When the National Cancer Institute’s landmark National Lung Screening Trial (NLST) found that screening with low-dose CT reduced lung cancer mortality in high-risk individuals by 20 percent compared to chest x-rays, it changed the landscape of lung cancer screening, with hospitals across the nation launching programs to help current and former smokers improve their chances of surviving this deadliest form of cancer through early detection.
As a result of these screening programs, however—along with incidental findings on chest X-ray or CT scans obtained for other purposes—an estimated one million pulmonary nodules are being detected in the U.S. each year. The challenge now is to distinguish between benign and malignant nodules, expediting diagnosis for malignant nodules while minimizing testing of those that are benign.
“It’s simply not feasible or appropriate to take everyone with a lung nodule to the OR and do invasive tests,” says thoracic surgeon David D. Shersher, MD. “You need a strategy to identify who needs more of a workup, who needs to be followed, and who doesn’t.”
At MD Anderson Cancer Center at Cooper, that strategy entailed creation of a dedicated multi-disciplinary Lung Nodule Program, spearheaded by Dr. Shersher and medical oncologist Polina Khrizman, MD. In addition to their respective specialties, the disciplines that comprise the program include pulmonologists , interventional pulmonologists, radiologists, an imaging navigator, a nurse navigator, and other pulmonary and cancer experts.
So how do you distinguish between a benign and malignant nodule without invasive testing?
“There is a certain appearance to nodules that are concerning, which our lung specialist radiologists recognize,” explains Dr. Khrizman. “It has to do with size and shape—if it’s well-circumscribed, ragged or invasive—and its growth pattern over time.”
“We also look at the patient’s age, smoking history, and environmental exposure to things l ike a sbes tos,” she cont inues. “All these components help us identify those nodules that are more or less likely to be concerning. Patient A may have a lung nodule that looks suspicious, and we may recommend biopsy right away. Patient B’s nodule, by its size and shape, isn’t as concerning, so we may recommend a CT in six months and follow-up in clinic.
“It’s very individualized, based on different risk stratification and what we see on imaging,” she adds.
“Surgery is indicated when concern is very high from a clinical standpoint and there’s tremendous risk, such as when a nodule is growing in size and PET shows it’s active,” Dr. Shersher says, noting that MD Anderson at Cooper offers a range of non-invasive testing, including biopsy performed through the airway by the interventional pulmonary team.
A unique aspect of MD Anderson at Cooper’s Lung Nodule Program is its emphasis on smoking cessation.
“We’ve built in a robust , evidence-based smoking cessation program that’s been shown to work over the long term,” Dr. Shersher says. “We know it takes up to nine attempts to quit smoking, and we have strategies that help people succeed.”
Drs. Shersher and Khrizman urge community physicians to get their at-risk patients screened for lung cancer—those between the ages of 55 and 74 who have a 30 pack/year smoking history and currently smoke or have quit within the past 15 years.
“For decades we struggled to find a test to identify lung cancer early,” Dr. Khrizman says. “Now we do, and it’s improving survivorship.”
“Our program is designed to guide and manage patients through this complex condition while keeping referring physicians informed throughout the care process,” Dr. Shersher adds.
For a direct physician-to-physician consultation about a patient, call Dr. Shersher at 609.947.3658 or Dr. Khrizman at 215.422.2484. For all new patient appointments, our schedulers can be reached at 1.855.MDA.COOPER.