There are only a few cancer diagnoses more terrifying than lung cancer. "This disease is responsible for about one-third of all U.S. cancer deaths every year," explained Lawrence Schmetterer, M.D., Cardiovascular and Thoracic Surgeon. "Only 15 percent of the people diagnosed with lung cancer live longer than five years."
"There are more than 94 million current and former smokers in the U.S., who are at a higher risk for lung cancer. In Columbiana County, an estimated 22.1 percent of adults are current cigarette smokers."
Since the 1960s when cigarette smoking was linked to lung cancer, researchers have been trying to come up with a way to detect lung cancer at earlier, more curable stages. On June 29th, National Cancer Institute researchers published the results of the National Lung Screening Trial (NLST), a comprehensive study which showed that getting screened for lung cancer specifically, having a low-dose radiation CT scan might actually reduce a person's chances of dying from this disease for higher risk groups of people.
"Lung cancer screening holds the promise of earlier detection and treatment for people at a higher risk for this disease," Dr. Schmetterer continued. "Most people do not know that they have lung cancer until they experience symptoms of the disease, at which time the cancer is likely advanced and has less chances of being cured. By screening for lung cancer and catching it early, the tumors can be removed surgically, which is hopefully before they've spread and become very difficult to cure."
Summary of NLST Study Results
Researchers have been looking at several screening approaches, with one of the most promising being the use of low-dose spiral CT (computed tomography) scans. These scans can produce detailed pictures showing a cross-section of the lungs. According to the NLST study, annual low-dose CT scans were shown to cut the death rate from lung cancer by 20 percent in heavy smokers or formerly heavy smokers, compared to those who received annual chest X-rays.
Over 50,000 people participated in the NLSTstudy, who were between the ages of 55-74, had smoked at least a pack of cigarettes a day for a minimum of 30 years or two packs a day for a minimum of 15 years, and were without symptoms, signs or history of lung cancer when the study began. Over a 3-yeard period, these participants were screened for lung cancer using either a low-dose radiation CT scan or a chest X-ray. Researchers found 20 percent fewer deaths due to lung cancer in the population screened with CT scans versus those who had chest X-rays.
"A CT scan gives a three-dimensional picture of the area of the body being observed, so it's much more detailed than a normal two-dimensional X-ray," Dr. Schmetterer continued. "Most previous studies, which used chest X-rays to screen subjects, didn't reflect a benefit in lung cancer mortality as a result of those screenings. However, the NLST study shows that we may be able to save lives by using CT scans as screening tools to identify lung cancer in higher risk groups."
Should Everyone Be Screened?
There's not evidence that screening for lung cancer in the general population would produce the same results as the NLST study, which looked at a very specific group of people current and former heavy smokers between the ages of 55 and 74, who showed no symptoms for lung cancer at the time of screenings. However, the Lung Cancer Alliance suggests that if a person hasn't stopped smoking by the time he or she +turns 45, his or her risk level for lung cancer will remain high enough that screening for at least 15 years after quitting smoking is still beneficial.
Currently, most insurers including Medicare, don't cover CT screens for lung cancer, and these scans typically cost about four to five times more than a chest X-ray. However, many of these CT scans may be covered by insurance as a diagnostic scan if the person has already developed symptoms like a cough, chest pain or shortness of breath.
Bottom Line: While the NLST study showed that CT lung cancer screening can reduce the risk of lung cancer deaths in current and former smokers, it must also be emphasized that smoking cessation is the most important risk reduction strategy for lung cancer. For example, it is estimated that quitting smoking will in ten years time reduce a smoker's risk of death from lung cancer as much as the CT lung cancer screening did in this study.
"If you are a heavy smoker, regular CT lung cancer screening may reduce your risk of dying from lung cancer by detecting this disease at an earlier stage when it is more successfully treatable," Dr. Schmetterer concluded. "But, by far, the best way to decrease your risk for developing lung cancer is to stop smoking. If you're ready to quit, there are many treatments that can boost your odds of success. Talk to your doctor about what approach might be best for you."
Lawrence Schmetterer, M.D., is a board certified cardiovascular and thoracic surgeon affiliated with Salem Community Hospital's Medical Staff, where he provides a weekly outpatient clinic. His office is located at 20 Ohltown Road, Suite 206 in Austintown, 330-743-3604.