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Scans are Breath of Fresh Air

Unless people stamp out their cigarettes for good, we’ll never truly crush lung cancer. But new advances in early detection are starting to give patients a fighting chance against this fatal disease.
Until recently, the prognosis for someone with lung cancer wasn’t much better than it was 30 years ago: 160,000 people a year die of lung cancer in the United States, and treatment for most people only means a 15 percent chance of survival after five years.

If caught in the earliest stages, however, a lung cancer patient can have a five-year survival rate in the 70 percent to 80 percent range. The trouble is, most people don’t yet know that screening heavy smokers or former smokers for lung cancer can save lives.

In the early 2000s, studies showed that CT screenings could catch lung cancers in their earliest stages. In one study, published in the journal Lancet, 1,000 smokers were screened, with CT scans finding cancers in 2.7 percent of them. Of those, 80 percent were stage 1 cancer.

The medical community was initially unimpressed. Unfortunately, the study wasn’t designed to prove that screening and early detection translated to lives saved.

A few decades earlier, chest X-rays were supposed to help lung cancer patients by diagnosing the disease early, but that screening mechanism was never shown to actually save lives despite numerous clinical trials. Fatalism gripped the medical community – a pervasive opinion that once a lung cancer is visible, it’s usually too late.

Thankfully, a change was on the horizon. Because of the National Lung Screening Trial, a large multicenter, blinded clinical study published in the New England Journal of Medicine in 2011, CT scans are quickly catching on as an effective way to curb lung cancer deaths. CT scans can detect lung cancers at a much smaller size than chest X-rays.

The National Lung Screening Trial recruited more than 53,000 smokers or former smokers between the ages of 55 and 74 at multiple centers across the nation. To participate, the smokers had to have had at least a “30 pack-year smoking history,” meaning they had to have smoked one pack a day over 30 years, two packs a day over 15 years, etc.

The patients were divided into two groups. One received annual low-dose CT exams, while the control group received annual chest X-rays. Over the two-year screening period and subsequent follow-up period, the results were significant. Because CT scans were able to detect earlier stages of cancer, treatments were more effective for this group and they had a 20 percent reduction in mortality from lung cancer. In fact, those screened with low-dose CT scans were 7 percent less likely to die overall.

At Hoag, we were quick to adopt CT screening for those at high risk, and our results mirrored the national statistics. Between 2006 and 2012, we conducted 520 scans, finding lung cancer in 2.4 percent – with 1 percent of the total discovered to have stage 1 cancer. The stage 1 lung cancer patients were able to have curative surgery and avoid chemotherapy.

It’s a dramatic advance in lung cancer diagnosis and survival. With this relatively simple diagnostic tool, we can save 20,000 lives a year in the United States.

Insurance companies still do not cover the procedure. At Hoag, patients pay $125 out of pocket for their exams.

But I am hopeful that will change. More than six major national professional societies over the last year and a half have come out with guidelines recommending the use of low-dose CT scanning as a screening tool for lung cancer, including the American Cancer Society.

In the next few months, it is likely that another group will join the ranks of those who recommend CT scans: the U.S. Preventative Services Task Force, whose recommendations Medicare takes seriously when creating policy. If Medicare starts to pay for the procedure, it is likely private insurance companies will follow suit.

In general, the organizations all recommend annual low-dose CT screening in 55- to 74-year-olds who have smoked at least the equivalent of one pack a day for 30 years.

Keep in mind, we are still talking about a reduction in deaths – not complete triumph. Smoking is still the main culprit in 85 percent of all lung cancer deaths, so the main message remains unchanged: Quit smoking – or better yet, don’t start.

But if you are at high risk for lung cancer, talk to your doctor about getting screened. It just might save your life.

– Dr. Winston Whitney is the Lung Cancer Early Detection Program director at Hoag Memorial Hospital Presbyterian.