News Headline: Reducing death by lung cancer
Outlet Full Name: Seacoast Online
Author Name: Karen Dandurant
PORTSMOUTH — A government agency is recommending annual lung cancer screenings for high-risk patients, saying studies indicate it may reduce by 20 percent the mortality rate for this too often deadly disease.
Currently, a diagnosis of lung cancer is made based on symptoms. It’s often too late by then because of the rapid progression of the disease.
“Lung cancer kills more than any of the other cancers combined, including breast, prostate and colorectal cancers,” said Dr. Steven Milman, a thoracic surgeon at Portsmouth Regional Hospital who favors the recommendation.
The recommendation is awaiting final approval by the U.S. Preventative Services Task Force. An article by the task force, published in the Annals of Internal Medicine, makes the recommendation based on studies that included oncologists, thoracic surgeons, radiologists and pulmonologists.
If adopted, the low-dose radiation CT (computed tomography) scans will serve a high-risk population and should eventually be eligible for coverage by medical insurance, just like mammography.
The CT screening will be recommended to patients age 55 to 79 who have been longtime heavy smokers, meaning about a pack a day for 30 years or an equivalent, such as two packs a day for 15 years. Also, those with a strong family history of the disease or exposure to asbestos will be candidates for screening.
Milman said the test will allow early detection. Without early intervention, Milman said the outcome for survival is too often grim.
“Unless we find it in the early stage, there are no good options,” Milman said. “We have surgery, chemotherapy and radiation, but it is often too late to do more than palliative care.”
Dr. Panos Fidias is a medical oncologist who specializes in thoracic oncology at Exeter Hospital.
“I am very much in favor of the recommendation,” Fidias said. “This is a bad cancer. It is staged and unless we find it in stage 1, the prognosis is not going to be good because there is a rapid decline. So it behooves us to find it early.”
A CT scan is better than an X-ray, Milman said. He said studies done with X-rays do not show a significant benefit versus waiting for symptoms to show up.
“An X-ray cannot detect small nodules,” Milman said. “Plus, it is done front to back, and side to side, so if a nodule is hidden, we can’t see it. A CT is three-dimensional and can show nodules as small as 2 millimeters.”
A low-radiation dose CT scan is used for the lung screening. Fidias said the test has only 10 to 20 percent of the radiation exposure of the diagnostic high-resolution scans and no contrast dyes are needed.
The concern with the CT scan is the cost, and that as much as 90 percent of the nodules will not be cancer.
“The test is a distinction between air and a solid nodule, so a low dose is good enough to find the mass,” Fidias said. “The devil is in the details of course, as most of what shows up will not be cancer. There will be a low rate of malignancies. Most will simply be small abnormalities. Still, the test is warranted for the chances of finding lung cancers earlier.”
Fidias said that in about 50 percent of mammograms for breast cancer, a patient is called back for a follow-up, also often a false positive.
“What we do find we can address and hopefully cure,” Milman said. “If something shows up, we will monitor it for two years. If there is no growth in that time, we are no longer as concerned. If it is suspicious, we can do further testing, including removal for biopsy.”
The largest issue to be addressed if the testing becomes a routine recommendation is to have sufficient staff to efficiently read and monitor all the results. Fidias said that is a question to be answered by each individual medical facility.
“I think we will need multiple teams, comprised of oncologists, radiologists and thoracic surgeons to look at the follow-up tests and make recommendations,” Fidias said.
Despite the false positive risk, Milman said the testing is cost effective in the long run. He said the cost of the test is far less than the cost of treatment and palliative care for a patient.
Both say it may be several years before the recommendation becomes the norm for patients.