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Scan may foil lung cancer

A study finds the test can help spot the disease early and increase survival odds.

By LISA GREENE
Published October 26, 2006

Most people diagnosed with lung cancer are dead within a year.

The nation’s biggest cancer killer has no equivalent of the mammogram or the colonoscopy — no easy way to detect it early. By the time most people are diagnosed, it’s too late to save them.

All that could change.

Tests using high-tech scanners called spiral CTs can spot lung tumors so early that most patients will live, researchers said in a study published today in the New England Journal of Medicine.

“This is a profound and watershed moment for the lung cancer community that we won’t really see for years to come,’’ said Laurie Fenton, president of the Lung Cancer Alliance, a national advocacy group. “It’s the most important news for this community that has ever happened.”

In the largest study of early screening, researchers at 38 cancer centers in seven countries screened more than 31,000 people at high risk for lung cancer. Participants, all age 40 or older, were current or former smokers, had been exposed to such environmental hazards as asbestos, or to secondhand smoke.

Those screenings spotted early-stage lung tumors in more than 400 patients. Their survival rate over 10 years: 88 percent. Among the 302 who immediately had tumors removed, the 10-year survival rate was 92 percent.

“We’ve never seen these numbers in stage one lung cancer,’’ said Dr. Michael Unger, author of the Journal editorial and director of the early detection and prevention lung cancer program at Fox Chase Cancer Center in Philadelphia. “It’s 70 percent at best. And most people are not detected in stage one.”

The overall five-year survival rate for lung cancer is a far more dismal 15 percent.

“Ultimately, screening is all about preventing people from dying,’’ said Dr. David Yankelevitz, a study co-author and radiology and cardiothoracic surgery professor at Cornell University. “I think we’ve shown that here.”

Screenings debate

Still, key questions remain about the potential of the screening to save lives. Advocates and scientists already disagree.

The big question: Should public health agencies recommend screening for people at high risk?

Such questions are especially controversial for lung cancer, because many researchers and advocates believe lung cancer research has been neglected because the disease carries the stigma of smoking.

“Unfortunately, we have not left behind the idea that lung cancer is a punishment, not a disease,” said Unger’s editorial.

Cancer advocates say it’s past time for broader screening.

“Lung cancer has been held to a different standard,” Fenton said.

Questions remain about the value of such tests as mammograms, PSA blood tests and Pap smears, Fenton said, but health officials still endorse their use. Others say this study, while impressive, doesn’t provide enough evidence for broad recommendations.

“We’re certainly watching it with high interest,’’ said Dr. Gary Kelloff, special adviser in the division of cancer treatment and diagnosis at the National Cancer Institute. But the NCI’s concern is that this study was not a randomized trial, the gold-standard for proving a screening could lessen deaths.

A randomized trial would study another group of similar people who weren’t screened to see how they were affected by lung cancer.

Advocates say the statistics on lung cancer deaths are well known, so such a costly trial isn’t needed. But researchers say the study doesn’t prove fewer people would die. Some of the cancers found might have been slow to advance, and some screenings could result in unneeded surgeries, they said.

That’s a concern with most cancer screenings. But Kelloff said with lung cancer, the stakes are higher.

“If you have a suspicious Pap smear, you can get another, or have a biopsy with a day or two of bleeding,’’ he said. “A lung biopsy is more invasive than almost any other organ.”

Study will prompt talk

 At H. Lee Moffitt Cancer Center & Research Institute in Tampa, which took part in the study, Dr. Melvyn Tockman also believes it’s too early to call for broad screening. But Tockman and others said the study will likely prompt doctors to talk to certain patients.

“A doctor might recommend it if he has a particular person at high risk, for example, if there’s lung cancer in the family, or an individual who’s been a heavy smoker,’’ said Tockman, director of the molecular screening program at Moffitt and an oncology professor at the University of South Florida.

The Lung Cancer Alliance is urging people at high risk to talk with their doctors about the scans. These include:

• Smokers and former smokers over age 50 with more than a “10 pack year history” of smoking. (One pack year means smoking a pack a day for a year).

• Adults with “significant exposure” to cigarette smoke and a close relative diagnosed with lung cancer before age 50.

Tockman and Yankelevitz hope the study may also prompt some insurance companies to start covering spiral CT scans, which uses a rotating device to take hundreds of X-ray pictures of the lungs. Such a test for lung cancer typically costs $200 to $300 and is not usually covered by insurance, Yankelevitz said.

With Tockman as chief investigator, Moffitt screened 1,151 patients. Moffitt found 53 patients with cancer; 24 of those were spotted in stage one.

Among them was Maurice Arcand, a retired Air Force veteran who lives in Melbourne. Arcand, now 74, first started smoking in the Air Force when he was 18.

“It’s hard to stop when everybody around you is smoking,” he said. “They used to put cigarettes in the field rations.”

He tried everything to quit his two-pack-a-day habit, including hypnosis and nicotine gum. He still remembers the last cigarette: Oct. 1, 1992, on the way to the doctor who put him on a nicotine patch.

“I’m so glad I did stop,’’ he said. “I’ve felt so much better since I did.”
But Arcand still worried, so when he saw a newspaper item about the study while visiting Tampa, he volunteered. On his third annual screening, almost five years ago, they found a spot. Arcand had surgery to remove a wedge of his left lung.

“I think they got it out so quickly that I’m very fortunate,” Arcand said. “I have no doubt — I’d probably be dead.”

[Last modified October 26, 2006, 06:16:50]