Erin Gillaspie, MD, MPH, FACS, a faculty member of Vanderbilt University Medical Center’s Department of Thoracic Surgery, discussed improvements in lung cancer outcomes due to new screenings and therapies.
Erin Gillaspie, MD, MPH, FACS, of Vanderbilt University Medical Center (VUMC), explained how lung cancer survival rates have improved by implementing new screenings and immunotherapies. Gillaspie is a faculty member of VUMC’s Department of Thoracic Surgery and an assistant professor of thoracic surgery. She also presented at The American Journal of Managed Care®’s Institute for Value-Based Medicine® held in Nashville, Tennessee, on August 17, 2023.
What are traditional lung cancer outcomes and how have they been improving?
There's a couple of things to know about lung cancer. I think, first and foremost, it impacts a huge number of people. Most people are somehow impacted by cancer, and, in particular, lung cancer. So it’s very, very common. We see it as one of our top 3 every single year in both men and women, but the other really important thing to note is it's a particularly lethal cancer.
When we think about cancers, we think about sort of our mortality and our survival. Lung cancer, unfortunately, historically, has always scored really poorly. Our 5-year survival is nowhere near where any of us wants it to be, and we've seen really big improvements in some of the other cancer types. So, breast and colon, where we've seen a huge amount of wonderful research, and funding for that research help to make massive advances. Lung cancer is a little lagging behind, but we're now starting to get some great momentum in that space as well. It's important to know that lung cancer remains the number 1 cancer killer.
So, what are some of the big changes that we see that's having a huge impact on that? Well, I think one of the most important things to talk about is the NLST, so the National Lung Screening Trial. That was an incredible trial that helped us to usher in an era of lung cancer testing in which we're allowed to test people without lung cancer who are high risk for lung cancer and do screening for that.
We know about screening in a lot of other cancer types, right? We do mammograms for breast cancer screening, we do colonoscopies for colon cancer screening, we do pap smears, but for a long time, we actually had nothing in lung cancer, because chest x-rays really actually weren't helping us to catch things sooner and faster. This brilliant trial came out looking at the use of low-dose CT scans that's using about the same amount of radiation as a chest X ray but in CT scan format. It allows us to see the lungs much more clearly in much greater detail to try to identify cancers sooner.
For people who are higher risk, what category of people is that? So, it’s people 50 to 80 who have at least 20-year pack-year smoking history who are current smokers or who have quit sort of within the last 15 years. For those folks, we’re able to do lung cancer screening. Our primary care doctors are so wonderful about asking patients about it, but we really want our patients as well to be asking, “Do I meet the criteria for this?” It's a great opportunity to define things sooner.
Since we've started developing lung cancer screening programs around the country, we've started to see a change in when we're diagnosing lung cancer. Most lung cancer is diagnosed in stage IV, and that's because most people don't have any symptoms when they have lung cancer. Usually, a cancer has to get pretty big or be in a particular location before people start having symptoms from it, so this allows us to catch up before those symptoms. We're starting to see a little bit of a shift, we call it a stage shift, so more people getting caught in that stage I, and that has a huge impact on survival.
We're also living in an immunotherapy and molecular era, and it is so exciting, [that] all of these new therapies are being developed to specifically target some of the mutations in cancer, to help leverage the immune system to attack cancer. With the advent of some of these therapies, we're also seeing that needle move, and for the first time in a long time, we're seeing our 5-year survival for kind of the whole spectrum of lung cancer improve, and so that's really, really exciting for us.