Lung Cancer Screening

November 21, 2011 Ralph W. Aye, MD, FACS

We screen for breast cancer with mammography, colon cancer with colonoscopy, and prostate cancer with blood tests and exams – why not lung cancer?

If you’re a smoker or a former smoker, or even if you’ve had significant second-hand smoke exposure, you’ve probably worried about your chances of getting lung cancer, and whether there is anything you can do about it. Perhaps you even asked your doctor about getting an x-ray; he or she may have told you that there is no proof that it helps. That’s because a national study done years ago showed no benefit from getting chest X-rays, and therefore it’s not recommended.

The studies

However, since 2000, Swedish has participated in an international study – the International Early Lung Cancer Action Project (I-ELCAP) - to see whether CT scans or CAT scans – very highly detailed X-rays – might be able to find lung cancer earlier and improve cure rates. The study was begun by a group of investigators from Cornell University in New York. They knew that CT scans were very sensitive and would probably show a lot of abnormalities, and that most of them wouldn’t be cancer, so they worked out a system to determine which abnormalities were likely to be cancer. Their system worked, and they showed that when lung cancer was discovered through their screening system the cure rate was over 80%. That’s remarkable, because the normal cure rate for lung cancer is only 15%.

Because of their success, the National Cancer Institute (NCI) began a randomized study with over 50,000 participants. Half of them got annual CT scans and the other half got only chest X-rays. The results were just completed and were very exciting. The group that got CT scans had 20% fewer deaths from lung cancer than the other group!

The results are still being analyzed and there are concerns about safety from too many interventions, radiation exposure, and cost. It will take time to work through these issues, and there is still no general endorsement of lung cancer screening. However, several national organizations now cautiously support screening in high risk groups that meet the criteria for the national study.

Who should get screened, and how?

This high risk group includes smoker or former smokers between 55 and 74 who have a 30 pack-year smoking history. That means smoking 1 pack per day for 30 years, or 2 packs per day for 15 years, or other multiples of 30.

In addition, I-ELCAP and the NCI study were done with a multi-disciplinary team including diagnostic and interventional radiologists, pathologists, surgeons, pulmonologists, and oncologists. In other words, screening for lung cancer is about more than just getting a CT scan. It’s about having a system and expertise for managing all of the abnormalities, just as I-ELCAP showed initially. Without this system, there is a real risk of doing more harm than good.

Swedish’s screening program

Swedish, in partnership with Seattle Radiologists, has participated in the I-ELCAP trial since 2000, and has registered over 1000 participants. Thirty lung cancers have been identified in 26 participants, with 85% being stage I or early lung cancer - with the highest chance of a cure - compared to the customary 15%. The Swedish team has developed the expertise to perform lung cancer screening safely and effectively.

Insurance still doesn’t pay for lung cancer screening, so there is a charge of $300 for the first scan. If an abnormality is found, it’s likely that insurance will pay for follow up scans. Be prepared to have an abnormal scan, since nearly 25% are; very few abnormalities are lung cancer. We recommend repeat scanning once a year.

If you believe you have had significant second-hand tobacco exposure you may qualify for a free CT scan through a study funded by the Flight Attendants Medical Research Institute, studying the effects of second-hand tobacco exposure.

To participate or for more information call the screening center at 206-292-7700, or our Thoracic Clinic at 206-215-6800.

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