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Submitted by Providence

What is the leading cause of cancer deaths in the U.S.? It is not breast, colon, skin or prostate cancer. It’s lung cancer. And the key to saving lives—early detection by screening—recently became more widely available for many Americans.

On February 10, 2022, the Centers for Medicare and Medicaid Services (CMS) announced its updated lung cancer screening eligibility guidelines for people covered by Medicare. As a result, most private insurance plans are required to cover lung cancer screening for those now at high risk under the U.S. Preventative Services Taskforce (USPSTF) criteria. This recommendation nearly doubled the number of individuals eligible for screening by lowering the recommended age range to begin screening from 55 to  50, as well as reducing the minimum pack-year smoking history from 30 to 20.

“Lung cancer kills more people than colon, breast and prostate cancer combined,” says Dr. Dominique Pepper, Providence South Sound Pulmonology. “The early detection of lung cancer with lung cancer screening is key to better survival. At Providence, we are expediting the evaluation, diagnosis, and treatment of lung cancer. Patients with risk factors for lung cancer will undergo lung cancer screening—with chest CT—to detect suspicious lung nodules.”

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Dora Hinchcliffe with her grandchildren Carter and Hayden. Photo courtesy: Providence

You Can’t Break a Promise to a Grandchild

Dora Hinchcliffe is 70 years young. A widow, mother of three and grandmother to “her world” of Carter, 10, and Hayden, 14. The family has lived in Olympia for decades. Dora waitressed for many years, but along the way decided it was best for the family to stay at home and raise her three boys while her husband worked as a longshoreman. He died in 2006 of cancer.

“I call it the C word,” Dora recalls. “We were married 31 years. He had cancer of the liver and went real fast,”

More than a decade ago, Dora was diagnosed with Lymphocytic Leukemia, cancer of the white cells within the bone marrow.

“My doctor told me I would die with this, not of it,” she says. “I loved that. They keep an eye on my blood counts every six months or so.”

Even though Dora was a longtime smoker, she never smoked around her grandchildren.

“I thought they might be able to smell it on me, but I made a point to never let them see me smoke,” she says. “I love them with all my heart, and I see them and take care of them quite a bit. One day, Hayden came up to me and said, ‘Grandma, do you smoke?’ I told him I did, but that it wasn’t good for me or anyone, and that I would quit on his birthday. I promised him.”

So, on October 8, 2017, Dora smoked her last cigarette. Hayden turned 9 on October 9, 2017.

“I tried to quit over the years, but people who smoke have to realize they are addicted, and you can’t have even one. I would quit for a while and then think I was fine and just have one. Then a while later I would have two. Then a while later I would buy a pack and I was right back to my old habit. Now, my state of mind is I can’t have even one, I’m addicted,” she shares. “For my grandchildren, I stuck with it and thank goodness I did. You can’t lie to your grandkids.”

A True Advocate for Screening

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Although Dora quit smoking, she was still at risk and went for a lung screening. They found cancer. Photo courtesy: Providence

Another thing Dora has decided is she needs to be more proactive in her healthcare decisions. With the recent help of a new primary care provider, she confirmed she was a candidate for lung cancer screening.

She was referred to Providence South Sound Pulmonary. Following a CAT scan, a bronchoscopy was done by Dr. Richard Redman. The findings were confirmed: the C word.

“The finding on my lung kinda knocked me off my feet,” Dora admits. “But they were great about it. They said, ‘We can remove this,’ so that’s what we did.”

Redman presented Dora’s findings at the Providence Regional Cancer System Tumor board, a multi-disciplinary conference where cases are discussed between providers to establish the best way to proceed for an optimal outcome. Dora’s case was referred to cardiothoracic surgeon Nels Carroll, M.D., of Providence Olympia Cardiac Surgery.

Dora had two synchronous lesions in her left upper lobe and left lower lobe with marginal lung function, requiring a very complex procedure.

“Dora was unique in that she actually had two separate cancers and traditional teachings would indicate removing her entire lung,” says Carroll. “This was not a good option for her, because her long history of smoking meant her lung function was not very good. But we made it clear there was no compromising, we were committed to giving her the absolute best treatment.”

The surgery had to completely eliminate both cancers, preserve as much healthy lung tissue as possible, and get Dora up on her feet and moving as quickly as possible. Carroll was able to accomplish this via a robotic-assisted, minimally-invasive resection.

“Rather than a pneumonectomy through a large incision, we performed a robotic left upper lobe apical trisegmentectomy in addition to a left lower lobe superior segmentectomy with thorough mediastinal lymph node dissection,” he explains.

A total of 15 nodes from 8 separate lymph node stations were removed. Dora went home just two days later.

“I’m glad they caught it and were able to remove it when they did,” Dora says. “March 20 is a date I’ll never forget, and I’m not good on dates.”

Now Dora is telling everyone she knows they need to talk to their doctors about getting referred for screening. Her oldest son is now eligible because of the latest change in screening recommendations.

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Providence Regional Cancer System Lewis County Cancer Center. Photo courtesy: Providence

“The main thing I want to get across is for people to talk to their physician, be proactive and ask for the scan,” Dora says. “We need to communicate with our doctors to keep an eye out for these types of things and get our lungs checked out.”

And once referred, the team of pulmonologists and oncologists within the Providence Regional Cancer System have processes in place to provide coordinated care and the best possible outcomes.

The 5-year survival of lung cancer is 68%-92% if early stage (Stage I) and less than 10% if late stage (stage IV). However, only 10% of lung cancers in the United States are diagnosed at an early stage when a surgical cure is possible.

“Our goal is to evaluate all patients with suspicious lung nodules within one week of initial chest CT in our dedicated pulmonology lung nodule clinic at Providence Pulmonary and Sleep Medicine, 500 Lilly Road NE in Olympia” continues Pepper. “Following comprehensive pulmonary evaluation, our next goal is to perform the diagnostic lung nodule biopsy within two weeks of initial chest CT. Our final goal is to ensure that patients with early-stage lung cancer who are suitable surgical candidates are evaluated urgently by the thoracic surgery team for life-saving surgical resection and cure.”

Under the newly approved guidelines, about 14 million people in the U.S. are at high-risk for lung cancer and should talk to their primary care provider about getting screened. Those considered high risk under the new criteria include people 50-80 years of age with a 20 or higher pack-year history who currently smoke or have quit within the last 15 years.

For more information on cancer screenings, contact the Providence Regional Cancer System at 360.754.3934 or go to their Providence Regional Cancer System website.

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