Lung Cancer Poses Deadliest Threat - By Far

[Christine]

Proof, in my opinion, that LC screening with CT scans works.

TheStar.com

Lung cancer poses deadliest threat - by far

September 27, 2007

Elvira Cordileone

Staff Reporter

In the time it takes to read the next few paragraphs, someone will die of lung cancer somewhere in the world.

The Global Lung Cancer Coalition says lung cancer consumes one human being every 30 seconds – more than breast and prostate cancer combined, with another 1.2 million new cases diagnosed every year.

If everything goes well, Milton resident Sherry Walker, 57, won't be among the casualties.

In June, surgeons made a crescent-shaped slice along the right side of her upper back, cracked open her ribs and removed the top lobe of one lung, where a 2.5-centimetre tumour festered. Tests later revealed a trace of cancerous cells in a single lymph node, putting her in stage two of the disease.

Walker's early diagnosis came to light by a stroke of good fortune. In March, family doctor Helen Pyle told her about an early lung cancer screening study for people at high risk – former and current smokers included – at Princess Margaret Hospital. As a half-pack-a-day smoker for most of her adult life, she had no trouble qualifying for the study.

The hospital is the only Canadian institution participating in an International Early Lung Cancer Action Program, which aims to prove that early detection saves lives. It uses a CT scan, which shows many cross-sectional images of the lungs from top to bottom. An X-ray shows only two views of the chest, front and side and can miss lung cancers.

Since the program started in 2004, it has detected 20 lung cancers in 1,000 scans, of which the vast majority (78 per cent) were in stage one, says Heidi Roberts, principal investigator. This is when lung cancer has the best cure rate. Usually by the time symptoms appear, it's too late.

Walker, who has now stopped smoking, had the 20-second, low-dose computed tomography (CT) scan in April. Two days later, she got a call telling her she needed an emergency biopsy.

In the year before the diagnosis, Walker experienced a succession of colds, sore throats and fatigue so acute she even quit her beloved bowling league.

Although two chest X-rays revealed nothing, she insists her little Shih Tzu, Maggie, knew better.

"Maggie wouldn't leave my side. She would lie at the edge of the bed beside me, right up along my upper back," Walker recalls. "I remember thinking, `What is she doing?'"

Walker's chemotherapy ends in November, and she now expects to die of something other than lung cancer at a ripe old age. She will be monitored with CT scans every three months.

Lung cancer is the most common – and deadliest – of all cancers, according to Lung Cancer Canada. Last year, almost 23,000 Canadians were diagnosed with the disease and another 27,000 cases are expected to be diagnosed this year.

"That 27,000 is the size of a small town," says Dallas Petroff, Lung Cancer Canada's executive director.

"Visualize losing a small town every year and it's amazing there hasn't been more of an outcry."

The Canadian Cancer Statistics 2007 report predicts the disease will claim about 9,000 Canadian women in 2007.

By contrast, breast cancer deaths will number about 5,300 – even though twice as many women will be diagnosed with breast cancer as lung cancer.

Early detection saves lives, says radiologist Heidi Roberts, Princess Margaret's principal investigator.

Nevertheless, no regular screening programs exist to catch the disease early, when treatment is more successful and less invasive.

Dr. James Gowling, chair of the Cancer Advocacy Coalition of Canada, also points out lung cancer research lacks the lavish funding raised by breast cancer advocacy. That's because most lung cancer patients don't live long enough to advocate for their disease, he says.

"If you look at the amount of money spent on breast cancer, there's a 30-times' difference," says Gowling, a Cambridge-based hematologist and oncologist.

In a recent telephone conversation from Seoul, Korea, while attending a biannual world conference on lung cancer, Gowling says lung cancer treatment is 20 years behind breast cancer. Finding tumour markers and developing drugs targeted to those markers requires a lot more research – and funding.

"Lung cancer is a neglected and stigmatized disease," says Sunil Verma, a medical oncologist at Sunnybrook Hospital's Odette Cancer Centre.

The stigma comes from its association with smoking. According to Lung Cancer Canada, 35 per cent of the people who get it are former smokers and 50 per cent are current smokers. But 15 per cent of those who get lung cancer never smoked.

Susan Managbana belongs to the latter group. She never put a cigarette to her lips but has advanced lung cancer.

Managbana, 45, came from Singapore on a visitor's visa in 2005. She met Toronto resident Peter Laidlaw, and they married last year. Her cancer came to light in a routine immigration chest X-ray. A biopsy in December revealed malignant cells had spread. Surgery wouldn't help.

"I'd had no symptoms at all, only migraine," says Managbana. Nevertheless, she has a good quality of life today, thanks to an experimental drug called erlotinib, (trade name Tarceva), which inhibits cells from growing and multiplying.

"The drug was effective very quickly," says Laidlaw. "In less than a week, the pain disappeared, the size of the tumour reduced and she's stable."

But the couple faces another worry: The drug's clinical trials only admit people who've had chemotherapy, so they have to pay for the drug out of their own pockets. Laidlaw says it costs $1,900 a month – and he's self-employed as a consulting engineer and part-time vintner.

There's no effective screening for lung cancer, and its symptoms, such as a persistent cough or back pain, are vague. Lung Cancer Canada reports about 85 per cent of people diagnosed with lung cancer die within five years of diagnosis.

Walker insists the screening program saved her from early death, but the medical community is divided about whether screening reduces mortality rates.

"It's a statistical feature (the doubters) are looking for," Roberts says. "They want a randomized trial for 10 years."

She points to a study published in the New England Journal of Medicine last October that concluded 92 per cent of those discovered to have early stage lung cancer through CT scans who were treated survived 10 years after diagnosis.

"I totally believe in this work," Roberts states.

Verma goes further: "If we do detect it earlier, we can cure this cancer. But in more than half the cases, it's already advanced."

For more information, visit the website at lungcancercanada.ca.

[wendyr]

I recently had a general check up with my primary doc. Since I'm 63 years old and smoked 2 packs a day for over 40 years (quit 2001) I asked for a spiral ct and was refused. A chest xray was all I got. It showed nothing but still, I wonder...........

wendyr

[nikk67]

I just posted the link to this article under an ongoing post in general! Glad to see it was already on here!

PS My 17 yr old cat stays by side when I am bedridden and gets up and down the stairs or to the washroom with me all night long when I cant sleep. He is a great caregiver! My pit bull mix dog stays lying curled up at my feet when I am on the couch! Pets are such a blessing and comfort.

Wendy - not sure what a spiral CT is but wont they do any CT scan? Get xrays as often as possible (at least yearly?!) if thats all they will do.