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Early detection is your best bet for long term survival

The changing season and cooler weather drives people indoors for longer periods of time. So, it’s no surprise that coughing and hoarseness may increase due to dry indoor air. However, if you are a smoker, there may be more to explain your raspy, hoarse voice than the environment.

According to the Centers for Disease Control and Prevention (CDC), lung cancer is the third most common cancer in the United States. It is the leading cause of cancer death among men and women, making up almost 25 percent of all cancer deaths. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined.

The American Cancer Society (ACS) notes that chances of a man developing lung cancer in his lifetime is about 1 in 15; for a woman, the risk is about 1 in 17. These numbers include both people who smoke and those who don’t smoke. The risk is much higher for smokers, while for those who don’t, the risk is lower.

The primary reason for lung cancer is cigarette smoking. Other risk factors include radiation therapy, family history, and exposure to asbestos and other heavy metals. Signs of lung cancer don’t appear until the later stages of the disease, so it is not uncommon that it’s often discovered when patients visit their doctor for other health issues.

The most common symptoms of lung cancer are a persistent cough, hoarseness, loss of appetite, shortness of breath, weight loss, feeling tired or weak – many of which can be explained away by other maladies, or a busy life. Some lung cancers can cause a group of symptoms which occur together.

This was true for Carrie Montoya.

Carrie started smoking at age 16, primarily due to peer pressure. “I grew up in a little town in Nebraska, and started because most of my friends smoked,” she said.

After high school, she joined the Air Force where smoking had its advantages. “If you smoked, you got a break,” she said. In fact, it was over cigarettes during smoke breaks that Carrie made many friends at work. “Smokers have smokers for friends.”

Carrie was a medic in the military and knew enough about medicine to self-diagnose when she didn’t feel well. She confesses she hadn’t seen a doctor in over 10 years, but she kept her weight in check, felt good, was busy with family, travel, and weekends at the lake.

However, things changed in May.

Carrie was at the lake to open the cabin for the summer. That Saturday, she cleaned, planted flowers, and drove back and forth to Minot more than once to take care of business and run errands. That evening at bedtime, she noticed she had difficulty getting into bed.

“The bed is high, and I couldn’t get my leg high enough to get in. I had to lift it manually,” she said. She attributed it to fatigue and added, “I thought I’d just worked really hard that day.”

The next morning when Carrie woke up, she noticed one side of her face was drooping. The medic in her kicked in, and she was certain she had the signs of a stroke. Carrie and her husband returned to Minot and went to Trinity Health’s ER, where an MRI showed a mass on her brain. Carrie consulted with Maria Li, MD, Neurosurgery, and 48 hours later, after a flurry of medical tests, emergency preparations, and life-altering decisions, Carrie underwent a craniotomy. It turned out to be a seven hour event, during which she remained awake so doctors could monitor the removal of the tumor to avoid potential paralysis. Afterwards, Carrie learned that tests revealed the primary site of her tumor was in her lung.

Although lung cancer has long been the leading cause of cancer deaths in the U.S., widely accepted screening tools are available to detect it at an early enough stage to make treatment more successful. This was not always the case.

In 2011, the National Lung Screening Trial (NLST) published results from its eight-year study that compared two ways of detecting lung cancer: low-dose helical computed tomography (CT) and standard chest X-ray. Helical CT uses X-rays to obtain a multiple-image scan of the entire chest, while a standard chest X-ray produces a single image of the chest.

The study findings revealed that participants who received low-dose helical CT scans had a 15 to 20 percent lower risk of dying from lung cancer than participants who received standard chest X-rays. Low-dose CT scans proved safe and effective in catching tumors in patients at the highest risk for developing lung cancer. For lung specialists, this was a game changer.

Scott Lewis, MD, medical director of Trinity Health’s Radiology Department, says based on those studies, Trinity provides a low-dose CT screening program for past and current smokers who meet certain criteria.

“This is an important program because in the past, medicine has not had a safe screening tool to detect lung cancer in these high-risk patients,” Dr. Lewis said in a press release. “Low-dose CT is safe, and it will help identify patients with early stage, treatable lung cancer and in the long run help reduce the number of deaths.”

Early screening can play an important role in survival rates, although statistics show that in 2020, only five percent of eligible individuals were screened for lung cancer. Low-dose CT scans help identify abnormal areas in the lungs that could indicate cancer.

The U.S. Preventive Services Task Force recommends that individuals at high risk for developing lung cancer undergo an annual low-dose CT screening exam, which is quick and easy. You may qualify for a low-dose CT lung cancer screening if you meet all these criteria: Are between 50 and 80 years old; have no signs or symptoms of lung cancer; are a current smoker or have quit within the last 15 years; and have smoked the equivalent of at least one pack a day for 20-30 years.

Carrie says that prior to her diagnosis, regular doctor visits would have been a catch-22. “For smokers, it’s a Pandora’s box. If I go in, and they find something, then I’d have to treat it. I convinced myself I was healthy because I felt fine.”

Survival rates increase substantially when lung cancer is diagnosed at an early stage. ACS data show the five-year survival rate for stage 1 diagnosis is 68-92%, whereas the survival rate for stage 4 diagnosis is 0-10%.

Carrie knows she will never be cancer free and will require scans every three months to monitor whether her cancer has returned or spread. She maintains an extraordinarily positive attitude, which she claims as the only way to deal with what may come. She said it’s how she was raised. In some ways, she says she feels healthier: she’s quit smoking, walks more and has less stress.

“Dr. Li saved my life in more ways than one,” she said. “I should have died of a massive stroke or could have died driving to Minot. I could have died in surgery, or ended up paralyzed, but here I am. If I had gone to Mayo, or anywhere else in the U.S., there is no better outcome that I could’ve gotten. I love my doctors at Trinity.”

Patients interested in being screened should talk to their primary care provider or call Trinity’s Pulmonary Clinic at 701-857-5741. You will need to be seen by a provider for a face to-face clinic visit to discuss qualifications and the risks and benefits of low-dose CT. A provider’s order is needed to receive a low-dose CT exam.

For information about Trinity’s lung cancer screening program, log on to www.trinityhealth.org/lowdose.