Life-Saving and Life-Changing Stories from Chest CT Scans
Lung Case Studies
*All patient names are fictitious.
**Some stories have been compiled from several case studies and publications.
Carol: After reading a newspaper editorial that proposed making heart scans available for all Americans, Carol, age 67, made an appointment for herself. Good news: She had no heart disease. Other news: She was a non-smoker, yet the scan found a small cancerous nodule. Today she is cancer free, thanks to early detection and treatment.
Carol* was an active, healthy white woman of 67 when she read an Op-Ed piece in The Mercury News (San Jose, California) about the benefits of getting a heart scan. The article, “Heart screening scan should be available to all,” noted that the simple and accurate Coronary Artery Calcium (CAC) test is administered to presidents, astronauts, and Air Force pilots to assess their fitness for duty. The authors, a cardiologist and two professors of public health, pointed out that since half of all fatal heart attacks happen without warning, the public should have the same access to the CAC test as high-ranking officials.1
When Carol went for her annual physical three months later, she asked her primary care physician about the CAC test. The physician explained that it’s a 10-minute CT scan of the chest that measures how much calcium and plaque are present in the blood vessels that deliver blood and oxygen to the heart. Although she was a non-smoker, Carol wanted to know if she could be at risk for heart disease, heart attack, or stroke. Most medical insurance currently doesn’t cover a preventive CT scan like the CAC test, but the cost is often less than $100. Carol decided to get the scan and scheduled an appointment.
“The good news was that the test revealed that I had 0% calcium buildup in the vessels to my heart [the range is 0-400+]. The bad news was that the scan revealed a mass in my lung. The diagnosis was lung cancer.” A month later, Carol underwent surgery to remove the lower left lobe of the cancerous lung. The tumor was removed before it had spread to lymph nodes or other parts of the body, and Carol is expected to make a full recovery.
Cancer is assigned a stage at the time of diagnosis; the stage of any cancer tells how much is in the body, how far it has spread, what kind of treatment is needed, and the overall outlook. The earliest stage of lung cancer is 0, going up to stage 4. The higher the number, the more the cancer has spread.
Only 16% of lung cancers are detected in early stages. When they are, up to 92% of people can expect to live at least five years.3 Carol was fortunate; most lung cancers are not diagnosed until symptoms appear. By then, the cancer has already spread and is difficult to treat.
Carol was painfully aware of how devastating lung cancer can be. Only three years earlier, her husband had died of lung cancer. Like Carol, he was a non-smoker and healthy; he had been an Ironman competitor and cross-country cyclist. He didn’t start to show symptoms until his cancer had reached stage 4, too late for a cure. The five-year survival rate for stage 4 lung cancer is only 7%.
Following her surgery, Carol reached out to the cardiologist who had co-authored the article that led to her CT scan of the chest, She wrote, “ Because my cancer was discovered at stage 1 and completely removed, I am now in effect cured and have no evidence of cancer…From the bottom of my heart and lungs, THANK YOU for sharing with me and thousands of other readers the importance of having the CT that you said should be available to all…”
A CAC is a low-dose CT scan of the chest that uses special X-ray technology to take thin cross-sectional images of the heart, called slices. When the slices are combined, they create a 3-D look at the heart to measure the plaque deposits in the blood vessels that bring oxygen to the heart. The CT scan also provides images of the lungs and can detect abnormal nodules that are small. It evaluates the density of the bones of the spine, called vertebrae, to determine if there is any thinning and weakness present; if so, a bone disease (osteoporosis) can require treatment. The CT scan will also show if there is liver damage or problems with abdominal fat.
REFERENCES
Maron D, Bommer W, Shortell S. Heart screening scan should be available to all, The Mercury News, February 8, 2018, updated February 12, 2018. https://www.mercurynews.com/2018/02/08/opinion-heart-screening-scan-should-be-available-to-all/ (Accessed 1 October 2021)
Non-Small Cell Lung Cancer Stages. American Cancer Society, Atlanta, GA. https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/staging-nsclc.html (Accessed 1 October 2021)
Eldridge L, MD, Stage I Lung Cancer Life Expectancy, VeryWell Health, November 4, 2020, Medically reviewed by Doru Paul, MD. https://www.verywellhealth.com/stage-1-lung-cancer-life-expectancy-2249418 (Accessed 1 October 2021)
Wexler, A. What are the stages of lung cancer? Medical News Today, Updated Februry 10, 2021, Medically reviewed by Jenneh Rishe, RN. (Accessed 1 October 2021)
Lung Cancer Survival Rates. American Cancer Society, Atlanta, GA. https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/survival-rates.html (Accessed 1 October 2021)
Email from “Carol” to David J. Maron, MD, FACC, FAHA, Clinical Professor of Medicine (Cardiovascular), Director, Preventive Cardiology, Stanford University.