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To Smokers and Former Smokers (and Those Who Love Them): Potentially Life-Saving Advice from 2 RCCA Oncologists

What if there was a safe, painless, and quick screening test that could reduce the number of lung cancer deaths by 20%? And what if that test was covered by Medicare, Medicaid, and most commercial insurers?

What percentage of eligible people do you think would take advantage of that potentially life-saving screening?

Ninety-five percent? Ninety percent? Eighty percent?

The good news, says Denis Fitzgerald, MD, is that there is such a test. The bad news, he adds, is that only 4% of New Jersey residents who meet the criteria for screening have been documented to have had the testing.

“Low-dose computed tomography, or CT, scans have been shown to significantly reduce deaths from lung cancer in current and former smokers. However, the American Lung Association (ALA) reports that only 1 in 25 people in New Jersey who should have this screening has undergone testing,”1 says Dr. Fitzgerald, a board-certified medical oncologist and hematologist who practices in the Little Silver, NJ office of Regional Cancer Care Associates (RCCA), one of the nation’s largest networks of oncology specialists.

“The screening rate for New Jersey is well below the national rate of 6%.1 While our rate may not fully reflect screening of people who belong to some managed care organizations that don’t report their testing data,1 it’s clear that we are missing opportunities to identify lung cancer in its early stages, when it can be treated most effectively,” says Dr. Fitzgerald.

Headshot of Dr. Denis Fitzgerald, MD
Dr. Fitzgerald, board certified hematology, internal medicine, and medical oncology, practicing with RCCA in Little Silver, NJ

Screening: Who, what, and why does it matter?

The United States Preventive Services Task Force (USPSTF) is a panel of medical experts that advises the federal government on steps to protect the health of Americans.
Rachel Levenbach, MD, explains that the task force recommends annual screening with low-dose CT for people aged 50 to 80 years who have a 20 pack-year history and who currently smoke or who quit smoking within the past 15 years.2 

“The term ‘20 pack-year history’ can be a little confusing. Basically, it means having smoked an average of one pack of cigarettes a day for 20 years, an average of two packs a day for 10 or more years, or some other number of cigarette packs per day multiplied by years of smoking that is equivalent to one pack a day for 20 years,”1 explains Dr. Levenbach, a board-certified medical oncologist and hematologist who practices in RCCA’s Moorestown, NJ office.

Dr. Levenbach continues, “The CT screen used to image the lungs of current and former smokers for signs of lung cancer employs a low dose of radiation. The test is painless and can be completed quickly. Further, Medicare, the state Medicaid program, and most commercial insurers cover the screening for people who meet the age and smoking-history requirements, although it’s important to check with your insurer beforehand, as people may be responsible for a co-pay or similar costs.”

And does the screening really make a difference?

Headshot of Dr. Rachel Levenbach, MD
Dr. Levenbach, board certified hematology, internal medicine, and medical oncology, practicing with RCCA in Moorestown, NJ

Absolutely, says Vinod Varki, MD, a board-certified medical oncologist and hematologist who practices in RCCA’s Riverdale, NJ office.   

“The impact of low-dose CT screening was examined in a trial that enrolled 53,454 people at high risk for lung cancer.
3 Those patients were randomly assigned to receive either a low-dose CT or a chest X-ray. Over three rounds of annual screening, more than 24% of people in the CT scan group had a positive screen, compared with 6.9% in the X-ray group,” Dr. Varki explains.

He adds, “It’s important to remember that a screening test does not establish the presence of a disease. Instead, it identifies a finding that warrants further evaluation. Fortunately, the great majority of people in both groups did not have lung cancer. Among those who did, however, there was a 20% reduction in the lung cancer death rate among those who had CT screening relative to those who had an X-ray. This underscores the value of CT scans in identifying lung cancer early in its development, when we have the greatest ability to achieve positive outcomes.”

Headshot of Dr. Vinod Varki, MD
Dr. Varki board certified hematology, internal medicine, and medical oncology, practicing with RCCA in Riverdale, NJ

Dr. Varki continues, “This large, nationwide study that established the benefit of CT screening in current and former smokers was reported in 2011. In the 12 years since then, numerous new treatments – including immunotherapies and targeted therapies – have been approved for lung cancer, and we’ve learned far more about how to use those therapies, as well as surgery and radiation therapy, in combinations and sequences to develop truly individualized care plans, making early recognition of lung cancer more beneficial to patients than ever.”

Lung cancer trends in New Jersey

An estimated 5,920 people across New Jersey will be diagnosed with lung cancer this year, and 2,800 Garden State residents are expected to die from the disease in 2023.4 (See accompanying table, “Lung cancer diagnoses and deaths: Recent trends in New Jersey.”)

“Lung cancer remains the leading cause of death from cancer and is projected to claim more than 127,000 lives across the United States this year,”4 notes Dr. Levenbach. “While we’ve made significant progress in recent years, survival rates remain much lower than they are for other common cancers. For example, the 5-year relative survival rate for localized lung cancer is 65%,5 compared to 99% for both breast cancer and prostate cancer.6,7 However, the lung cancer survival rate has increased in recent years, and is likely to rise even further given the abundance of newly approved treatments and other therapies in late stages of clinical evaluation. Further, the 5-year survival rate for localized cancer is almost twice that of lung cancer that has spread regionally, and much greater than the rate for lung cancer that has reached distant sites in the body, which underscores the importance of early detection through CT screening,” the cancer specialist adds.

Dr. Fitzgerald notes that treatment advances are one of the main reasons lung cancer deaths have declined statewide and in each of New Jersey’s 21 counties over the last few years.8 “Recently approved agents include therapies designed for first-line use in localized cancers and medications for people with metastatic lung cancer that has spread distantly on prior treatment. We have an array of options for all stages of lung cancer and can offer people with advanced disease several therapies that extend life and preserve quality of life.”

The medical oncologist adds, “At our RCCA care centers, we deliver the latest treatments to patients right here in the community. People don’t need to travel to a major academic medical center in a large city to receive cutting-edge therapies or participate in clinical trials. Making these treatments readily accessible in the community setting is critical not only for improving outcomes for the individual patient but also for reducing the overall toll that lung cancer takes.”

Dr. Varki explains that new cases of lung cancer also have been falling in New Jersey in recent years, with diagnoses dropping in 16 of the state’s 21 counties, while remaining stable in Cape May, Hunterdon, Ocean, Salem, and Warren counties from 2015 to 2019, the last period for which statistics are available.8

“The decline in lung cancer cases is driven primarily by reduced rates of smoking,” the medical oncologist says. He notes, however, “In New Jersey, about 11% of adults still smoke cigarettes.9 I urge those people to talk with their primary care provider about smoking cessation. There are a number of effective smoking-cessation approaches available, and even if you have been unsuccessful in past attempts to stop smoking, it is definitely worth another try as this may be the time you succeed.”

Words to live by from RCCA’s cancer specialists

Dr. Fitzgerald, who serves as RCCA’s board chairperson, says, “We have more than 90 cancer specialists practicing at 20+ locations across New Jersey, Connecticut, Maryland and the Washington DC area. Every one of those clinicians knows firsthand the terrible toll that lung cancer takes on individuals and on those who love them. We also know, however, that people with lung cancer have more treatment options, and more cause for hope, than ever before, particularly when their cancer is diagnosed early. To everyone out there who smokes, or who used to smoke, and who meets the criteria for CT screening, our message to you is simple: Don’t delay. Take advantage of this potentially life-saving test, both for the sake of your life, and for the people in your life who love you and want you with them.”

*******

Drs. Fitzgerald, Levenbach, and Varki are among the 90+ cancer specialists who treat patients at more than 20 RCCA care centers located throughout New Jersey, Connecticut, Maryland, and the Washington, DC, area. RCCA oncologists and hematologists see more than 23,000 new patients each year and provide care to more than 225,000 established patients, collaborating closely with their patients’ other physicians. They offer patients the latest in cutting-edge treatments, including immunotherapies and targeted therapy, as well as access to a wide range of clinical trials. In addition to serving patients who have solid tumors, blood-based cancers, and benign blood disorders such as anemia, RCCA care centers also provide infusion services to people with a number of non-oncologic conditions—including multiple sclerosis, Crohn’s disease, asthma, iron-deficiency anemia, and rheumatoid arthritis—who take intravenously-administered medications.

To learn more about RCCA, call
844-928-0089 or visit RCCA.com.  

 

References:

  1. American Lung Association. State of Lung Cancer 2022. New Jersey. Available at https://www.lung.org/research/state-of-lung-cancer/states/new-jersey. Accessed April 18, 2023.
  2. S. Preventive Services Task Force. Final Recommendation Statement – Lung Cancer: Screening. March 9, 2021. Available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening. Accessed April 18, 2023.
  3. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409.
  4. American Cancer Society. Cancer Facts & Figures 2023. Available at https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/2023-cancer-facts-figures.html. Accessed April 18, 2023.
  5. American Cancer Society. Lung Cancer Survival Rates. Available at https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/survival-rates.html. Accessed April 19, 2023.
  6. American Cancer Society. Survival Rates for Breast Cancer. Available at https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html. Accessed April 19, 2023.
  7. American Cancer Society. Survival Rates for Prostate Cancer. Available at https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/survival-rates.html. Accessed April 19, 2023.
  8. National Cancer Institute. State Cancer Profiles. Available at: https://statecancerprofiles.cancer.gov/. Accessed April 18, 2023.
  9. State of New Jersey Department of Health. Tobacco control. Available at https://www.nj.gov/health/fhs/tobacco/. Accessed April 18, 2023

Lung cancer diagnoses and deaths: Recent trends in New Jersey

 

 

Diagnoses

Deaths

Location

Average
Annual Count,
2015-2019

5-year Trend

Average
Annual Count, 2016-2020

5-Year Trend

United States

223,216

Falling

142,497

Falling

New Jersey

5,980

Falling

3,442

Falling

Atlantic County

238

Falling

135

Falling

Bergen County

595

Falling

331

Falling

Burlington County

355

Falling

201

Falling

Camden County

398

Falling

229

Falling

Cape May County

129

Stable

68

Falling

Cumberland County

122

Falling

81

Falling

Essex County

391

Falling

225

Falling

Gloucester County

249

Falling

150

Falling

Hudson County

268

Falling

156

Falling

Hunterdon County

76

Stable

44

Falling

Mercer County

237

Falling

133

Falling

Middlesex County

465

Falling

266

Falling

Monmouth County

492

Falling

278

Falling

Morris County

302

Falling

174

Falling

Ocean County

711

Stable

395

Falling

Passaic County

256

Falling

153

Falling

Salem County

73

Stable

43

Falling

Somerset County

166

Falling

98

Falling

Sussex County

114

Falling

68

Falling

Union County

248

Falling

156

Falling

Warren County

95

Stable

57

Falling

Source: National Cancer Institute. State Cancer Profiles. Available at: https://statecancerprofiles.cancer.gov/. Accessed April 19, 2023.

 

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