Bringing care to the community: Lung cancer screening program expands through MUSC regional hospitals

If you’re a longtime smoker, you could be walking around with lung cancer and not know it. That’s what nurse practitioner Alex Ingram tells her patients at MUSC Health Lancaster. She doesn’t say it to scare them but to let them know that there’s a screening test that can look for lung cancer and find it before the symptoms become obvious, when it’s still possible to treat the cancer with minimal interventions.

National Lung Cancer Screening Day

Saturday, Nov. 12

Along with clinics across the nation, MUSC Hollings Cancer Center and MUSC Health are opening their lung screening clinics on Saturday, Nov. 12 to increase awareness and accessibility of this lifesaving screening.

To sign up for a screening, you first need to meet with the nurse practitioner who has been designated to that lung screening program. Make an appointment by contacting:

843-792-9300: Charleston and surrounding areas.
803-416-5470: Chester and Lancaster.
803-409-7030: Columbia, Kershaw and surrounding areas.
843-673-7529: Florence.

“There's a lot of hard conversations that I have to have,” said Ingram, who handles the lung cancer screening and nodule management program in Lancaster and Chester.

MUSC Hollings Cancer Center providers Gerard Silvestri, M.D., and Nichole Tanner, M.D., and nurse practitioner Cassie Frazier, along with smoking cessation expert Benjamin Toll, Ph.D., worked with leaders in the MUSC Health Regional Health Network to extend the Charleston screening program into MUSC Health-Lancaster Division in the spring of 2021. The program has since expanded into MUSC Health-Florence Division and MUSC Health-Midlands Division.

Ingram said the lung cancer scans happen only after a shared decision-making conversation between her and the patient. If the scan comes back clean, then patients return in a year for a new scan – the same way that women have yearly screening mammograms.

“It's nice when I get to say, ‘I'll see you next year,’ but lately, that hasn't been the case very often,” she said. She’s had 10 people get a diagnosis of lung cancer after their scans. “Those conversations are pretty hard, but just letting them know, ‘If you would have never come and done this, you would still be walking around right now with lung cancer and not know – and then I might not see you next year.’ That's, I think, a big ‘wow’ for them.”

MUSC Health-Florence Division’s chief medical officer also happens to be a pulmonologist, or lung doctor. Rami Zebian, M.D., sees patients with chronic obstructive pulmonary disease – COPD – and lung cancer. In most cases, his lung cancer patients with early-stage cancer were diagnosed because they got a scan for something else – a sore shoulder or a kidney stone – and the radiologist spotted the lung cancer.

Screening for people who are at high risk of lung cancer should be as common as regular screening mammograms and colonoscopies, he said. After all, lung cancer is the top cause of cancer deaths in the U.S. People with early-stage lung cancer usually don’t have any symptoms, yet when it’s caught early, lung cancer can often be treated simply with surgery or with radiation.

That was the case for Gary Davis, whose doctor insisted on lung scans because of his smoking history. When doctors saw a suspicious spot, they referred him to MUSC Hollings Cancer Center, where he underwent robotic surgery to remove part of his lung and recovered so quickly that he was fishing with his grandchildren a few weeks later.

People who think they need a lung cancer scan will first have a shared decision-making appointment with the nurse practitioner, like Ingram, at their local screening sites. At their appointments, Ingram ensures that patients qualify for the scan.

To be eligible for screening, people must be:

• Between the ages of 50 and 77 and;
  
  
• Be a current or former smoker who quit in the last 15 years and;
  
  
• Have at least a 20 pack-year history (one pack a day for 20 years; two packs a day for 10 years; etc.).

Upon confirming eligibility, Ingram sits down with patients to review their personal and family medical histories as well as any environmental risk factors. Every patient is then rated as low risk, intermediate risk or high risk – although most patients, by the time they meet Ingram, end up in the high-risk category.

"It could really save your life or your family member's life."

Alex Ingram, FNP

Ingram said that after the time she spends talking with patients, she often feels like she’s known them all of their lives. She tells her patients that lung cancer grows quietly at first.

“You don't really have signs and symptoms of anything until it's at a much more advanced stage, and then it's harder to treat,” she said. “So that's our goal – to catch these lung cancers very early so we can treat them.”

Non-small cell lung cancer has a 64% five-year survival rate when it’s diagnosed before it’s spread, but that rate drops to 37% once the cancer has spread outside the lungs. The American Lung Association estimates that lung cancer screening could reduce deaths by as much as 20%.

The Lancaster program has already screened more than 350 people so far this year, but with a smoking rate of more than 20% of adults in Lancaster County, well above the national rate of 14%, there are many more who could benefit from the screening.

Ingram has spread the word in primary care practices in her area about the screening, but she notes that people don’t need a doctor’s referral to see her. Anyone who thinks they qualify for the screening may make an appointment with her.

“It could really save your life or your family member's life,” she said. “I do recommend, if you have smoked in the past or if you are still smoking, that you at least come get checked to make sure you're not walking around with lung cancer.”

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