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Helping smokers quit while they’re ahead Lung Cancer Institute offers Tobacco Quit program, early screening

Study shows compelling evidence that early detection means greater chance of cure

Some cigarette smokers wait until they have difficulty breathing or are presented with a bleak diagnosis before they decide to quit. But others, take action sooner, like 70 year old Ann Johnson, who was motivated by the good news she received in April 2012 after undergoing a low dose CT lung scan at Somerset Medical Center (SMC).

The Bridgewater resident had smoked for 49 years and she was sure the test would show that she was in trouble. Happily for her, that was not the case.

“I decided to quit while I was ahead,” Johnson said. But after five decades of smoking, she knew that she faced a Herculean challenge.

In January of 2012, the SMC launched its new Lung Cancer Institute at Steeplechase Cancer Center which offers two programs: the Lung Cancer Screening Program and the Tobacco Quitcenter.

Johnson is one of 146 patients who have been screened since the inception of the program.

With the help of Dr. Chris Kotsen, psychologist and tobacco treatment specialist with the Tobacco Quitcenter, Johnson was able to employ techniques such as visualization and ‘self-talk’ which helps to change the thinking pattern of someone with a nicotine addiction, according to Kotsen.

With the help of Chantix®, a non-nicotine prescription drug which is said to block the nicotine receptors in the brain, and the coaching she received Johnson was able to say goodbye to her addiction for good.

“I wasn’t sure that I could do it. I used to say, sure I can quit. I quit every night when I go to bed. But now I’m so grateful that I don’t have lung cancer or heart disease and I have actually quit. I can say I feel really good now,” Johnson said.

For 62 year old Marion Romanoski of Bridgewater, emphysema was her biggest fear. After 43 years of smoking, she heard about the low dose CT scan for lung cancer and decided first to quit and then undergo the test afterward.

With the coaching she received through the Tobacco Quitcenter and the nicotine patch, she began her journey to wean off of cigarettes in February 2012 and by June she had successfully quit. Then she underwent a low dose CT screen. The scan did reveal a small nodule, which is believed to be benign. But she will be screened every six months.

“When I had heard that quitting smoking was as difficult as trying to quit heroin, I knew that I was going to need some help if I wanted to quit,” she said.

“Now I feel good and I am so happy to breathe in fresh air without tasting and smelling cigarette smoke,” Romansoki said.

According to Dr. Chris Kotsen, without any coaching or assistance, the success rate is discouraging. “Three out of 100 people are able to successfully quit smoking without any assistance. With the assistance provided by the Quitcenter, our success rate has been 38 out of 100,” he said.

New low dose CT lung scan

According to the United States Centers for Disease Control (CDC), lung cancer is the number one cause of cancer death in the U.S.

A major National Cancer Institute (NCI) study, reported in the New England Journal of Medicine in the summer of 2011, revealed compelling evidence that CT screening for lung cancer could dramatically reverse lung cancer death rates, according to Katrina Losa, director of cancer services at SMC and a registered nurse. Losa oversees The Steeplechase Cancer Center as well as SMC’s in-patient oncology unit.

She said, “The study found that participants who received low-dose CT scans had a 20% lower risk of dying from lung cancer than participants who received standard chest X-rays. Based on this information, we wanted to make a commitment to the community and offer CT lung scans at a very affordable rate.”

The screening is offered to those who fall into the high-risk category for $99. Across the nation, the average cost of the test is between $200 and $250.

Losa said while there was some debate following the NCI study about the risks and benefits of low dose CT screening, in July 2012, the American Association for Thoracic Surgery issued guidelines strongly recommending annual CT screening for high risk patients with long histories of heavy smoking.

To serve the needs of this patient population, SMC formed a multidisciplinary team that includes: pulmonologists, surgeons, oncologists, radiologists, nurses and staff from the medical center’s Tobacco Quit Center.”

“We are not only diagnosing lung issues, but also cardiac disease. The screening revealed that a dozen patients had cardiac disease they didn’t know they had. 30 percent were diagnosed with some form of benign lung disease and seven of the patients, out of the 146 were diagnosed with stage 2 cancer,” Losa said.

Who is considered ‘High Risk’?

Current or former smokers between 55 and 74 years old with 30 or more “pack years” (number of packs of cigarettes smoked per day multiplied by the number of years smoked) are considered high risk, according to Losa.

Also, in the high-risk category are current smokers or those who have quit within the past 15 years, anyone who has been exposed to radon, silica, cadmium, asbestos, arsenic, beryllium, chromium, diesel fumes or nickel or who has a family history of lung cancer or Chronic Obstructive Pulmonary Disease (COPD) or pulmonary fibrosis.

Losa said living in Central New Jersey also presents a number of environmental factors, like pollution and radon exposure, which can have a demonstrable impact on the onset of lung cancer.

No symptoms during early stage

According to Dr. Jean-Phillippe Bocage, M.D., a Thoracic surgeon and Chair of the Lung Cancer Institute, the insidious aspect of lung cancer is that there are no symptoms in the early stages and by the time symptoms are present, it’s too late.

“As opposed to a chest x-ray, a lose dose CT scan will allow you to see much more. It will allow you to see anything that changes and grows and has the potential to become cancer,” Bocage said.

He said once a patient is coughing up blood, losing weight without trying, and the tumor becomes large, one is less likely to achieve a successful outcome.

“A plain chest x-ray is good for detecting a collapsed lung or pneumonia, but an x-ray does not allow you to see a 2 millimeter nodule. The point is, you want to catch the growth as early as possible,” he said.

Bocage said once a patient is diagnosed with late stage lung cancer, the only option is to control it, the chances of curing it are remote.

Unlike other forms of cancer such as lymphoma that can be cured through radiation and chemotherapy, late stage lung cancer generally spreads quickly to other organs, according to Bocage.

Bocage said the biggest risk of a cat scan is getting a very small dose of radiation. But when you weigh it against missing a cancer, the benefit clearly outweighs the cost, according to Bocage.

New approach to surgery

New surgical techniques are making it easier to remove a cancerous tumor in the lungs.

Bocage said the old method of surgery required a six to eight inch incision so that the surgeon could reach into the patient’s chest. Generally the patient was not able to go back to work for three months.

He said, “With video-assisted surgery, I can make four small incisions and the surgery is completed in 45 minutes. The patient is then able to go home the next day and get back to work in two weeks.”

Bocage said, “For anyone who falls into the high-risk category, a low dose CT scan makes sense. It could make all the difference between controlling lung cancer and actually curing it.”

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