Detecting lung and breast cancer in their early stages can mean significant change for a patient’s treatment plan and outcome. Thanks to emerging technologies, new diagnostic methods are available that allow doctors to do just that.
Methodist Hospitals began using Electromagnetic Navigation Bronchoscopy, ENB and Endobronchial Ultrasound, ENUS, technologies to screen for lung cancer in June 2012 and the results have been positive.
Bharat Barai, the medical director of oncology at Methodist Hospitals, said in the third quarter of 2012, the diagnostic rate using the ENB was 44 percent, and it increased to 58 percent in the fourth quarter. In the first quarter of 2013 it is 62.5 percent. As with any new technology, there was a learning curve, he said, and the positive yield keeps improving.
The main therapy for treating lung cancer today is surgery and these new technologies allow doctors to diagnose lung cancer in its earlier stages, 1 and 2, while surgery is still possible.
“In the first half of 2012, we had 17 percent of cases of lung cancer cases diagnosed at stage 1 and 2,” Barai said. “Eighty-three percent were stage 3 and 4. After we implemented this new technology in the second half of 2012, we had 35 percent of cases that were diagnosed stage 1 and 2, so we doubled the patients that can be potentially cured with surgery.”
The ENB uses GPS-like minimally invasive technology to locate, enable biopsy and plan treatment for a lesion deep in the lung. EBUS is a technique that offers a more precise, minimally invasive way of assessing a patient’s lymph nodes and determining if lung cancer has spread to other parts of the body.
Methodist Hospitals also implemented low dose CT lung cancer screening in April 2013, Barai said.
“Right now, the name of the game in lung cancer is early diagnosis. We have that experience very much in breast cancer.”
The low dose CT scan lung cancer screening allows doctors to screen those at high risk for lung cancer and look for lesions early, even before a patient has symptoms, Barai said.
“As of Aug. 2, 2013, we had 44 calls of people who were interested in low dose screening,” Barai said. Out of the 22 who came for screening, four of them had positive findings. They were diagnosed early thanks to the scan and are going through appropriate treatment, he said. This markedly affects their survival rate, he said.
“As time goes by, we hope more people in the high risk situation will take advantage of it,” Barai said.
Methodist was the first hospital in Northwest Indiana to have ENB and EUB technologies, Barai said. He said it’s good to see other hospitals now working to acquire the technology because it means better options for patients.
Mohamed Farhat, a medical oncologist at Michiana Hematology Oncology in Crown Point, said he is happy to see new technologies like low density CT scans emerging for lung cancer detection.
Lung cancer is the No. 1 cancer related death, he said. “It unfortunately is very deadly and affects a large amount of population mostly because of smoking and other hazardous stuff out there. If we do find it early, there is a higher chance of survivability,” Farhat said. “With the newest imaging with a low density CT scan, which has a minimal amount of radiation, we found that we are able to detect lung cancer at an earlier stage.”
Patients who meet guidelines dictated by the National Comprehensive Cancer Network are able to be screened. Although the technology is still new, Farhat says he hopes that in the next few years, it will become a standard of care.
“It only makes sense because lung cancer has higher risk of mortality so we need to find something to improve that and this is what’s going to do it,” Farhat says.
Low density CT scans are less expensive than normal CAT scans and there is less radiation exposure for patients.
“It’s still very new and not every hospital has them but every hospital is looking to have them because they understand the benefit in helping patients," he says.
The goal is to find this cancer early.
"The hardest thing for me when I talk to patients with stage 4 lung cancer is to tell them this cancer is not curable," Farhat says. "That really breaks my heart. If we can find it early, the cure rate is much much higher.”
Early detection is also key in breast cancer survival. The Women’s Diagnostic Center in Munster is the only facility in Indiana that offers technology known as Positron Emission Mammography, or PET. This scan, which is currently used for patients who have already been diagnosed with breast cancer, demonstrates how tissue behaves and allows doctors to determine whether it is cancer behavior or normal breast tissue behavior.
“Our best way to beat death from breast cancer is early detection,” said Mary Nicholson, fellowship-trained breast radiologist at Community Hospital and regional director of breast imaging services for Community Healthcare System. “That’s why we’re excited to have a tool to find a breast cancer as small as 1.6 millimeters.”
Nicholson said that since the system went live Jan. 9, 2013, it detected a second breast cancer in the same breast or opposite breast for three out of 83 patients. Finding the second cancer early significantly affects the treatment of the patient’s cancer.
“It has been shown that about 5 percent of women with one breast cancer detected, will have a second breast cancer not detected by mammography, ultrasound or physical exam,” she says.
The PET is more specific than MRI because it allows the doctor to see the cancer through a new perspective.
An MRI uses a contrast material to show differences in blood flow but doesn’t show how cells are acting. The PET scan is more effective than mammography, 3D tomography, ultrasound or MRI.
“There’s a lot of potential overlap in a breast if you resign just to make observations of just how something looks," she says. "Good and bad things, normal and cancerous things can look alike, but they can behave and molecularly be very different.”
The PET scan is done by injecting a medicine into the area. A cancer cell will trap the medicine, but normal cells will release it.
“It’s a very discreet separate between cellular activity,” Nicholson says.
The PET technology is not new although its use for breast cancer patients is only about seven years old.
“As a fellowship trained breast radiologist, I really like this technology," Nicholson says. "I for a long time had been using the breast MRI. It has a lot more false positives meaning if you’re looking at objects within the breast, you may think something is a cancer and you biopsy and it turns out to be normal breast tissue.”
The recommendations for an average woman are to receive a yearly mammogram with a yearly breast exam by a doctor or trained nurse at age 40.
Nicholson says most breast cancers that are detected with yearly mammography and yearly breast exams will be in an early enough stage that 98 percent of the patients live at least 20 more years.
She says if PET screens become available for screening the general population, it would be revolutionary. There is active research going on to reduce the dose and reduce the cost of the technology so that could become a reality.
“If that happens, we are ready to go,” she says.