On October 26, 2011, lung cancer screening guidelines were published by the National Comprehensive Cancer Network (NCCN). The guidelines became necessary after data from the National Lung Screening Trial (NLST), sponsored by the National Cancer Institute, showed that screening with low-dose computed tomography (CT) decreases disease-specific mortality by 20% and all-cause mortality by 7% when compared to chest x-ray alone.1
Currently, the 5-year survival rate for lung cancer is only 15.6%.2 This is because lung cancer is usually discovered at a late stage when symptoms appear. In most cases, this is too late for curative treatment. CT screening could prove pivotal in changing the course of lung cancer for many individuals. In 2011 alone, it is estimated that 156,900 deaths from lung cancer will occur in the United States.2
The NLST findings and the publication of NCCN lung cancer screening guidelines could be a turning point in early diagnosis of lung cancer. This research and publication are extremely significant and pave the way for future adoption of public and private insurers providing coverage for lung cancer screening for individuals considered “high risk” for lung cancer. Please see the NCCN guidelines for a definition of “high risk.”3
The US Preventive Services Task Force (USPSTF), a federally funded and appointed panel, evaluates screening data and makes recommendations for screening. The USPSTF is slated to review the lung cancer screening data next year. Its recommendations are not mandatory in order to set clinical standards for management, but they are often used by public and private insurers to determine coverage.
Throughout November, Lung Cancer Awareness Month, it is fitting to celebrate the recent findings of the NLST and the adoption of clinical practice guidelines for lung cancer screening. For too long, smokers have been stigmatized when given a lung cancer diagnosis. Not only is it discriminatory to the patients who are addicted to nicotine, but it is also an inaccurate portrayal of the disease. In fact, data from the Centers for Disease Control and Prevention in 2006 showed that 60% of lung cancer patients had already quit smoking and 17.8% had never smoked.4
Lung cancer patients deserve our attention, support, compassion, and action. As nurse navigators it is our duty to be advocates for our patients. We can do this by promoting and implementing lung screening programs at our institutions. We have evidence now to show that it saves lives. We have NCCN guidelines to follow for diagnosis and surveillance. Determination of coverage is forthcoming. Mammogram reduces mortality from breast cancer by 15%, and given the NLST findings that CT lung screening reduces mortality by 20%, it is likely to become a covered service.
Imagine if a decade from now, the adoption of CT lung screening in the United States could raise the 5-year survival rate for lung cancer from 15% to 50%. I challenge nurse navigators to be the catalyst for change in their institutions. Pick up the torch and carry it for all the lung cancer survivors – past, present, and future – that you touch through navigation. You have an opportunity to screen patients for this deadly disease and detect lung cancer in its earliest stages, when it is treatable and curable. Make a difference in your patients’ lives and at the same time be a part of history in the making!
REFERENCES
- www.cancer.gov/clinicaltrials/noteworthy-trials/nlst.
- http://seer.cancer.gov/statfacts/html/lungb.html.
- www.nccn.org/professionals/physician_gls/pdf/lung_screening.pdf.
- www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm.
