Lung Cancer Screening Clinic Aims to Detect Cancer Early

Dr Cassandra Grenade

A persistent cough and trouble breathing led Angela Gordon to The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute’s (OSUCCC – James) Lung Cancer Screening Clinic at JamesCare East.

“My (primary care physician) recommended it; it’s a precaution,” says the long-time cigarette smoker as she sits in a 13th-floor examining room.

The goal of the Lung Cancer Screening Clinic is to detect lung cancer in the early stages in high-risk patients. It saves lives.

Cassandra Grenade, MD, greets Gordon.

“First, I’m going to make sure you meet the criteria (to be screened) and then I’ll describe the process, the CT scan, and then we’ll look at the results,” she says. “Don’t be surprised or alarmed if I come back and say you have some nodules in your lungs. They’re not related to cancer, they’re from smoking and previous infections, such as bronchitis. Ninety percent of the time we don’t find cancer, but when we do, it’s early, when it’s still treatable.”

Lung cancer is the leading cause of cancer death for men and women. There were an estimated 224,390 new cases diagnosed in 2016 and 158,080 deaths, according to the National Cancer Institute. Lung cancer occurs primarily in older patients, and the average age at diagnosis is 70.

“And smoking is the number-one risk factor for lung cancer,” Dr. Grenade says.

The OSUCCC – James Lung Cancer Screening Clinic at JamesCare East opened in September. The JamesCare clinic at the Martha Morehouse Medical Plaza Tower Building has been screening long-time smokers for several years.

National studies have shown that detecting lung cancer in the early stages reduced the mortality rate by 20 percent. The CT scan is the first step. It emits a low-level of radiation, but the risks are minimal, Dr. Grenade tells Gordon. “The radiation level is less than a normal CT scan, but a little more than a typical X-ray.”

If the CT scan shows cancer markers in the lungs, a PET scan that utilizes radioactive tracers for a more thorough picture of the lungs is the next step.

“We can sometimes get false-positive readings from a CT scan and this reduces the risk of that,” Dr. Grenade says of the PET scan, adding a lung biopsy is the next step if the PET scan shows cancer markers.

Gordon meets the criteria for eligibility for the lung cancer screening that Dr. Grenade describes to her: 55 to 80 years of age; a current smoker with a history of smoking 2 packs per day for 15 years or one pack per day for 30 years; or an ex-smoker who has quit within the past 15 years. Many healthcare plans cover the screenings, and the OSUCCC – James has programs to defray the costs for non-insured patients.

“And, we’ll want you to come back once a year for the screening,” Dr. Grenade tells Gordon. Patients who continue to smoke agree to yearly screenings until the age of 85, while those who have quit agree to yearly screenings for 15 years from the date they stopped smoking.

After Dr. Grenade explains the procedure and answers a few questions, Gordon is taken to Radiology and is placed in the CT scanner by Andrea Tschirner, an imaging technologist.

A recorded voice instructs Gordon to take a breath and hold it; the CT scan makes some whirling sounds and does a preliminary scan to make sure everything is lined up properly. The recorded voice tells Gordon to take another deep breath and hold it, the machine whirls for 4.6 seconds … and the scan is completed.

“I didn’t even notice the sounds,” Gordon says later. “It went by so quick.”

Gordon is escorted back to the examining room. While they wait for the results of the CT scan, Dr. Grenade talks to Gordon about smoking cessation options: Nicotine gum and patches, medication and the option of slowly reducing the number of cigarettes she smokes a day.

Gordon has tried to quit over the years, but hasn’t been successful.

“It’s harder when you quit cold turkey,” Dr. Grenade explains. “Set a date when you want to quit and gradually reduce the number of cigarettes you smoke per day.”

The health benefits from smoking cessation start immediately. After 20 minutes, your heart rate and blood pressure drop. After a year, the risk of heart disease drops by half; after five years, the risk of cancer of the mouth, throat, esophagus and bladder are cut in half; after 10 years, you’re half as likely to die from lung cancer, according to the 2010 Surgeon General’s Report on Tobacco.

Dr. Grenade makes sure her patients understand the dangers of smoking.

“Tobacco has 7,000 chemicals in it and a lot of them are carcinogens,” she tells Gordon. “You wouldn’t inhale ammonia, arsenic, lead of mercury, but you do when you smoke.”

Gordon is surprised there are so many harmful chemicals in cigarettes.

Dr. Grenade pulls the scans up on the computer in the examining room and Gordon stares at the pictures of her lungs, not exactly sure what she’s looking at.

“Everything looks good,” Dr. Grenade begins. “There’s no evidence of cancerous nodules anywhere. Or even any big nodules at all. There are only a few small nodules.”

Gordon is relieved.

“There is some emphysema, which is from smoking, and isn’t a surprise,” Dr. Grenade says, and showed Gordon a few small, dark spots on her lungs. This is the emphysema.

“Yours isn’t that bad, some people have these spots all over their lungs,” Dr. Grenade says. “If you stop smoking now, you have a good chance of preserving your lungs.”

Gordon says she’s determined to stop smoking “and maybe I won’t be so short of breath all the time.”

“This is all good news,” Dr. Grenade says. “You have good lungs and hopefully this will motivate you to stop smoking. I hope you’ll have quit when I see you in a year.”

For questions or to schedule a lung cancer screening at the OSUCCC – James, call 614-293-5066 or 800-293-5066. The clinic at Martha Morehouse Medical Plaza Tower Building, 2050 Kenny Rd., is on Mondays, while the clinic at University Hospital East, 181 Taylor Ave., is on Thursdays.