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Lung cancer is currently the leading cause of cancer death in the United States for both men and women, claiming more lives annually than colon, breast and prostate cancers combined. The American Cancer Society estimates that in Virginia there will more than 3,800 deaths due to lung cancer in 2017. To help reverse these trends and improve lung cancer survivorship through early detection, VCU Health and VCU Massey Cancer Center have opened a comprehensive Lung Cancer Screening Clinic at the VCU Health Stony Point Campus.

Established by the director of the Lung Cancer Screening Program at VCU Health, Mark Parker, M.D., F.A.C.R., who is also co-section chief of cardiothoracic imaging and director of the thoracic imaging fellowship at the VCU School of Medicine, the clinic screens high-risk individuals with a low-dose CT (LDCT) scan to detect lung cancer and other lung conditions in their early stages when they are most treatable. Survival rates are five times higher when lung cancer is detected early, according to the American Lung Association.

“Historically there was never a good screening test for lung cancer,” said Parker, who recently authored and published the first textbook on lung cancer screening for primary care physicians. “For decades, experts were looking for a screening exam that would find the disease in its early stages. By the time a patient begins to show symptoms, the cancer has often spread to other parts of their body.”

A comprehensive approach to lung health featuring a dedicated pulmonologist, nurse navigator, informed and shared decision making and smoking cessation counseling sets the clinic apart from other screening programs in the region.Patrick Nana-Sinkam, M.D., F.C.C.P., is a pulmonologist and member of the Cancer Cell Signaling and Cancer Prevention and Control research programs and Linda Grandis Blatt Endowed Chair in Cancer Research at VCU Massey Cancer Center as well as chair of and professor in the Division of Pulmonary Disease and Critical Care Medicine at the VCU School of Medicine. He meets with patients to review their individual lung cancer risk and make an informed and shared decision about whether to move forward with the scan. This one-on-one consultation helps educate patients about the benefits and risks of a lung scan and includes them in the decision-making process. Informed and shared decision making about lung cancer screening is generally recommended by medical associations, and offering it in the lung cancer screening clinic makes it easier for primary care physicians and other providers to refer patients for a lung scan.  

The LDCT scan employs state-of-the-art CT scanners that are optimized to provide the lowest dose of radiation possible. IV contrast is not necessary for the scan, and the patient is not required to make any preparations. The scans are read and reported by onsite board-certified and fellowship-trained thoracic radiologists, providing expert assessment of scan results. Results are given within 30-40 minutes of the screen, and Nana-Sinkam reviews the results with patients and provides recommendations. The reports include ordinal coronary calcium scoring and emphysema scoring for optimal risk assessment and treatment planning.

“We provide the results on the spot, and if they’re motivated to quit smoking, we provide smoking cessation counseling,” Nana-Sinkam said. “We’re really trying to do everything in one setting.”

The clinic’s nurse navigator and program coordinator, Michelle Futrell, M.S.N., M.B.A., R.N., guides patients through the entire process, including scheduling the screening appointment, coordinating medical records and insurance authorization and scheduling any necessary referrals and diagnostic procedures. She also reviews results and recommendations with referring providers. In addition, Futrell is a trained smoking cessation counselor and meets with any patient who is interested in quitting smoking.

If cancer is detected during the scan, the team works in partnership with a multidisciplinary group of lung cancer experts at Massey Cancer Center to ensure seamless access to the kind of high-quality cancer care, leading technology and cutting-edge therapies, including immunotherapies and precision oncology tailored to specific genetic mutations, only available at cancer centers like Massey that are designated by the National Cancer Institute.

The clinic is the latest evolution of the overall VCU Health Lung Cancer Screening Program that launched in 2012. The program was Virginia’s first American College of Radiology-Designated lung cancer screening center and is the only Center of Excellence in Central Virginia recognized by the Lung Cancer Alliance. Parker worked with VCU Health to develop the Lung Cancer Screening Program based on results from the landmark National Lung Screening Trial (NLST), which demonstrated a 15 to 20 percent reduction in mortality from lung cancer through annual screening with a LDCT scan.

The U.S. Preventive Services Task Force (USPSTF) recommends the scan for adults ages 55 to 80 who have a history of smoking at least a pack a day for 30 years and currently smoke or have quit within the past 15 years. Medicare, Medicaid and most private/public insurance plans provide screening coverage for patients who meet the USPSTF eligibility guidelines. Screening for the early detection of lung cancer has been endorsed by approximately 40 medical societies and organizations, including the American Lung Association, the American Cancer Society and the National Comprehensive Cancer Network.

Those who do not meet clinical criteria for the CT scan still have the option of scheduling a consultation with Nana-Sinkam to assess their risk for lung cancer. Nana-Sinkam’s hope is that criteria for the scan will expand to include individuals outside of the main risk group.

“If we were to implement lung cancer screening with CT scan widespread, we’d probably save about 12,000 lives per year in the U.S.,” Nana-Sinkam said. “There are several other risk factors that should be considered when you’re trying to determine someone’s risk of lung cancer, such as age, ethnicity, socioeconomic status, body mass index, family history of lung cancer, COPD, duration of smoking history and exposure to radon, asbestos and other cancer-causing agents.”

In addition, new diagnostic tools may be on the horizon. Nana-Sinkam is currently studying genetic biomarkers as a means of developing blood-based tests for the early detection of lung cancer and the development and application of new targeted therapies. This work is supported by a grant from the National Cancer Institute. “This is really what I believe to be the future of early detection of lung cancer,” he said.

For more information on the VCU Health Lung Cancer Screening Clinic, visit vculungscan.com or call 804-827-LUNG (5864) to schedule an appointment. The clinic is located at VCU Health Stony Point, but LDCT lung scans are also available downtown at VCU Medical Center.

Written by: Melissa Mitchell