Amy Ambler says she feels like the happiest cancer patient ever.
And maybe she should.
Noticing her past history of smoking, her family doctor, Dr. Jeffrey Jump, suggested on Nov. 8 that she have a routine CT scan to test for lung cancer.
The following day, she learned she had a worrisome spot on her lungs. The day after that, a biopsy confirmed the diagnosis: Stage 1A lung cancer.
When the results came back positive, doctors at CHI Memorial's Standefer Lung Center fast-tracked Ambler's case to do further tests, find her a surgeon, and schedule an operation.
On Monday, Nov. 21, less than two weeks after her positive test results, Ambler had successful surgery. She went home the following day.
She's doing fine and is ecstatic about how fast things moved. Last week, she returned to work and began driving again.
"I have been shuffled between tests to get it all done, so the anxiety and the fears and the deep concern and all of that hasn't even had time to take a deep hold," Ambler said. Ambler is not her real name. She asked to remain anonymous, she said, because she doesn't want acquaintances to fuss over her.
It normally takes between 90 and 100 days from the time a patient is diagnosed with lung cancer until their treatment starts, according to CHI Memorial Dr. Krishnendu Bhadra, an interventional pulmonologist who was one of Ambler's doctors. In eight weeks, a lung cancer can grow from one stage to the next, making survival more difficult, he said.
"The typical route for a patient is that their primary care physician says they have an abnormal test, and they send them to a subspecialist, and the average time to get into their office is 27 days," Bhadra said. But time is of the essence with lung cancer.
"Cancer doesn't take a day off," he said.
Convincing more people to get tested for lung cancer and then getting the ones who turn up positive into treatment quickly is key to successfully converting a cancer that has traditionally been one of the most deadly into one that is treatable, doctors say.
"CT screening is a huge deal, a major deal," Bhadra said. "Lung cancer kills more people than breast, colon and prostate cancer combined."
"If you find it early, lung cancer is incredibly easy to cure," said CHI Memorial's Dr. Rob Headrick, who was Ambler's surgeon. "If we catch it through screening, at an early stage, the treatment is simple and the 10-year survival rate is 90 percent."
Screening is critical because lung cancer often presents no symptoms until it is too late. The lungs themselves have no pain receptors, so unless a tumor is pressing against a nerve, it won't be felt.
Lung cancer is more common in Tennessee than in other parts of the country.
"I describe Chattanooga as the belt buckle of the Tobacco Belt," Bhadra said. "We have one of the highest rates of smoking and lung cancer in the U.S."
The tools for doctors have gotten better in recent years. While X-rays were unable to detect small cancers, CT scans can identify them while they are still tiny and easier to treat. Radiation therapy has also improved. New techniques allow doctors to better target the exact location of the tumor and use multiple beams of radiation to reduce the number of treatments required.
Where in the past, a patient might have needed 33 to 36 visits for radiation therapy, now the same effect can be achieved in only four to six visits, at least for stage 1 and 2 cancers.
Surgery is also much less invasive with shorter hospital stays.
"In 2000, to do a lung operation required a big incision, spreading the ribs, and the average length of stay was eight days, over a week in the hospital," Headrick said. Now surgeons can make a small incision in the side of the chest and a patient can go home the next day, he said.
But none of those treatment options are very helpful if the cancer is not caught until it is stage 3 or 4 and has spread beyond the lungs to other parts of the body.
That's why convincing patients and family doctors to get a CT scan is so important, Bhadra said.
In Ambler's case, her family doctor, Dr. Jump, recommended the scan.
"It was really important he did that," Bhadra said. "He is the person who saved her life."
Many people don't realize that their health insurance already covers screening for lung cancer, Headrick said.
If you are between the ages of 55 and 80, smoked for 30 pack-years, and have not quit within the past 15 years, you probably qualify for a free screening. "Pack-years" refers to the number of packs of cigarettes you smoked per day multiplied by the number of years you've been smoking. So "30 pack-years" could be a pack a day for 30 years, or a pack and a half for 20 years or two packs for 15 years.
Almost all employer health insurance plans, Medicare, Affordable Care Act policies and individual health insurance plans are required to provide the free screening.
CHI Memorial has seen a dramatic improvement in discovering lung cancer at an earlier stage, when it can be treated. On average, only about 15 to 20 percent of all lung cancers are discovered in Stage 1 or 2, a major reason the disease is so deadly. But almost half — 47 percent— of CHI Memorial's lung cancers are stage 1 or 2. Lung cancer specialists at the cancer center are hoping to figure out a way to dramatically expand the number of screenings they perform in the metro area, to as many as 10,000 per year.
But catching lung cancer early is not enough, CHI Memorial's specialists say. The time between when the cancer is discovered and the patient begins treatment also needs to be shortened.
"Anyone who has been told that they might have cancer or do have cancer — your world got rocked," Headrick said. "One of the things we don't have to do in taking care of these patients is to drag the process out."
Instead of scheduling tests for the next week, CHI Memorial's lung center team has been working to perform the tests immediately, and to do several at once, if possible.
When you have cancer, "nothing is worse than to feel like the system is in slow motion and not treating you like that is the most important," Headrick said.
Doctors also warn a screening is not just for people who are longtime smokers.
"About 15 percent [of people with lung cancer] are lifelong nonsmokers," Headrick said, "people exposed to radon or secondhand smoke, or occupational exposures like asbestos that can lead to lung cancer."
For lung cancer specialists, the improved prospects for survival are exciting.
"When I was in medical school, lung cancer was universally a disease where you were going to die, and now it is not," Bhadra said.
"I've been to too many funerals for family and friends who died of lung cancer," Headrick said. "I'm 53. The vision I have is that in my career, lung cancer may become something that is no big deal. Then maybe we can quit going to funerals. We just have to get people to come in early."