Patient Bert Evens had no symptoms to suggest anything was wrong. But a routine lung cancer screening for high-risk patients helped identify a small, suspicious area that warranted further monitoring.
“I have no symptoms. I mean, I walk, I'm an avid scuba diver,” Evens said. “I absolutely would not have had any clue anything was wrong if it wasn't for this screening.”
Evens was enrolled in The Vancouver Clinic’s (TVC) lung cancer screening program, which uses low-dose CT scans to look for abnormalities that could indicate lung cancer in people at higher risk. His story, and November’s Lung Cancer Awareness Month, highlight the importance of early detection as lung cancer screening remains underused among people at high risk.
In Washington, just 15.8% of people at high risk for lung cancer received screening, compared with 18.2% nationally, according to the American Lung Association. About 28.4% of lung cancer cases in the state are diagnosed at an early stage, roughly in line with the national rate of 28.1%. However, Washington’s early-diagnosis rate improved by 10% over the past five years.
At TVC, about two-thirds of its known eligible population is enrolled in its screening program, according to Dr. Nicholas Wysham, a pulmonologist who helped establish the initiative in 2019. The clinic performs about 210 lung cancer screenings each month, according to program coordinator Shelby De La Cruz.
“It's a really effective, pretty easy, and underutilized cancer screening modality,” Wysham said. “It's also the most effective in the sense that the number needed to screen to save a life is about 300.”
When TVC created the program, Wysham said the goal was to go beyond offering scans by helping identify eligible patients, get them screened, and ensure they return for annual follow-ups.
“We were really focused on not just doing the scan, but on what the patient's path is all the way through this,” Wysham said. “How can we find the patients? How can we get them in the program?”
The clinic sends annual mailers to patients who may qualify for the program. Eligible patients ages 50 to 77 must have smoked at least 20 pack-years; former smokers must have quit within the past 15 years. Enrolled patients receive a low-dose CT scan each year, even if previous scans did not identify suspicious findings.
A pack-year is calculated by multiplying the number of packs a person smoked daily by the number of years they smoked. For example, smoking one pack a day for 20 years or two packs a day for 10 years equals 20 pack-years.
To improve accessibility, the clinic has expanded screening appointment availability to include evening hours until 7:40 p.m. and select Saturdays and Sundays. De La Cruz said the additional hours make it easier for patients to schedule screenings without taking time off work.
One of the greatest challenges the program faces is identifying eligible patients. Screening eligibility depends in part on a patient's smoking history, including how much they smoked and for how long. Wysham said that information is not always accurately documented in medical records.
“A lot of patients who have a history of smoking aren't fully, I suppose, transparent with their clinicians about how long or how much they've smoked,” he said.
People who are still smoking can qualify for screening if they meet the other eligibility requirements. Wysham said the program takes a nonjudgmental approach, with the goal of helping patients access screening regardless of whether they are ready to quit.
“All my colleagues try to approach it in a non-judgmental manner, and there's a lot of tools that we can use to help people quit,” he said. “But even if they're not ready to quit, we can get them in screening. You don't have to quit smoking to be screened.”
For Evens, screening in 2023 identified a small area that doctors monitored over the following three years. A recent biopsy confirmed the area was cancerous, and that it had not spread to his lymph nodes. After discussing treatment options with specialists familiar with scuba diving, Evens and his doctors decided surgery was the best option. In the meantime, he has been able to take planned trips, continue scuba diving and play saxophone.
“I'm not somebody who runs to the doctor every time I get an owie of some sort,” Evens said. “So I don't know how long this would have gone if I hadn't been found.”
Wysham said people who may qualify should talk with their health care provider about screening, even if they feel well. Finding lung cancer earlier can provide more opportunities for treatment before it advances.
To confirm eligibility and enroll in TVC’s screening program, call 360-541-2253 or visit shorturl.at/ow3lA. Screening is also available at Legacy Health and PeaceHealth.
