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I opened my newspaper and found the following article on page 2:

http://www.knoxnews.com/kns/health_and_ ... 90,00.html

Focus on: Detecting lung cancer

Should CT scans be test of choice to diagnose disease?

By MICHAEL STROH, Baltimore Sun

November 8, 2006

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 in the New England Journal of Medicine, concluded that heavy smokers who undergo spiral computed tomography scans significantly improve their odds of catching cancerous lesions in the earliest and most curable form.

The American Cancer Society and other influential health-care organizations have not endorsed CT screening for lung cancer.

"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 to detect 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. A tumor has to reach nearly the size of a quarter before it's detectable with a traditional chest X-ray. CT scans can show cancerous nodules smaller than a centimeter.

To test whether the scans 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 those cases, the nodules were classified as Stage 1 tumors, the earliest and most treatable form of the disease.

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

Eight patients in the study diagnosed with Stage 1 tumors refused treatment for unexplained reasons; all of them died within five years.

Many clinicians view the results as strong proof 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," said Dr. Esner Cole, director of the Lung Center at St. Agnes Hospital in Baltimore. Cole, who helped recruit patients for the CT scan study, said he's confident early screening is beneficial.

Most insurance companies, however, don't cover CT scans for lung cancer screening. Cost isn't the only reason for a cautious approach. Dr. Elliott Fishman, a professor of radiology and oncology at Johns Hopkins University, said another concern is that widespread use of CT scans to screen for lung cancer may lead to risky and potentially unnecessary biopsies and surgeries.

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

Still, as long as people understand the limitations of scientific knowledge about CT scans, experts say 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 Baltimore's Harbor Hospital.

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