Recommendations for family members of lung ca patients

[Suzie Q]

OK, I know that whole-body CT for those without disease or symptoms is a contentious issue, in that not many cancers are detected but a good many patients wind up with further testing for benign processes (to make sure they are benign) based on those CT findings, BUT is there a recommendation for screening for family members of those who have lung ca?

But might not the screening be more fruitful in the narrow population of immediate family members than in a general population with low risk factors?

What is the general consensus on how family members should be monitored?

~Karen

[teresag]

Hi Karen -

Although there is evidence from epidemiologic studies that lung cancer may run in families, by far environmental influences are more powerful in causing lung cancer. You may know that work is being done on identifying genes that play a role, and this does suggest that we will someday find the source of familial predisposition to lung cancer.

That said, even in long-term smokers (people known to be at high risk of developing lung cancer), CT screening has not proven beneficial. At present, there is a very large study being done to determine if spiral CT screening is beneficial. Previous studies have had mixed results.

CT scans are, unfortunately, not very specific to cancer. Although a CT might show a suspicious lesion, the CT gives little clue as to whether it's benign or malignant, worrisome or harmless. The older we get, the more "weird" little abnormalities, such as calcifications, we develop that are completely harmless. So screening shows up lots of nodules, but the great majority of them are harmless.

Add to that the fact that biopsying all of those suspicious spots would yield few cancers, potentially cause complications, result in lost productivity for the patient, cause pain and worry, etc., not to mention being costly, and the end result is that the advantages of screening do not outweigh the disadvantages.

- Teresa

[teresag]

The studies have demonstrated that chest x-rays are not a very effective screening method for people at risk of lung cancer. An annual chest x-ray won't hurt, Jana, but chances are good that if something is found, it will be harmless. Most docs would just watch a solitary lung nodule rather than put someone through a biopsy (which risks collapsing the lung.) If there is a lesion, and it grows fast, it's probably worrisome; if it doesn't, it's probably not. There are no absolutes - only "probablies."

Unfortunately, there is no test that can tell whether or not a "suspicious" lesion might be cancer, and, as I said above, we all have lesions that are not (at least those of us over forty-ish. ) Even biopsies are imperfect - there is a chance that the biopsy will only show normal cells and miss the abnormal cells due to unavoidable sampling error. And PET scans, sometimes thought of as the "acid test" for cancer, show up other things that are "hot," such as inflammation. Arthritic joints, for example, will show up "hot" on a PET.

Bottom line: I think if you want a yearly chest x-ray, and if you are indeed at high risk and really want it, there is no harm in getting one. Insurance, of course, will not pay for it - you will have to. But be prepared to hear, at some point, that there is an odd, undefined spot on the lung, and then you and your doc will have to decide what to do about it, if anything. Tough choice. Best of luck to you, Teresa