Smokers may want CT scan for lung cancer

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Smokers may want CT scan for lung cancer

Baltimore Sun

By Michael Stroh

November 03, 2006

Having a skilled diagnostic pulmonary specialist is really, really important

Should I get scanned?

That is the question some current and former smokers have been asking themselves in the wake of widely publicized findings on the benefit of early lung cancer screening.

The study, reported last week in the New England Journal of Medicine, concluded that heavy smokers who undergo spiral computed tomography (CT) scans significantly improve their odds of catching cancerous lesions in the earliest and most curable form.

Screening for lung cancer sounds like a no-brainer. But experts remain surprisingly divided.

The American Cancer Society and other influential health care organizations have not endorsed CT screening for lung cancer - and said they likely won't until there's more solid evidence to show that it helps.

'Health policy isn't made on the basis of one study,' said Robert Smith, the society's director of screening.

Most agree that there's an urgent need for new diagnostic tools against the disease, which kills at least 165,000 Americans each year - more than the combined toll of breast, prostate, colon and pancreatic cancers.

For more than a decade, a group at Weill Cornell Medical College in New York has championed CT scans. That's because a tumor has to reach nearly the size of a quarter before it's detectable with a traditional chest X-ray, which is widely considered to be ineffective at spotting early-stage lung cancer.

CT scans - also known as CAT scans - can pick out cancerous nodules smaller than a centimeter.

To test whether they can save lives, researchers scanned nearly 31,600 current and former smokers in seven countries. Tiny cancerous nodules were detected in 484 patients. In 85 percent of these cases, the nodules were classified as Stage I tumors, the earliest and most treatable form of the disease.

With treatment, researchers estimated that 88 percent of the patients would survive 10 years. The typical five-year survival rate for lung cancer is 70 percent.

Eight patients in the study diagnosed with Stage I tumors refused treatment for unexplained reasons. All died within five years.

Many clinicians view the results as strong proof of the idea that early CT scans make a difference. Critics contend that while the study may have shown CT screening can catch cancer earlier, it didn't prove that the technology helps prolong life.

For definitive evidence of that, many experts are awaiting the results of the National Lung Screening Trial, a large National Cancer Institute-funded study of 50,000 current or former smokers. Volunteers in the study were randomly selected to receive either a standard chest X-ray or a CT scan. Results aren't expected until 2009 at the earliest.

Some clinicians are unwilling to wait.

'It's not hard to beat the miserable statistics we currently have,' says Dr. Esner Cole, director of the Lung Center at St. Agnes Hospital. Cole, who helped recruit patients for the CT scan study, said that he's confident that early screening is beneficial.

Insurance companies, however, don't cover CT scans for lung cancer screening, which can run several hundred dollars. So St. Agnes and some other area hospitals have begun to offer discounted scans to qualifying current and former smokers.

St. Agnes and Union Memorial Hospital charge $75 for the service. Franklin Square Hospital Center offers $100 CT lung screens.

'We felt we had an obligation to begin to offer this,' says Dr. William Krimsky, chief of interventional pulmonology at Franklin Square.

Cost isn't the only reason for a cautious approach to the idea of widespread use of CT scans to screen for lung cancer. Dr. Elliott Fishman, a professor of radiology and oncology at the Johns Hopkins University , said another concern is that it may lead to risky and potentially unnecessary biopsy or surgery.

As many as 60 percent of CT screens from smokers will be flagged as abnormal because smokers' lungs often contain scar tissue, infections, inflammation and suspicious-looking areas.

Still, as long as people understand the limitations of scientific knowledge about CT scans, experts say that people who have had significant exposure to tobacco or other cancer-causing agents such as asbestos might want to consider it.

'It's very hard to say, 'No, don't do it,'' concedes Fishman, who is a principal investigator for the National Cancer Institute study.

Experts advise people considering a CT scan to go to a place with physicians experienced in assessing the risk of early-stage lung cancer. 'Having a skilled diagnostic pulmonary specialist is really, really important,' says Dr. Young Lee, chief of oncology at Harbor Hospital.

Gary Kaufman and his wife, Judy, went to St. Agnes for a CT scan last year. Both had once been heavy smokers, going through two or more packs of cigarettes a day for more than 20 years. 'I had one burning all the time,' Judy says.

When the results came back, Judy's lungs were found to be clear. But the scan revealed a small nodule on Gary's lower left lobe. 'It was what I feared when I said yes to doing this,' he says.

The nodule was too small to biopsy, so doctors decided to follow it to see whether it changes. So far, it hasn't.

Gary, 66, who is a retired Elkridge mortician, concedes that the knowledge that he might be carrying around a tiny time bomb is worrisome. But he says he has no regrets about getting scanned.

'Now I can look out for this,' he says.

michael.stroh@baltsun.com

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