancer is that it grows in asymptomatic patients,” says William Mayfield, M.D., Chief Surgical Officer for WellStar Health System and a board-certified thoracic and cardiovascular surgeon at Marietta’s WellStar Kennestone Hospital. “By the time you have symptoms, it’s generally too late to cure. The best way to cure lung cancer is to detect it in its earliest stages and take it out.”
Sounds simple enough, but there’s one catch – and it’s a pretty big one. To date, there is no widely accepted method for early detection.
“We have screening exams for breast cancer and for cervical cancer in women, but lung cancer kills more women than breast cancer and cervical cancer combined,” Dr. Mayfield says. “We have screening for colon cancer and prostate cancer in men, but lung cancer kills more men than colon cancer, prostate cancer and pancreatic cancer combined. So what’s the problem – why aren’t we screening for the deadliest disease?”
To address the situation, Dr. Mayfield, a pioneer in video-assisted cardiac and thoracic surgery who’s practiced for 20 years, has joined forces with an international effort to determine if low-dose radiation computed tomography chest images (i.e., CT scans) are, indeed, the most effective means to detect lung cancer early on.
Dr. Mayfield serves as principal investigator for WellStar Health System’s participation in I-ELCAP, the International Early Lung Cancer Action Program. Founded in 1991 by a group of physicians at Cornell University, the study, Dr. Mayfield says, “aims to determine whether or not low-dose CT scanning saves lives by early detection. That’s what we’re trying to do – determine if low-dose CT scanning saves lives from lung cancer.”
Because they involve low-level radiation, Dr. Mayfield says CT scans are drawing some fire as a safe means of early detection. In response, he points to another once-controversial procedure that’s now the leading means of early detection for breast cancer – mammography.
“The criticisms of CT scanning for lung cancer are the same as the criticisms were of mammography for breast cancer screening 15 years ago,” he says. “Mammography had to undergo 10 years of testing and scrutiny and statistical analysis before it was determined that it really was saving women’s lives with breast cancer.”
Stage 1A adenocarcinoma caught early through screening
Local Impact
WellStar Health System, which operates five hospitals in the Metro Atlanta area along with numerous physicians’ group sites, is enrolling participants for the study, which it refers to simply as the Lung Cancer Screening Study. Anyone 40 and over, who either is a current smoker, has smoked for at least one year or lived for at least 10 years with a smoker, is eligible.
For agreeing to take part, Dr. Mayfield says, participants receive a considerable discount on the cost of the CT scan. The $270 fee for each test can be covered with funds from a flexible spending account. “This is a huge discount over what you would be required to pay for a CT scan and an interpretation under any medical plan,” he says.
Plus, unless a patient has an abnormality such as a mass, discovered via chest X-ray or has a clinical condition such as pneumonia or some probable cause, such as coughing up blood, insurance companies tend to deny coverage for a CT scan.
“The study is entirely voluntary,” says Vickie Beckler, R.N., WellStar Health System’s lung cancer screening coordinator. “The one thing we do ask each participant is that they commit to coming back for at least one follow-up. However, to be effective for screening for early stage lung cancer, you really need more than one follow-up. We encourage annual screenings. For most people that first follow up will be 12 months, but for a few it could be sooner – it just depends on what we find on the initial screening exam.”
As for length of participation, there is no set-in-stone cutoff date for the study to end. “The study is actually just set for accruals until Cornell determines that the database proves statistically that the detection and the workup of these patients saves lives,” Dr. Mayfield says.
Participants don’t have to be WellStar Health System patients, either. The study is open to anyone willing to drive to one of four screening sites: WellStar Cobb Hospital in Austell, WellStar Douglas Hospital in Douglasville, WellStar Kennestone Hospital in Marietta and WellStar Paulding Hospital in Dallas.
Beckler’s job is to explain the study to participants and assist with completion of enrollment documents, then stay with them throughout the procedure. She also reports the findings back to the participant, after the scans have been analyzed by study subinvestigators, who are pulmonologists at WellStar Health System’s STAT (Specialty Teams and Treatment) Clinic, a cancer treatment facility located on the WellStar Kennestone campus.
“We have a multidisciplinary team of lung specialists that works with us on the study, including dedicated radiologists and pulmonologists,” Beckler says.
It usually takes about a week to mail the test results to participants, but Beckler goes over them verbally prior to that. And if cancer is suspected, Dr. Mayfield meets with participants and discusses their options with them. After that, it’s up to the patient and his or her primary care physician to come up with a treatment plan. WellStar Health System patients are likely to be treated at the STAT Multidisciplinary Lung Cancer Clinic, where Beckler works closely with a nurse navigator who is assigned to each patient to monitor that person’s progress.
It is important to note that the I-ELCAP Lung Cancer Screening program is a part of the larger continuum of care program for lung cancer at WellStar Health System. That continuum of care includes Smoking Cessation Clinics, the I-ELCAP Study, the STAT Multi- Disciplinary Clinic and other advanced medical services. Those advanced services for lung cancer include CyberKnife radiation therapy for appropriately selected patients, video-assisted thoracic surgery for cancer surgery and clinical trials available through affiliated medical oncologists.
Positive Side Effects In addition to gathering data to prove the CT scan’s effectiveness, Dr. Mayfield says, “We are picking up very early stage lung cancers in people who are completely asymptomatic, who had no idea they had lung cancer, who would very likely have died of their disease. It truly is changing people’s lives.”The study is also helping to uncover other abnormalities. “We also do look at incidental data,” Dr. Mayfield says. “We have found thyroid cancers, coronary artery disease and some aortic aneurysms. Those are incidental findings; the patients are treated for those by the appropriate practitioners, but it is not the focus of the study.”
So far, about 450 people have participated in the study at WellStar Health System, Dr. Mayfield says, in addition to some 45,000 international participants at other study sites, which are located at universities and medical centers throughout the United States and abroad.
“It’s not really about numbers,” Beckler says, “it’s about quality and doing what’s right for the patient. There’s so much that goes into each case. We have a very thorough program. Much of our program’s success is due to the dedicated physician leadership team heading the study.”
Indeed, WellStar Health System has been, if not exactly keeping the study under wraps, not shouting it from the rooftops, either. The reason: Response from within the WellStar Health System itself since participation began in June 2008 has been strong. Also, word of mouth is proving an outstanding method of getting the message across.
“Through word of mouth, this has developed a life of its own,” Dr. Mayfield says. “For example, we’ll have a patient who comes in and gets scanned and she feels it’s so important that she then calls her sister to get her scanned, and then she and her sister get their husbands to come in and get scanned. It’s been somewhat of a viral syndrome that markets itself.”
And getting the word out to women is key. “Nothing in the medical world moves until you get women involved,” Dr. Mayfield says. “Women are going out there and getting their mammograms and their pap smears. I want them to know that if they are a smoker or former smoker, they’re at higher risk of dying from lung cancer than they are breast or cervical cancer. We have to get women around this issue because it’s the most lethal cancer of all for them.”
Dr. Mayfield is more than aware that it will take action on the part of many individuals to make a difference. “We have a chance to change the course of this disease in our local population,” he says, “and it’s really a matter of awareness. That means asking our primary care doctors to talk to their patients that smoke or were former smokers, and realize that they really, really are at risk of lung cancer – and that we’ll never answer the question about early detection unless we all pull together and support this type of study.”
