During an exam before shoulder surgery in 2022, doctors discovered Venus White had the chronic lung disease COPD and suggested she get a kind of chest X-ray called a CT scan.
With her primary doctor hard to reach, the 60-year-old West Baltimore grandmother said she finally got a referral after about a year. It showed a mass on her right side. She had lung cancer, the deadliest type of cancer that is often discovered so late it’s hard to treat.
“They say I beat the odds; I caught it in time, even after the delay,” White said. “But other people don’t get the scan. Everyone knows about mammograms for breast cancer and colonoscopies for colon cancer, but no one talks about lung cancer.”
Maryland has one of the worst rates for annual lung cancer screening ― less than 3% — among national numbers that are uniformly low. In contrast, 83% of Marylanders eligible for mammograms get them, and doctors at the University of Maryland Medical Center where White was treated say lack of awareness is a big problem.
“We know a large percentage of people are at risk of developing lung cancer from smoking or secondhand smoke, and the more you smoke the higher the risk,” said Dr. Taofeek Owonikoko, a thoracic oncologist specializing in treating lung cancer at the medical center. “If we wait until the patient presents with symptoms, their survival is under 20%.”
Owonikoko is heading a new effort to get more people screened early. A dozen hospitals across the University of Maryland Medical System will roll out a plan to identify and schedule at-risk patients for scans, help them get follow-up care, and send a van to patients in underserved areas, all by year’s end.
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Lung cancer scans haven’t had the same massive yearslong campaign to raise awareness as breast and colon cancer screenings, said Owonikoko, who is also executive director of the medical center’s Marlene and Stewart Greenebaum Comprehensive Cancer Center and professor of oncology at the University of Maryland School of Medicine.
Plus, not everyone is as familiar with CT scans or associates them with lung cancer. A CT scan uses X-ray technology with small amounts of radiation to get extra-detailed pictures of the lungs.
Few also know who needs screening. It’s anyone aged 50 to 80 who smoked a pack a day for 20 years, or two packs a day for a decade, or used to smoke up to 15 years ago, according to recommendations from a federal advisory panel and the American Cancer Society. That’s about 15 million people.
Smoking is by far the biggest risk factor, though tobacco smoking rates are dropping, a trend doctors want to encourage. There are fewer cases of lung cancer in nonsmokers, but the number is rising, possibly linked to pollution, secondhand smoke or genetics. There aren’t screening recommendations for them.
Lung cancer remains the second most common cancer in men and women, with nearly 234,600 new cases a year. It’s the most fatal type of cancer, with more than 125,000 deaths annually — more than colon, breast and prostate cancer combined, according to the American Cancer Society.
The Greenebaum cancer center will tap an $8-million, five-year grant from the pharmaceutical firm AstraZeneca for its screening plan.
A new Center for Cancer Health Equity within the cancer center will help address cancer health disparities in underserved communities, which includes rural and minority groups. Black patients, for example, are 15% less likely than white patients to be diagnosed with lung cancer early and survive five years, according to the American Lung Association. The group also that found just 2.9% of eligible Marylanders were screened last year, compared with 4.5% nationally.
A new survey by the American Cancer Society found a higher rate of scanning among eligible people nationally, about 20%. But the rate dropped to about 5% when they don’t have a regular medical provider.
New DNA screening technology
Scientists at the Johns Hopkins Kimmel Cancer Center think they’ve found a way to increase uptake of testing. It uses AI technology to look for lung cancer in DNA fragment patterns found in patients’ blood.
Scientists estimate that using this test to boost the rate of lung cancer screening to 50% within five years could quadruple the number of lung cancers detected and prevent about 14,000 deaths. They are seeking approval from the U.S. Food and Drug Administration for lung cancer screening and plan to test the approach for other cancers.
“We have a simple blood test that could be done in a doctor’s office that would tell patients whether they have potential signs of lung cancer and should get a follow-up CT scan,” said a statement from Dr. Victor E. Velculescu, author of a study of this method published June 3 in the journal Cancer Discovery and a co-director of the Cancer Genetics and Epigenetics program at Kimmel Cancer Center.
White, who is now cancer-free, said more options could help get more people tested, though she knows persuading some people won’t be easy. Some people just don’t want to know, she said, and they don’t want to quit smoking, which she did 10 months ago.
“Every day I get up, I know I’m blessed,” said White, who just had her 12th grandchild.
“I’ve been spreading the word,” she said. “When I see someone smoking, I mention having a scan. It’s so important and only takes a few minutes.”
