By Evy Schiffman
Without the CT test that you recommended, I would never have suspected I had lung cancer.
I am one of the lucky few cured of lung cancer, a rare outcome for patients diagnosed with the leading cause of cancer deaths annually worldwide. My good fortune is due to the serendipity of accidental early detection, the key to long-term patient survival. Reading a commentary titled “Heart screening scan should be available to all” by Dr. David Maron, Dr. William Bommer, and Stephen Shortell, Ph.D. in my local newspaper, The Mercury News, saved my life.
The National Institutes of Health estimates 154,050 people in the U.S. will die of lung cancer in 2018, more than the other three deadliest cancers combined (colorectal/50,630, pancreatic/44,330, breast/41,400). Because most early stage patients are asymptomatic, lung cancer is usually diagnosed late stage. It has metastasized to other parts of the body and treatment and survivability are problematic. My case shows the critical importance of early diagnosis.
The commentary I read made the case for universal insurance coverage of a coronary artery calcium CT scan to detect heart attack and stroke risks. The authors argued that pilots, astronauts, and senior military officers receive the scan to determine fitness for duty; it is also part of the president’s annual physical.
I am a healthy 67-year-old never-smoker, who is proactive in trying to circumvent future health problems. I requested the test as part of my annual physical with my primary care physician. The CT scan brought good news: I am at low risk for heart attack or stroke. The test also revealed unexpected bad news: a mass in the lower left lobe of my lung.
This finding was neither the point of the scan, nor even on my mind. Because the mass was determined to be early stage (1A) lung cancer, this inadvertent finding saved my life. Just a few months after I had read what turned out to be the life-saving commentary for me, I underwent surgical removal of my lower left lobe at Stanford Hospital. I am now NED, no evidence of disease. I will have follow-up screenings for at least five years but require no chemotherapy or radiation.
The American Joint Committee on Cancer’s staging system classifying disease progression rates the five-year survival for a stage 4 lung cancer patient at approximately 18 percent, but 92 percent if discovered at stage 1. Early detection is critical to making lung cancer a chronically manageable, survivable disease.
This is the goal of the Bonnie J. Addario Lung Cancer Foundation (ALCF), an international patient education, support, research, and advocacy organization. Founder Bonnie Addario’s lung cancer story is atypical. Her stage 3B diagnosis in 2004 gave her a mere 5 percent chance of surviving five years. Addario is a super survivor, an outlier who turned her survival into a mission by founding a nonprofit to empower patients fighting lung cancer, long falsely stigmatized as a smokers’ disease. Bonnie and ALCF tell the real news—anyone can get lung cancer.
Stigma brings shame and blame, and it has had negative consequences on research funding. The Lung Cancer Foundation of America reports more than half of new lung cancer patients have never smoked or quit years ago. The number one killer of men and women is heart and vascular disease. The largest known cause of these diseases is smoking, but we certainly don’t blame patients with these diseases.
ALCF’s Genomics of Young Lung Study shows that a growing number of newly diagnosed patients are under age 39, have never smoked, and are athletes. This global trial proved that 90 percent of these patients have a genetic driver mutation causing their cancer.
In 2015 Medicare approved coverage of low-dose lung cancer CT screening for a high-risk population ages 55-77 who currently smoke or have quit within the past 15 years and had smoked an average of one pack a day for 30 years. Based on these criteria, I and thousands more do not qualify for screening coverage.
Lung cancer discovery adds another powerful argument to the original case made by the authors of the commentary: universal insurance coverage of the coronary artery calcium CT scan. By revealing risk factors for heart attack, stroke, and early stage lung cancer, the test is a trifecta of lifesaving and cost-saving benefits for all.
Evy Schiffman is a full-time volunteer for the Bonnie J. Addario Lung Cancer Foundation, San Carlos, CA. Her husband, Neil, an Ironman, cross-country cyclist, and never-smoker, died in 2015 of stage 4 lung cancer.