A new study finds that a $250 test can detect lung cancer at its earliest stages. But doctors remain cautious about the value of universal screening.
At 76, E. Patrick Flynn believes he is alive today only because a CT scan detected a tiny tumor in his lung in 1996. “Not the slightest question in the world,” says Flynn, a former smoker. The Carmel, N.Y., resident underwent surgery shortly after the tumor was found and has visited his doctor for annual CT scans ever since. They’ve given him peace of mind and allowed him to enjoy "all the pleasures of life" such as golfing, investing in real estate and spending time with his seven grandchildren.
Flynn may well be right that his life was extended by those painless diagnostic procedures. In a study published in this week's New England Journal of Medicine, researchers report that early detection of lung cancer followed by surgery within one month results in a 10-year survival rate of 92 percent. That’s a big deal because lung cancer kills more Americans than any other cancer. Each year 173,000 Americans are diagnosed with the disease and 164,000 die from it. Overall, the five-year survival rate is just 15 percent compared with 86 percent for breast cancer. Lung cancer tends to develop silently, with the classic symptoms, including chest pain and coughing, not appearing until the disease is advanced. "What this study shows is that if you find it in the early stage, we might be able to improve mortality,” says Dr. Michael Unger of the Pulmonary Cancer Detection and Prevention Program at Fox Chase Cancer Center, who wrote an editorial that accompanied the findings.
In the study, called the International Early Lung Cancer Action Program, investigators using low-dose spiral computer tomography screened 31,567 asymptomatic people at risk for lung cancer from 1993 through 2005. They diagnosed lung cancer in 484 participants; 412 (including Flynn) had Stage 1, the earliest stage of lung cancer. Stage 1 lung cancer, with an estimated 10-year survival rate of 88 percent. Of the 302 patients with Stage I cancer who underwent surgery within a month after diagnosis, the survival rate was 92 percent. The eight participants with Stage I cancer who did not get treated died within five years after diagnosis.
Should people get screened now ? “Unfortunately, it’s very hard to give a black-and-white answer,” says Dr. Norman Edelman, chief medical officer to the American Lung Association. An ALA committee is looking into whether the group should revise its position on early CT scanning. But for now, the ALA and most doctors are waiting for the results of a gold-standard, randomized, controlled trial by the National Cancer Institute, called the National Lung Screening Trial. This study, which began in 2002 and should be completed in 2009, is examining whether screening with CT or chest X-rays can reduce deaths from lung cancer in 53,000 current or former smokers without symptoms of the disease.
For now, the new study performed without a control group does not change current clinical recommendations. “Most of the policy leaders in the world will want to have evidence from randomized, controlled trials,” says epidemiologist Robert Smith, director of cancer screening for the American Cancer Society. Each screen costs around $250 which would add up year after year, if they were performed on 100 million people. Researchers believe the best candidates for CT screening are current and former smokers who have smoked for at least 20 years, as well as people with environmental exposure to hazardous materials such as asbestos.
“Since it is not a randomized trial, the data cannot and do not demonstrate that screening for lung cancer with CT reduces lung-cancer mortality,” says Dr. Ella A. Kazerooni, director of the cardiothoracic radiology at the University of Michigan and an investigator in the NCI study. "Without a randomization trial that also tracks a group not getting CT, it is not possible to make comments regarding prevention of lung-cancer deaths.” The study “suggests, but does not prove, that CT screening should be performed and is clearly not enough to change public health-care policy,” she says. Read more To Catch A Killer part two here.
By Karen Springen
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