A unique, multidisciplinary clinic designed for current and former smokers to help them assess the condition of their lungs and to get them started down the road to quitting will open this Friday at the Seattle Cancer Care Alliance. The clinic also is for current and former smokers diagnosed with a precancerous lung nodule that needs further assessment and treatment. Early detection of lung disease and cancer, and ultimately quitting smoking, is key to preventing and reducing the incidence of lung cancer while giving smokers a healthier life, according to Jason Chien, M.D., M.S., a pulmonary and critical-care specialist at the SCCA who directs the new clinic. He is also a clinical researcher at Fred Hutchinson Cancer Research Center. "Based upon what we know about early versus late stage lung cancer, we believe that early detection of lung cancer should extend life. If you are looking for biomarkers that can detect early stage lung disease, who do you study? People who smoke," Chien said. "The only way to end the majority of lung cancer cases that we see today is for everyone to stop smoking. Realistically, that's unlikely to happen, and even if it does, lung cancer will still be a major health problem in the foreseeable future because former smokers remain at risk for lung cancer. So the alternative is to reach people at high risk much earlier to try to identify the cancer earlier or identify people at highest risk for the cancer." The weekly clinic on Fridays will serve two patient populations: "worried well" current or former smokers who are concerned about their health, their risk of lung cancer and who want to quit, as well as patients whose primary- care doctors have discovered a lung nodule during a routine chest X-ray. What makes this service unique for both groups is that every patient will meet with a physician for a thorough pulmonary assessment and smokers who want to quit will be referred to the SCCA Smoke Free Life Program, directed by Abigail Halperin, M.D., director of the Tobacco Studies Program at the University of Washington, and co-medical director of Free & Clear, the nation's largest smoking-cessation program. Quitting smoking stops the risk of developing lung cancer from rising any more than it already has. However, former smokers always have a risk of lung cancer; this risk is fixed at the time they quit and actually increases as they approach the age of 70, Chien said. The evaluation of otherwise healthy smokers will include a lung function test and if determined clinically appropriate, a CT scan of the lungs. Since it is not yet established that CT screening will extend the life of lung cancer patients, the SCCA program will not automatically recommend a radiology exam unless it is truly needed. The use of CT scans for lung-cancer-screening is not standard practice; avoiding unnecessary scans prevents radiation exposure and lowers costs. The evaluation exam is not covered by insurance. It's more likely that smoking-related respiratory diseases such as emphysema will be found during an exam than cancer, Chien said. Additional care for any diagnosed illness such as emphysema, COPD, chronic bronchitis, or asthma likely will be covered by insurance. Patients who are referred to the clinic to have lung nodules assessed will be evaluated by a multidisciplinary team consisting of a pulmonologist, thoracic surgeon, chest-CT expert and nuclear-medicine specialist. If a malignancy is diagnosed, the team will also facilitate the next course of action for the patient, such as meeting with an oncologist or a surgeon. Such follow-up treatment is likely covered by insurance. "We envision this service as a comprehensive center for primary-care physicians to refer their patients so that they can have their nodules thoroughly evaluated and diagnosed," Chien said. About the Seattle Cancer Care Alliance The Seattle Cancer Care Alliance, established in 1998, unites the adult and pediatric cancer-care services of Fred Hutchinson Cancer Research Center, UW Medicine and Children's Hospital and Regional Medical Center. A major focus of SCCA is to speed the transfer of new diagnostic and treatment techniques from the research setting to the patient bedside while providing premier, patient-focused cancer care. Patients who come to SCCA receive the latest research-based cancer therapies as well as cutting-edge treatments for a number of non-malignant diseases under development by its partner organizations. SCCA has three clinical-care sites: an outpatient clinic on the Hutchinson Center campus, a pediatric-inpatient unit at Children's and an adult-inpatient unit at UW Medical Center. For more information about SCCA, visit

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