Saved by the screen

A CT scan at University of Colorado Hospital revealed a cancerous nodule in Donna Vogelsong’s left lung. She couldn’t be more grateful.
August 4th, 2016
Donna Vogelsong thought a CT scan of her lung was no big deal. As it turned out, it was.
Donna Vogelsong thought a CT scan of her lung was no big deal. As it turned out, it was.

Last fall, Donna Vogelsong was diagnosed with lung cancer. She couldn’t be more grateful.

Vogelsong, 63, of Aurora, knows all too well the price of the disease. Advanced lung cancer claimed her older brother’s life, just before the surgery that has extended hers. She has the chance her brother will never have in large part because a CT screen caught her cancer early.

“Early screening saved my life,” Vogelsong said.

She received the screening through the Lung Cancer Screening Clinic at University of Colorado Hospital, which launched in November 2014 after the Centers for Medicare and Medicaid Services approved low-dose CT scans for patients who meet specific criteria (see link at the end of this story). The screen revealed small spots in the lower lobes of each of Vogelsong’s lungs.

In April, University of Colorado Hospital cardiothoracic surgeon Michael Weyant, MD, removed the lower lobe of Vogelsong’s left lung, where a roughly 2-centimeter adenocarcinoma had nestled. She’ll get regular scans to monitor the nodule that remains in the right lung, said Derek Linderman, MD, co-director of the Nodule Clinic at UCH.

She urged others who qualify to get the scan. “Lives are at stake. Lung cancer is a silent killer.”

Screen savers

Vogelsong is one of about 300 patients screened since the program began, said Stephen Malkoski, MD, PhD, who co-directs the Nodule Clinic with Linderman. The original U.S. Preventive Services Task Force study that supported the effectiveness of lung cancer screenings showed that it took about 300 CT scans to save the life of one lung cancer patient. The program at UCH is doing far better: Vogelsong is one of four diagnosed with lung cancer; a fifth had metastatic renal cancer, Malkoski said.

Stephen Malkoski
Stephen Malkoski, MD, PhD, says about 300 low-dose CT scans at the Lung Cancer Screening Clinic have detected five cancers.

One reason for the success rate is that Linderman and Malkoski assess the lung cancer risk of patients who meet the criteria for a screening. Instead of screening everyone who qualifies, they calculate the six-year risk of lung cancer, based on smoking history, family history, body mass index, and other factors.

“We’re trying to capture those at highest risk for the screenings,” Linderman said.

Vogelsong’s experience shows that very often good medical care is the product of collective effort rather than individual heroism. The tiny spots on her lungs could easily have escaped detection. She had received a scan in 2012 after complaining of shortness of breath, Linderman said, but it wasn’t clear what the small hazy smudge in the left lung was. The image remained in her medical record, however, and was ultimately to prove vital to her diagnosis.

In 2015, Vogelsong had a colonoscopy as part of her routine preventive care. She followed up with her primary care provider, Kandace Shepherd, PA, who saw that Vogelsong’s smoking history – she smoked for more than 30 years before quitting in 2002 – and other factors triggered a “best practice advisory” in UCHealth’s Epic electronic health record recommending that she get the CT screen.

“I said, ‘Sure, no big deal,’” Vogelsong recalled.

Detective work

Derek Linderman
Derek Linderman, MD, who co-directs UCH’s Nodule Clinic with Malkoski, performed a bronchoscopic lung biopsy on Donna Vogelsong.

It turned out to be a very big deal after the screening in late September. She met with Linderman, who showed her the CT scan, which revealed nodules in both lungs. He recommended waiting three months, then repeating the scans to determine if there were any changes. A second scan in December showed that the nodule in the left lung had grown.

But like the still-hazy CT images of her lungs, Vogelsong’s diagnosis was far from sharply etched. She went through two separate biopsies of the left lung, one by an interventional radiologist, another through a bronchoscopy performed by Linderman. Both came back negative. Still, the UCH team recommended surgery to remove the lower lobe and carefully explained why.

Linderman noted that a comparison of the 2012 and 2015 scans also showed the spot in the left lung had changed. He added that, while it’s very difficult to get a bronchoscopy sample definitively proving malignancy, the evidence pointed to cancer.

“They were so confident and understanding and answered every question I had,” Vogelsong said. She had also done her own research, using the Patient Resource Center at UCH to help her make the decision to have the surgery. Because the cancers lay deep in the tissue of the lung, Weyant explained that he would need to remove the entire lower lobe, not a section, of the lung.

“I felt very confident that I was getting the right treatment,” Vogelsong said.

Second chance

She scheduled the surgery for April, but any anxiety she felt was overcome by the trauma of her brother’s illness. A heavy smoker – he smoked about three packs of cigarettes a day for decades – he was diagnosed with lung cancer in January 2016 and given only a couple of months to live unless he received treatment, she said. He went through a round of chemotherapy but died just days before Vogelsong’s scheduled surgery. On the day of his funeral, Weyant removed the lower lobe of her left lung.

She feels confident her brother would have approved of her decision to go forward with the surgery and take advantage of the second chance given to her by the lung cancer screening and her decision to quit smoking more than a decade ago.

lungs
The hazy gray area near the bottom of the right side of this CT image was the cancerous nodule in Donna Vogelsong’s left lung.

“I am now at peace with whatever happens,” she said. “I wanted to have the opportunity to see my grandchildren graduate from school and college. It’s an opportunity my brother missed.”

Donna Vogelsong wants more people to have that opportunity. She encourages others who qualify to get the screening. “It doesn’t hurt,” she said. “It takes five minutes.”

The time Vogelsong invested in the screening paid for what promised to be many bright days ahead. She’s grateful to her providers at UCH and many others. In mid-July she traveled to Southern California on a 10-day trip that included thanking members of her sister’s church who had prayed for her during her ordeal. She is slowly rebuilding her stamina and plans to steadily increase her walking and exercising.

“I have a new lease on life,” she said. “I feel complete and happy. When you find out you have cancer, it changes your life forever. I am finding new joy in every part of my life and want to bring joy to other people. I want to be with my grandchildren to see the world. I want to start living again.”

For more on the Lung Cancer Screening Program click here.

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.