Facing Up to the Possibility of Lung Cancer

Right now, lung cancer is responsible for more deaths than colon, breast, and prostate cancer combined. But a new screening method could change all that. 

In assessing early detection, lung cancer used to be placed in the same category as pancreatic and ovarian cancer: by the time the cancer was found, it was often too late to treat it effectively. But within the last few years, a new test is bringing new hope for those with a high risk of lung cancer—low-dose computed tomography (LDCT). 

“LDCT is an imaging procedure using X-rays and sophisticated computers to produce pictures of the lung that can pick up early stages of lung cancer,” says Grace Hillyer, assistant professor of Epidemiology and one of this year’s Calderone Junior Faculty Award winners. “We now have a chance to catch it early, when it’s easier to treat or even curable—which has never been true for lung cancer.”

Research shows that lung cancer screening can reduce mortality by as much as 20 percent—a possibility that gives hope to many. Based on the findings of the National Lung Screening Trial, four years ago, the United States Preventive Services Task Force published recommendations for annual lung cancer screening among high-risk populations: people with a smoking history equivalent of a pack of cigarettes a day for 30 years and former smokers with similarly heavy smoking habits who quit within the past 15 years. By recommending LDCT screenings just for the people at highest risk for lung cancer, the benefits are believed to be the greatest. 

While public awareness of lung screenings is fairly low, this situation is expected to change quickly as more hospitals equip themselves to offer screenings and more doctors recommend them to individual patients. Just last year, Medicare and Medicaid added the expensive yearly test to their coverage plans, and private insurers are likely to follow suit soon. 

But for screenings to be effective in reducing lung cancer deaths, patients, even those aware of the options, must overcome their fears, weigh the harms and benefits, then commit to getting one done every year. Although tobacco cessation is the most effective means to prevent lung cancer, LDCT screening will save many lives. 

Through her years of working with Alfred Neugut, Myron M. Studner Professor of Cancer Research and professor of Epidemiology, on colorectal cancer, Hillyer has learned a lot about the rationale behind patient and doctors’ decisions surrounding cancer screening tests. For example, while colonoscopy is the most commonly recommended colorectal cancer screening test, some large healthcare organizations and patients with limited access to healthcare or a gastroenterologist prefer the simple, cheap, and easy to perform fecal immunochemical test that, when performed regularly, can be as effective as colonoscopy in identifying colorectal cancer at an early, treatable stage. “What interests me the most are the reasons why people do what they do and don’t do when it comes to cancer screening,” she says. 

In her pilot study, supported by Calderone prize funds and a grant from the Herbert Irving Comprehensive Cancer Center, Hillyer aims to learn how to find patients with a high risk for lung cancer, based on their smoking history, and learn about their attitudes toward lung screening with LDCT. Working with the primary care services clinic at the Associates of Internal Medicine here in Washington Heights, most of the patients in Hillyer’s study are Hispanic, a population with a high lung cancer mortality rate. Ultimately, she hopes her findings will help in the design of effective interventions to encourage high-risk individuals most at risk of lung cancer to get the screenings they need. 

In the cancer research world, thanks in part to Vice President Joe Biden’s “Cancer Moonshot” effort, much of the recent attention and funding has focused on precision medicine and its ability to target an individual’s specific genes to fight cancer. Many in public health, including Hillyer, are skeptical of relying on this highly individualized approach alone, advocating for a larger focus on prevention and screening for broad populations. 

“Precision medicine holds a certain fascination—it’s new and exciting, but there is still much we don’t know about it,” says Hillyer. “It might take many years before precision medicine can make a difference in cancer prevention. I don’t think it’s time to give up on what we’re doing now in screening and early detection.”