Lung cancer is the No. 1 cancer killer globally, taking more lives than breast, prostate and colorectal cancers combined— and 20 percent of those people have never smoked, according to the American Cancer Society (ACS).
An early diagnosis can be life-saving. The five-year survival rate for patients with stage 1 lung cancer is roughly above 80 percent1, while it’s only about 1 percent at stage 41, says Dr. Momen Wahidi, an interventional pulmonologist at Duke University Medical Center.
One culprit? Untracked, untreated incidental lung nodules. These appear on scans as spots or shadows during unrelated health screenings — think of pneumonia or a physical injury — and may eventually turn into lung cancer. Incidental lung nodules have an estimated 25 percent malignancy rate[i],[ii],[iii], compared to up to only two percent in populations whose lung cancer was identified during a routine screening.3,4,5
“Any finding on a scan that’s not expected to be there would be a suspicious finding that should be followed up on,” Wahidi says. The problem, some experts say, is that until recent years, the extent to which doctors have followed and managed lung nodules has involved using sticky notes, spreadsheets and other manual means. This lack of efficient infrastructure has contributed to 71 percent of incidental lung nodules going unfollowed and unmanaged.[iv]
Fortunately, new technologies are helping oncologists diagnose — and treat — lung cancer faster. But that’s just part of the equation: patients have an important role in this fight, too.
Advancements in lung cancer care
On the physician side, one technology being used to manage incidental lung nodules is the LungGPS™ Patient Management Platform. This software uses artificial intelligence to quickly evaluate various medical reports and flag to doctors any lung nodules that are important for them to review and follow up on, while automating administrative tasks and clinical workflow.
Usually, treatment for a suspicious lung nodule doesn’t begin until five or six months after it’s identified.[v] “Our goal is to reduce that time frame to less than 30 days. That’s what the LungGPS™ Patient Management Platform is about — ensuring that no patient falls through the cracks,” says Emily Elswick, vice president and general manager of lung health at Medtronic, the global medical technology, services and solutions company that manufactures the LungGPS™ platform.
When an incidental lung nodule is suspicious, oncologists nowadays can use minimally invasive technology to seek a possible diagnosis, Elswick adds.
“Now, we have electromagnetic navigation bronchoscopy technology that allows physicians to take catheter-based technology and drive it deep into the lungs to a lesion — almost like a GPS in your car — to acquire tissue and aid the physician in diagnosing that patient,” says Elswick, referencing one of the company’s diagnostic technologies, the superDimension™ navigation system.
Oncologists say the development of minimally invasive diagnostic tools is another critical aspect of lung cancer care. “Sometimes getting to peripheral pulmonary nodules by conventional approaches is limited, so having advanced software or platforms is an important piece of the puzzle,” says Dr. George Cheng, an interventional pulmonologist at Duke University Medical Center.
Still, knowing which patients need a diagnosis in the first place is key. “We recognize that we could have the best minimally invasive diagnostic technologies,” Elswick says, “but if clinicians aren’t getting to those patients early enough, none of it matters.”
That’s where patients and their families come in.
The importance of self-advocacy
Patients knowing the right questions to ask when a lung nodule appears on a CT scan or X-ray is equally crucial in improving lung cancer outcomes. If your doctor informs you he or she has spotted a lung nodule, take it upon yourself to seek out information by asking questions like, “Should I be concerned?” and “What are my options?” Elswick says.
“By no means are we advocating that people undergo unnecessary imaging or unnecessary procedures — it’s about acting right on that day, at the right time, during that procedure,” and then using that guidance to continue asking questions about your health during future appointments. “It’s really about being an advocate for your health,” Elswick says.
[i] Tanner NT, Aggarwal J, Gould MK, et al. Management of pulmonary nodules by community pulmonologists: A multicenter observational study. Chest. 2015;148:1405.
[ii]MacMahon H et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology. 2017;284:228.
[iii] Church TR et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013;368:1980-91.
[iv] Blagev DP et al. Follow-up of incidental pulmonary nodules and the radiology report. J Am Coll Radiol. 2014;11:378-383.
[v] Gildea TR, DaCosta Byfield S, Hogarth DK, Wilson DS, Quinn CC. A retrospective analysis of delays in the diagnosis of lung cancer and associated costs. Clinicoecon Outcomes Res. 2017;9:261.