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Lung Cancer Screening

Mission Health Poised to Usher in New Era of Hope for Lung Cancer Patients Everyone in western North Carolina deserves the best care possible – the patient at high risk for lung cancer, especially so. As medical advances in all specialties continue to progress at rapid rates, Mission Health remains committed to our role as the region’s leading healthcare provider through an outstanding combination of superior quality of care, unequalled compassion in our caregivers, and a system-wide commitment to sustainable practices.

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Our Why Lung cancer is an exceptionally devastating health challenge in Western North Carolina. The history of tobacco use in this community, along with its value as an economic driver for over a century, puts Mission Health’s patient demographic at increased risk for developing lung cancer.

Lung cancer is associated with some surprising and sobering statistics: Most lethal cancer for both men and women in the United States, and in the world Mortality surpasses that of breast, prostate, and colon cancer combined Responsible for over 150,000 deaths annually in the United States alone Unfortunately, many lung cancer patients are diagnosed when the disease has progressed to late stages (stages III or IV), making the illness difficult to treat and nearly impossible to cure.

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The Case For

Low-Dose CT

Mission Health aspires to lead a groundbreaking preventive care model with a new screening method for early lung cancer detection as its centerpiece. The screening method is called low-dose helical computed tomography (low-dose CT), and is nothing short of revolutionary. The 2002-2004 National Lung Screening Trial, a study published by the New England Journal of Medicine in 2011 and funded by the National Cancer Institute, found that screening definitively reduced the rate of mortality from lung cancer. Below is a snapshot of the study’s parameters: 30 participating hospitals across the country 53,454 subjects who were determined to be at high risk for developing lung cancer Participants were ages 55-74 with at least a 30 pack year history of smoking; they were either still smoking or had quit within the past 15 years.

One participant group received a yearly low-dose CT scan for two years. The other group received single view chest X-rays over the same period.

Due to ethical considerations, the study concluded earlier than expected, as the benefits of low-dose CT over chest X-rays were overwhelmingly apparent.

A host of highly respected lung cancer organizations, such as the Lung Cancer Initiative of North Carolina, the American College of Radiology, and the Lung Cancer Alliance, acknowledge the importance of low-dose CT as the most important new diagnostic tool for lowering the national lung cancer death rate.

Low-dose CT screenings have been shown to reduce mortality, as they more accurately uncover early stage lung cancer, allowing physicians to treat patients more effectively, and subjecting patients to a safer screening experience. Dose reduction software enables low-dose CT scans to impart far less radiation than a standard chest CT. Better yet, the screening process is a quick (less than 30 seconds) and painless “one breath” test, requiring no pre-procedure medication or injections.

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Cutting-Edge Tools.

Unparalleled Results.

Dr. Oliver Binns, thoracic and cardiac surgeon at Mission Hospital, refers to this diagnostic tool as a true game changer when it comes to saving more lives.

Simply put, this low-dose CT screening achieves what we haven’t been able to accomplish in the past; since we catch the disease significantly earlier with this test, we can treat patients earlier. This translates into increased survival and a higher chance for cure.

Dr. Oliver Binns Thoracic and Cardiac Surgeon at Mission Hospital

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Hospitals and health systems who have instituted low-dose CT screening programs have seen stage III and IV lung cancer diagnoses plummet to unheard of levels in the 25-30 percent range.

Statistics confirm Dr. Binns' comments: 75 percent of lung cancer diagnosis signify incurable disease with less than a five percent chance at a five-year survival rate (a figure that has remained relatively unchanged in decades).

In the first year of the Mission lung cancer screening program nine of 703 patients were diagnosed with lung cancer.

Of those nine patients four were diagnosed with stage one disease and more than half were diagnosed with stage one or two disease. This is a vast improvement over our non-screened patients. Historically, 76 percent of Mission Health patients diagnosed with lung cancer are diagnosed at either stage III or IV, and the other 24 percent of patients are diagnosed at stages I or II. Mission Health hopes to flip this statistic with the low-dose CT Lung Cancer Screening Program; this program is critical to our success.

Hospitals and health systems who have instituted low-dose CT screening programs have seen stage III and IV lung cancer diagnoses plummet to unheard of levels in the 25-30 percent range. One such institution is Lahey Hospital and Medical Center in Burlington, Massachusetts, which saw dramatic and positive results after the establishment of their screening program. Before the screening program was introduced, the number of all patients receiving stage III diagnoses was 24 percent; patients diagnosed at stage IV constituted 36 percent of the diagnosed population.

Amazingly, between 2012 and 2016, when low-dose CT screening was implemented, patient statistics shifted to 12 percent for stage III and nine percent for stage IV – a reduction by more than half for each patient population.

Dr. Gregory Campbell, a pulmonologist with Asheville Pulmonary and Critical Care Associates, P.A., and board certified in Pulmonary Medicine, Internal Medicine, and Critical Care, asserts that the diagnostic process is complex.

“Finding cancer early is a two-fold process; [diagnosis requires] the CT to find the nodule, and the diagnostic test to help confirm the diagnosis. In the time of screening, we must be prepared for the false positive results that were prevalent in the initial studies. Fortunately, we are at a point where the resolution of our CT scanning and the capability of our diagnostic testing – including endobronchial ultrasound, navigational bronchoscopy, and CT guided biopsy – help discern what is benign from [what is] cancer,” he explains. Having a robust screening, diagnostic testing and a multidisciplinary team for interpretation of the results is vital to making the screening program successful.

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Life-Changing Advantages Low-dose CT enables doctors to stop lung cancer in its tracks in an unprecedented way. The low-dose CT screening method can produce diagnoses faster and earlier than the largely inefective chest X-ray methods of the past — a tremendous advantage for high-risk patients. The ability to find smaller, early stage cancer before they become symptomatic is our best chance for a cure.

Dr. John Ende, Director of Body Imaging for Asheville Radiology Associates, is a veteran in his field, and echoes clinical thoughts on the monumental change low-dose CT scans are ushering in: “I’ve diagnosed a lot of patients with inoperable lung cancer in my 20 years of practicing radiology. I look forward to finding early lung cancer in the small nodule stage while it can be treated,” he shares, emphasizing the transformation this innovation will prompt in his work and lives of his patients.

When compared with the options of traditional radiography or no screening, the low-dose CT lung cancer screening also makes fiscal sense, particularly relative to Medicare and Medicaid coverage. The Centers for Medicare and Medicaid Services (CMS) approved coverage in 2015, the first time lung cancer screening has been approved for Medicare coverage.

This coverage not only provides evidence of sustainability, but is of vital importance to our patient community; three quarters of our patient population are Medicare/Medicaid patients. In a November 2014 article by the New England Journal of Medicine titled “Cost-Effectiveness of CT Screening in the National Lung Screening Trial,” it was concluded that low-dose CT screening was potentially cost-effective when compared to other screening modalities.

John F. Ende, MD Director of Body Imaging Asheville Radiology Associates

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Plan of Action Investment in the lung cancer screening program will benefit countless community members and not only maintain Mission Health's ranking as one of the Top 10 Hospitals in North Carolina, but as a high-performing hospital in the area of lung cancer surgery, per U.S. News & World Report.

Program funding will require crafting a complex logistical system. However, screening recipients and lung cancer patients will benefit greatly from this addition; the care provided by Mission Health staff, clinicians and team members will be enhanced and strengthened by this carefully designed framework.

The specialized roles of the staff forming the interdependent team to lead the low-dose CT Lung Cancer Program are crucial to its success.

Each specialist has his own unique area of expertise; thus, a thriving program requires a care team that includes: Pathologists Pulmonologists Thoracic surgeons Radiation oncologists Medical oncologists Nurse Navigators C-T screening technicians Administrative staff

The importance of skilled clinicians and staff cannot be overstated, notes Dr. Campbell. “Having the availability of screening, diagnostic testing, and a multidisciplinary team for interpretation of the results, is vital to making the screening program successful.”

The low-dose CT Lung Cancer Screening Program will also complement and strengthen existing innovative programs Mission Health, such as the Lung Cancer Nurse Navigator Program and the Weekly Multidisciplinary Conference, each of which is assessed by an entire team of medical experts – from radiologists and surgeons, to navigators and oncologists – who specialize in lung cancer treatment.

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Low-dose CT screening is an essential addition to our already-advanced arsenal of diagnostic tools, which includes endobronchial ultrasound, navigational bronchoscopy, and CT-guided biopsy. Mission Health has exhaustively studied other hospital systems’ successful low-dose CT screening programs. The data gathered will be used to structure our own exemplary program and gain accreditation from the American College of Radiology.

For the Mission Health Lung Cancer Screening Program to be successful, it will require: Marketing materials to inform and educate the community about the program and benefits Specialized training and testing in the low-dose CT scanning method for Mission Health radiologists, and continuing education for program practitioners Training and education for staff interpreting scan results Instructive reference tools for radiologists Specialized software for patient data management (screening through follow-up) Screening machinery Retro-fitting and/or construction of new, dedicated space within Mission Hospital for patients, screening, and administration Creating an administrative team, which is vital to successful implementation Dedicated personnel for program maintenance and communication with patients, referring providers, and program stakeholders IT solutions to identify screening patients and alert providers Program integration with existing and relevant Mission Health programs, such as the smoking cessation program already in place

Mission Health considers regional community members to be partners in growth. Together we can make a tremendous impact on the health and wellbeing of all those served in western North Carolina.

Mindful investment in the creation of the low-dose CT Lung Cancer Screening Program will require funds, research, development, and committed partnership between and among Mission Health leadership, staff, donors, and the community.

Mission Health stands on a strong foundation from which to build this program. An outstanding medical team consisting of radiologists, thoracic surgeons, radiation oncologists, and others is currently in place and meets weekly to discuss potential lung cancer diagnoses.

Consider this: While lung cancer kills more women than breast cancer, in 2015 fewer people were screened throughout the Mission Health system than on any single day of screening for breast cancer at Mission Breast Center. When it comes to screening for lung cancer, there is vast room for improvement; this revolutionary tool is an essential component in the creation of a new and successful diagnostic model.

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Return on Investment Establishment of the Lung Cancer Screening Program, and subsequently, earlier detections, will initiate a seismic shift in our region’s healthcare landscape, and save the lives of hundreds of community members.

The responsibility rests with Mission Health to pioneer this critical endeavor. In addition to the construction of and improvement to our facilities, the low-dose CT Lung Cancer Program project touches the heart of Mission Health’s purpose: to save lives and minimize the suffering of our patients.

The most significant of program outcomes will be the number of lives we can save. Implementing this program will extend the lives of our patients and enhance the work of our clinicians for generations to come.

The Mission Health Lung Cancer Screening Program will deliver a profound gift to patients, loved ones, clinicians, and caregivers – and offer a new level of hope for our community.

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