GRAND FORKS – Lung cancer is by far the leading cause of cancer death in this country, accounting for about one in five of all cancer deaths, research reveals – and a physician with Altru Health System is using new technology to bring hope and better outcomes for those who are fighting the disease. Each year, more people die of lung cancer than colon, breast and prostate cancers combined, according to the American Cancer Society. In 2024, an estimated 125,070 people in the U.
S. will succumb to the disease, more than three times the number of deaths from colorectal cancer, the second leading cause of cancer death. In North Dakota, lung cancer is the leading cause of cancer deaths.
It is the No. 1 most diagnosed cancer among men and women combined, according to the North Dakota Cancer Coalition. Only 25.
8% of all lung cancer cases nationally are diagnosed at an early stage, when the survival rate is much higher. “My goal is to shorten, as much as possible, the time between discovering the (cancerous) nodules and (the start of) treatment,” said Dr. Mohamad Bitar, a lung specialist who joined Altru last August after completing internal medicine residency training in Cincinnati, Ohio, and a fellowship in pulmonary and critical care in Houston, Texas.
ADVERTISEMENT To that end, this past spring, Altru installed a new technology, Ion Robotic Bronchoscopy by Intuitive, which allows Drs. Bitar and Antranik Mangardich, pulmonologists, to detect cancer in a minimally invasive peripheral lung biopsy. Bitar uses the technology to detect lung cancer earlier and more accurately, he said.
“(Early detection) makes for less chance that it has spread and more chance of curative treatment.” Ion’s ability to navigate to small nodules and enable precise biopsies may help patients get answers sooner, potentially allowing more time to consider treatment options, Bitar said. And, with this technology, the patient experiences less pain than other biopsy methods.
In the U.S., the average five-year survival rate for all stages of non-small cell lung cancer (the most common kind) is 23%, compared to 90% for all stages of breast cancer and 98% for all stages of prostate cancer, according to the National Cancer Institute.
One reason for the lower survival rate is that about 72% of patients diagnosed with lung cancer have non-localized disease, meaning the cancer has already spread by the time it is detected. How it works During the Ion Robotic Bronchoscopy procedure, a flexible catheter is threaded into the lung via the mouth and throat through an endotracheal tube, while the patient is sedated. A separate breathing tube is also inserted.
A CT (computed tomography) scan, similar to an X-ray, is used to identify possible cancer sites in the lung. That image is uploaded to and appears on a screen near the physician. The catheter, with a camera and light on the end, magnifies and illuminates the interior of the lung passageways; the image appears on another screen near the physician.
The device is also gathering real-time data as it moves through the airways, Bitar said. ADVERTISEMENT Informed by the 3D image on the nearby monitor, the physician guides and navigates the catheter on its way to the targeted nodule. A needle on the catheter is used to collect cell samples, which are removed and placed on a slide for examination by the pathologist.
The catheter and the needle are both very small, enabling the physician to reach miniscule areas in the lung, Bitar said, and making it possible to obtain very precise biopsies, navigate small nodules and more easily reach targeted areas. During these procedures, a pathologist is always in the same room, ready to analyze cell samples and provide immediate feedback about whether the cells are cancer and “to see if the patient is a surgical candidate or not,” Bitar said. In the process, the pathologist may also indicate if the sample is of insufficient quality or more cells are needed to make an accurate diagnosis.
A conclusive diagnosis can be reached 75 to 92% of the time, Bitar said. He works with a team, which also includes a radiologist and thoracic surgeon, to arrive at the correct diagnosis and treatment plan for the patient. Depending on the findings, the recommended treatment may involve surgery, radiation or chemotherapy – or a combination.
Use of the robotic bronchoscopy, which was first studied in medical research centers beginning in 2016, became more widespread in 2019, Bitar said. Altru has a large “catchment area,” or geographic location from which it expects to receive patients, including northwestern Minnesota and northeastern North Dakota, he said. “In that area, there is no center like (this).
” Advances in practice In the past, lung specialists used a scope – in a procedure similar to a colonoscopy – to locate and identify lung cancer, Bitar said. ADVERTISEMENT The physician “would go in blindly” to obtain cell samples, resulting in a success rate of 40 to 50%, he said. “It was technically a coin flip.
” A more effective method to obtain a biopsy – which is still used today – is inserting a needle into the lung from outside the body, he said. But it carries the risk of lung collapse, which occurs in one of five patients. With the Ion Robotic Bronchoscopy procedure, the rate of lung collapse is less than 1%.
The technology also reduces the chances of other complications, such as excessive bleeding. A collapsed lung may require the patient to be hospitalized or undergo one or two more procedures. In the treatment of cancer in lung nodules, in general, there’s no single pathway for treatment, Bitar said.
In the past, patients were referred to different specialists for multiple procedures. “With each procedure there’s a risk of complications, which can delay treatment,” he said. Scheduling appointments, undergoing more procedures and obtaining results all takes time, which delays arriving at an accurate diagnosis and starting curative treatment.
Hopeful signs The American Lung Association has reported continued progress for lung cancer survival rates in the U.S. The five-year survival rate – meaning the patient is alive five years after a lung cancer diagnosis – is now at 25% for lung cancer overall, up from 21% in 2014.
Experts have called that increase "remarkable progress." The association’s “State of Lung Cancer” report, released in November 2022, noted that Minnesota ranked fourth in the nation for lung cancer survival rates. The state’s rate was 29.
7%. ADVERTISEMENT Lung cancer is the second most diagnosed cancer in Minnesota, and the leading cause of cancer deaths in men and women. In that state, Indigenous people are most likely to be diagnosed with lung cancer.
And people of color who are diagnosed with lung cancer experience worse outcomes compared to white Americans, including lower survival rates, less likely to be diagnosed early, less likely to receive surgical treatment and more likely to receive no treatment. In North Dakota, the five-year survival rate is 28%, according to data from the Mayo Foundation for Medical Education and Research. A 2021 report, produced by the foundation, stated that in North Dakota there were 57 lung cancer diagnoses per 100,000 population that year.
And 28% of cases were diagnosed at an early stage, compared to the national average of 26%, in that year. It also reported that 14% of lung cancer patients in North Dakota did not receive treatment, compared to the U.S.
average of 20.6%, and that 10% of high-risk patients who qualify for lung cancer screening received an annual low-dose CT scan, compared to the national average of 6%. Quitting smoking and undergoing screening are the most effective means of reducing one’s risk for lung cancer, experts say.
If the cancer is caught before it spreads, the chance for five-year survival improves dramatically..
