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Can someone please explain?


Treebywater

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And I mean that seriously...

I've read the articles that are coming out about the CT Scans and screening for LC and I heard a blip on the radio about it (we don't watch T.V. so I haven't seen the coverage there).

What I don't understand is this: There is a huge focus in the coverage I've come across about lung cancers that could be found that wouldn't necessarily grow fast and/or result in death....

So my question is: WHY does that MATTER so much???? As deadly as this disease is.... don't you want to get cancer--any cancer OUT in case it COULD be deadly?

And is that the case in so many cases? The way they make it sound most findings would be such... Yet, We all know that over half of LC cases are found in their later stages.... Obviously there is a need for this screening. Obviously early stage things--harmless or otherwise are growing and spreading and killing people.... aren't they?

So WHY are they nitpicking over this, "What if it is slow-growing?" issue?

I totally get the issue of the sensitivity of the Lung. Obviously Lung biopsies are riskier and more involved than breast or other biopsies. And I think that point is right to be raised. But this other point about these "harmless tumors" just... seems to downplay the seriousness of the disease to me. I would hate to have people see this report and as a result think that lung cancer is often slow growing and nothing to worry about.

Don't get me wrong--HOOYAH for the study and HOORAY for the coverage, but I kept reading that and reading that and going, "What??"

Does anybody with a fuller understanding of the issue have any insight? Or is this as ludicrous to you guys as it sounds to me?

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This may help but not sure. THe new England Journal did a study on how effective a ct scan is for finding Lung Cancer in smokers, past smokers and non smokers. I do not know all details this is new and have not fully loooked into it yet. These are preliminary thoughts. The study showed an effective diagnosis rate for all three categories of people with and without LC.

I think this is being advocated as an Early detectionprogram much Like a Mammogram or a colonoscopy, or a PSA test for cancer. they want to advocate CT Scans as Early detection of Lung Cancer. Problem is CT Scans are 300$ a test and Insurance companies do not want to shell out that kind of money for everyone to get one every year. at 300 million people every year the is a lot of money for a test.

Lung Cancer Alliance has come out and said that said that something needs to be done.

These are my thoughts on 2 articles I have seen about this.

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I think it is about early detection. Although I haven't seen the reports you are referring to, what I can assume is that the article or story you saw (much like 99% of the coverage on LC that is out there) was incomplete.

The reports that an early detection screening may save lives is true. The report that some lung cancer grow slowly, is true.

Then it sounds like the ball was dropped.

Early detection can save lives. More people will survive LC if detected early- but the story is incomplete when it doesn't go on to describe the fact that without research, it doesn't matter that a lung cancer is found early if there are few treatment options.....

Some forms of lung cancer grow slowly. Follow-up should have been, and some grew extremely quickly...

The lung is difficult to biopsy and there are risks, some lung nodules are nothing. Follow up should have been, and others are dangerous tumors. Lung cancer is the deadliest cancer killer, killing more than breast, colon, prostate, AND pancreatic cancers combined.

I think I get what you're asking. Because we know what we know, those touched by lung cancer can see how incomplete a story like that is.

Kind of like the popular LC stories they run that focus heavily on smoking and quitting smoking....all true, yeah, that's great...but they don't tell the entire truth or teh flip side (non smokers get it too) and they end the story by saying to quit smoking and I know when watching something like that how utterly incomplete and negligent that is. Follow up on the fact that ex-smokers STILL get diagnosed decades after they quit. Follow up with the fact that even if you quit, you will always be at a higher risk and how important getting screened regularly might detect health problems earlier. Add in that fact that lung cancer receives little funding and that funding is needed for survival. Just quitting smoking isn't enough and for those who never smoked..well..they are at risk too.

Yes, I wish newstories would be more complete.

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The story was on GMA this am. Dr. Tim summarized it say that the CT scan showed about 20 in 100 with something? in their lung and that 1 in 100 was early lc. He indicated that this 'test' was still in its infancy and that the long term effects of handling this cancer hadn't been proven as to whether it cured or extended lives.

But, when questioned, he said that if he felt he was in a risk group for lc, he would have the test.

But I feel it is a signifigant step in the right direction and may become the mammogram or PSA test for lc.

I am going to discuss this with my dr. since I had been a long time smoker.

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To me it is just an excuse to justify the insurance companies not wanting to pay for screening ( about $ 200 per CT) for all people .

Most lung cancer grows fairly quickly, we know this because most lung cancer patients are dead within 5 years.

There are types that are slow. If someone were 85 years old with BAC perhaps they would choose not to treat but watch and wait. As below says less than 4 % of lung cancer is BAC and it is not related to those with a history of smoking.

Bronchioloalveolar carcinoma of the lung (BAC) is a subtype of adenocarcinoma of the lung. Although traditionally grouped with other non-small cell lung carcinomas (NSCLC), BAC has unique morphological features and clinical behavior such as bilateral lung involvement, indolent course and lack of association with smoking. Some epidemiologic studies report a significant increase in the incidence of BAC. We used the SEER database to compare the incidence, demographics, and overall survival of BAC patients as compared to other NSCLC types over the past two decades (1979-1998). Although the incidence of BAC has increased over the past two decades, BAC represents less than 4% of all NSCLC in every time period evaluated. The 1 year survival rate is significantly better for BAC patients relative to other histological subtypes of NSCLC. There has not been a marked increase in the incidence of BAC reported to SEER over the past 20 years.

Donna G

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Here are the two arguments doctors have told me against screening:

1. I am an example of things being found that are nothing. In 2002 they found an infiltrate on my lung with an abdominal scan. I had to get 3 month chest ct scans and the right one disappeared, then a left one appeared, then both disappeared. It caused aggrevation, but in my opinion it is best to know.

2. My mom's pulmonologist told me not to get another one until next year. He said he would hate for me to develop lung cancer at age 60 from the radiation from chest ct-scans if I get them every year.

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Dr Claudia Henschke from Columbia is a leading researcher in using Spiral CTs for early detection.

The price is even coming down from $450 to $200.

It is still probably a money issued, but $200 a year

won't break the bank for most people.

One additional plus is I believe the radiation dose from Spiral CT scans is lower than regular ones

Yes most people have something that will show on the scan since the resolution is mm not cm.

Henschke said there is a need to do a baseline and then sequential scans to compare the previous scans against. This eliminates a lot of false positives and unwanted/unnecessary tests

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I don't think they are nit-picking at wether it is slow growing or fast growing. I think the opposition is that there may be too many false positives and people freaking out for no reason or having serious surgical procedures that are not needed. I think the benefits would far outweigh the risks they are mentioning. I agree with Katie that the press is not stating the story with all the facts, but I am glad they are at least starting to tell the story!

Karen

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I went to the conference for the IELCAP and also have purchased the article in the New England Journal of Madicine. I have also met with Dr. Claudia Henschke. I have heard form people at the Lung Cancer Aliance. I have also heard from those who are saying "not yet" and "wait". Surprisingly, those people were from the American Cancer Society and the National Cancer Institute.

I listened to both sides of the arguement with a genuinely open mind say there wasn't one good reason given to wait to be perfectly honest.

The Pap Smear was never put through randomized trials, never scrutinized that it might not be the right thing. And consequently, people DON'T DIE of cervical cancer if detected and treated!!!

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I think insurance companies don't want to pay for all the false positive followups. But some extra false positives would definitely go a long way to increase lc awareness - wouldn't it?

Where do people get a CT scan for $200? I think my insurance is paying more like $1500 per scan. :shock:

Barb

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This particular scan (as I understand it) is a 20 second scan...low dose radiation spiral CT.

Maybe it's cheaper than a full scan.

Or maybe the 300 is a study subsidized number. I can write Dr Henschke with the question. I am writing her this weekend anyway.

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It's possible the screening found slow-growing tumours that may not have caused problems, critics said. After the screening, a biopsy of the lung nodule may be required, which carries a risk of a collapsed lung and other complications.

From http://www.cbc.ca/health/story/2006/10/ ... kip300x250

It is possible that the screening simply revealed many slow-growing or benign tumors that would not have caused problems if they had not been identified, said Dr. David Johnson of Vanderbilt University, past president of the American Society of Clinical Oncology.

From: http://www.latimes.com/news/nationworld ... crosspromo

Other experts point out that since CT scanners are very good at picking up the tiniest cancers — even ones that may look like cancer under the microscope but may not be lethal — some of the people who survived in this study could be people who weren't going to die from their cancer even without treatment.

"These are cancers that one dies with but not from," says Dr. Denise Aberle, professor of radiology at the UCLA Jonsson Comprehensive Cancer Center. Hence, these findings could falsely suggest that more people are surviving the disease.

From: http://abcnews.go.com/Health/story?id=2605509&page=3

These articles I guess explain themselves a bit more.... What's maddening is I looked at 4 or 5 Wednesday night that mentioned "Small tumors" in the way that I found so strange and without half so much information explaining as these and now I can't find that information again even when looking at the same sources.

Anyway... I am still troubled by this caveat. I still wonder if it is really that common to find 'tiny tumors that don't do any harm.' Are they referring to nodules? And if so... Isn't it good to know about those and watch them?

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I think it is worth the 200.00 for people who might be genetically predisposed to lung cancer. I worry about my kids, because thoratic cancers seem to run in my husband's family. The report suggested CT screenings after the age of 40 for those at risk --- but I was surprised to see that high of an age, as many on these boards are under 40. Hopefully, as mentioned in above messages, this becomes the "standard" test for everyone soon! The false positives are better than not catching it in the first place.

While I applaud any progress in early detection, the issue of curing currently diagnosed people remains all of our worry. I guess that is true for ANY late stage cancer diagnosis.

Welthy

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I also don't know where they're coming up with that 200-300 dollar range. I just looked up my explanation of benefits for my CT this past June and it was 1700 for the chest CT and 1700 for the upper abdomen. Now I realize that a screening CT would only be for the chest, but still, that was 1700, and that didn't include the $130 for the contrast, and the reading and the office visit, and all that....

Cindy

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Our health Insurance just changed now that my husband has retired. They no longer cover for PREVENTATIVE Health coverage, meaning PAPS, MAMOGRAMS, Checkups. I think a LOT of insurance companies work that way retired or not. STUPID is what that is in MHO, but what do I know?!?!?!

Also, I did hear back about 2 years ago from the U of MN who is a part of the CT verses X-Ray Study for LC, that they were complaining about the false positives even back then and had stated it appeared to be a pretty big issue in the medical world. :roll: You would THINK they would want to SAVE lives anyway they could? You would THINK!

Also, where in GOD'S name can you get a $200.00 CT scan?? WOW, I have never paid $200.00 for a CT scan, with or without contrast. I have been doing CT scans for over 11 years and they started out at $640.00 and are now up to $1,100.00 to $1,250.00.

I had one done in Vegas last November and they charged my insureance $1,650.00, and that was no different then what I have had here in Minnesota.

All I know is, there is NO OTHER medical technology that can offer early detection for lung cancer better then a CT scan, so WHY NOT go with it until they find something better? :roll::wink: It's all about the almight BUCK!

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I priced a full body ct screening and it was $895. Not sure if there are different machines, etc. I do know that they charge insurance companies a lot more than the cost :)

When my doctors in general always talk about the high costs if everyone got screened, the false positives, how much it would cost for follow up, my response has been blunt. I said: That's nice, but I really don't care about others and how the cost effects everyone, I only care about me :D

I should have had my dad screened sooner. Two weeks before his abdominal ct-scan,we drove by the imaging center and I actually said "Daddy, just for fun, next year you are going to pay for a chest ct-screening".

I will do one myself eventually once/if everything calms down.

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Also, I did hear back about 2 years ago from the U of MN who is a part of the CT verses X-Ray Study for LC, that they were complaining about the false positives even back then

Yeah, you think those false positives are bad...those false negatives on the x-rays can kill ya.

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