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My last blog focused on the importance of quitting smoking at any age due to proven links with many chronic and debilitating illnesses.

This past month I have been working with a new client—Bill, 67 years old and newly diagnosed with Stage 4 lung cancer.  He had no symptoms until 3 months ago when he began to note fatigue and low-level feelings of being “sea sick”.

His primary care provider moved forward with testing revealing lesions in both the lung and the liver.  The oncologist believes the lung is the primary site.

Bill told me that he has been smoking for over 30 years, cigarettes, cigars and the pipe.   During one of the office visits with the oncologist, Bill picked up a pamphlet stating “Are you at Risk for Lung Cancer? The pamphlet went on to describe the Lung Cancer Screening Program at the Landmark Medical Center.

It appears that a recent National Lung Cancer Screening Trial (2014) revealed that annual low dose Lung CT scans could reduce lung cancer by 20% in high-risk groups


High Risk individuals for lung cancer include the following:

  • You are between the ages of 50 and 80
  • You have a smoking history of 30 pack years (1 pack per day for 30 years or 2 packs a day for 15 years.)
  • You are a former smoker who has quit within the past 15 years
  • 20 pack years plus one Risk Factor that could include exposure to Asbestos, personal history of Lymphoma, head and neck cancer, COPD-Chronic Obstructive Pulmonary Disease and/or family history of lung cancer.

Landmark Medical Center offers a Lung Cancer Screening Program for high-risk individuals that can provide early detection of lung cancer.  The program involves the use of annual low dose CT lung scans, smoking cessation support and case by case review by their medical team of Radiologists, Pulmonologists, Oncologists and Surgeons.  This team will review all data and make recommendations to the primary care physician and the individual. Dr. Nadeem, who spearheads this program, stated that they have already picked up early lung cancers that can be more responsive to treatment.  Similar programs are offered in the Lifespan system.

Medicare is paying for this screening and prior authorization needs to be obtained to ensure coverage by the Medicare Advantage Plans and other private insurers.

When Bill shared this pamphlet with me, he became upset wondering why he was never referred to this program, as he meets all of the criteria.  When I discussed this with Dr. Nadeem, he stated that while many primary care physicians are doing this, it is not consistent across the board, nor has it become as routine as mammograms and colonoscopies. 

What is important and what I learned that day is for me as a care manager is to take a very thorough smoking history to help identify my clients who may be able to participate in such a screening program.   Also, as a care manager working with clients and attending many medical appointments, I can be sure to discuss this with the primary care physicians to ensure that they are aware of this initiative and actively referring their patients for the screening. 

While I can’t help Bill now, this whole experience has placed this whole issue on my radar screen.  Apparently, there is a lot more that needs to be done to ensure all medical professionals are aware of the study data, patient criteria, and the availability of annual screenings. As Bill sadly shared with me, “Maybe if I had these annual CT scans, I wouldn’t have Stage 4 cancer now.  It might just be Stage 2 or 3 and I would have a better chance.”

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