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Study examines benefit of CT scans for lung cancer detection

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By Catherine Clabby, McClatchy Newspapers

Article Launched: 01/15/2007 12:00:00 AM PST

RALEIGH, N.C. - Bambi MacRae never fretted about getting lung cancer. She stopped smoking more than 40 years ago when she was in her 20s. As a flight attendant, she inhaled others' smoke aplenty, but she quit that job in 1967.

Still, an advanced X-ray screening three years ago detected a small tumor in MacRae's right lung. It was found early, before malignancy spread. Surgery and chemotherapy eliminated it.

Now MacRae advocates regular computed tomography, so-called CT scans, for all former smokers. "It would save a lot of lives. It saved my life," said MacRae, 72, who lives in Wilmington, N.C., and volunteers with the American Lung Association and the Duke Comprehensive Cancer Center.

Hope was kindled in some circles this fall when a study published in the New England Journal of Medicine concluded that CT scans such as the one MacRae received reliably detect lung cancer at its most curable stage.

Some individuals and groups eager to stamp out lung cancer responded with calls for broader testing. A federal class-action lawsuit filed recently in Boston even demanded that Philip Morris USA pay for such chest scans for its consumers to detect early stage lung cancer.

in the fight against lung cancer - including the American Lung Association and the American Cancer Society - take more cautious stances. They praise the study for delivering promising preliminary data, but conclude that the results were not definitive.

Lung cancer is the most lethal malignancy among Americans. It kills more than 160,000 people a year -more than breast, prostate and colon cancer combined.

People who quit smoking reduce their risk of developing lung cancer, but they remain at greater risk than nonsmokers.

Heavy smokers, past and present, are at greatest risk. About half of new lung cancer cases strike former smokers, although the illness also occurs in people who never smoked.

Those who develop lung cancer are in trouble, partly because its early stages rarely produce symptoms, and most lung cancers aren't found until they spread. Nearly 85 percent of people diagnosed die within five years. Detected early, the cancer is easier to beat, with 50 percent of patients surviving.

So far, science has produced no equivalent to the common mammogram or colonoscopy to detect early lung cancer - and that's why the recent study of CT scans is drawing so much interest.

More than 30,000 people took part in the study, but they were not randomized, meaning their health outcomes were not compared with those of patients who did not receive CT scans. It is not clear how well the participating patients represented the wider population. And it's not known whether false cancer diagnoses based on CT scans resulted in injury or sickness to patients from unneeded surgery.

"We don't really know," said Dr. Norman H. Edelman, chief medical officer of the American Lung Association.

Edelman and others are waiting on the results of a larger, randomized study conducted by medical centers all over the country, including Wake Forest University Baptist Medical Center in Winston-Salem. Those results aren't expected until 2008.

Waiting for the larger study's conclusions makes sense, said Dr. Mark Socinski, an oncologist specializing in lung cancer treatment at the Lineberger Comprehensive Cancer Center in Chapel Hill. Because tens of millions of smokers and former smokers live in the United States, it would be wasteful to start regular screening if the outcomes weren't truly helpful to patients. The cost of the CT scans, which can be $500 apiece, plus the resulting medical interventions could add tens of billions of dollars to health-care spending.

"There are tens of millions of smokers in the United States," Socinski said. The latest federal estimate counted 45 million.

But Socinski stressed that patients at elevated risk of lung cancer should discuss the pros and cons of screening with their doctors. People most at risk are heavy smokers - those puffing at least a pack a day for decades.

Other risks must be considered too, such as having a parent or sibling who developed lung cancer. MacRae, the cancer survivor who wants wider use of scans, received two scans after alerting a doctor that a brother and a sister had lung cancer. Socinski said other risk factors include exposure to asbestos or radon and extensive radiation treatment to battle another type of cancer.

Dr. Peter B. Bach, a researcher at Memorial Sloan-Kettering Cancer Center in New York, said he has little faith in CT screening for lung cancer. Although the tests might find some lung cancers, he said, he considers it unlikely that the tests would reduce the number of cases of advanced lung cancer.

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