CENTRE COUNTY — Lung cancer is a source of more cancer deaths in the U.S. than breast, colon and prostate cancer combined. People diagnosed with lung cancer are living longer, higher-quality lives largely due to an early screening program offered at The Lung Center at Penn Highlands Healthcare.
Named a Center of Excellence with the GO2 for Lung Cancer, formerly known as Lung Center Alliance, the health system was the first in the region to introduce a low-dose CT lung screening program to detect cancerous lung nodules in 2015, and now Penn Highlands Healthcare is using artificial intelligence to identify potentially cancerous lung nodules as incidental findings.
“In the past 10 years, there has been a stage shift in the detection of lung cancer,” Sandeep Bansal, medical director of The Lung Center and interventional pulmonology at Penn Highlands Healthcare, shared. “Approximately 75% of the lung cancers we have detected through our low-dose CT screening program have been diagnosed at stage one or two when they are more treatable with positive outcomes.”
Those screened include high risk individuals between 50 and 80 years of age and those who have smoked for 20 pack years — a half pack a day for 40 years, one pack a day for 20 years or two packs a day for 10 years.
“Approximately 87% of lung cancer is caused by smoking,” Bansal said. “The other 13% is caused by genetics, radon and chemicals and minerals such as asbestos. Lung cancer does not have any symptoms in its early stages. By the time symptoms appear, it has progressed to stage three or four when the prognosis is not as good. When cancerous nodules are found at stage one, the five-year survival rate is greater than 80%.”
HOW THE SCREENING PROCESS WORKS
If a nodule is found during the low-dose CT scan, based on its size, location and appearance combined with the patient’s age and if they are/were a smoker, the physician assesses its probability of cancer. Blood and sputum tests also can be performed to add more information.
The probability is assigned three levels that include:
• Low — Patients are followed every three to six months for up to two years. According to Bansal, the primary goal of this complex process is to coordinate with patients in order for them to be followed by their primary care physicians so that they can receive the most appropriate care.
• Intermediate — Approximately 65% of lung nodules fall into this level. Most of these patients will undergo a biopsy procedure, typically a robotic bronchoscopy, which is a minimally invasive procedure performed under general anesthesia, that uses a robotic arm to guide a camera and light through the lungs to examine and biopsy lung tissue. Penn Highlands Healthcare began using robotics to help diagnose lung cancer in 2019.
• High — Surgery is recommended to remove the nodules and stage the cancer. Lung cancer detected at stages three or four will require chemotherapy and radiation.
THE AI TECHNOLOGY
The Lung Center at Penn Highlands Healthcare now leverages artificial intelligence from Eon, a leader in intelligent health care, to aid in the early detection of lung cancer.
The health system uses the Eon software to extract terminology from radiology reports that identifies and highlights incidental findings of potentially cancerous lung nodules. The software is able to identify probable lung nodules even when they are not specifically mentioned.
By analyzing medical imaging reports for subtle abnormalities that could be missed, the rate of early detection increases and patients with suspicious findings can receive appropriate follow-up care.
“This technology is relatively new in the detection of lung nodules, and we are pleased to offer this high level of surveillance to the people in the communities we serve,” Bansal said. “It is important to note that this type of early detection program is not typically offered in rural hospitals.”
PENN HIGHLANDS HEALTHCARE WINS AWARD
Recently, Penn Highlands Healthcare received the Eon Center of Excellence Gold Award for tracking and following up on the incidental lung nodules through a program that leads to potentially lifesaving care. This distinction is awarded to facilities that demonstrate exceptional patient return rates and provide evidence-based follow-up surveillance within the appropriate time period given the risk of potential lung cancer.
Since launching the partnership with Eon, more than 5,500 lung nodules have been identified. Patients whose nodules are greater than 8 mm and are considered high risk, have an on-time return rate of 93.2% which is well above ECOE benchmarks and averages. In addition, high-risk patients have a return rate of 95.2% which is considerably above ECOE benchmarks and averages.
