The way Frederic W. Grannis Jr., M.D., sees it, the math is nothing short of tragic.
More than 170,000 people will be diagnosed with lung cancer in the United States this year, and fewer than 10 percent of them will survive. That means lung cancer annually claims the lives of enough Americans to fill Dodger Stadium, the Los Angeles Coliseum and UCLA’s Pauley Pavilion — combined.
“The way we deal with lung cancer in the U.S. is broken,” said Grannis, thoracic surgeon in the City of Hope Lung Cancer Program. “By the time we find lung cancer, it is very difficult to treat. But lung cancer can be curable if it is caught early, and it can be caught early. We’re seeingthat.”
When Grannis says “we,” he is referring to a growing group of lung physicians pushing for imaging-based screening among current and former heavy smokers, who are considered at significant risk for developing lung cancer.
Grannis is an investigator in the International Early Lung Cancer Action Program, or I-ELCAP, a network of researchers at 40 institutions in the U.S., Europe and Asia who are studying the potential of computed tomography, or CT, for early lung cancer detection. City of Hope’s local effort, the only one in the Los Angeles area, is part of I-ELCAP.
In February, the I-ELCAP team reported in Archives of Internal Medicine that annual CT screening can detect many small-cell and non-small-cell lung cancer tumors when they are still minute (less than 15 millimeters across) and have not metastasized. Most of the solid, non-small-cell lung cancers found in the study so far - nearly 80 percent - were discovered before they could spread to nearby lymph nodes.
The majority of cancers found through CT have been stage 1 cancers,” Grannis said, “and the five-year survival rate for those with node-negative disease is very high.”
I-ELCAP began in 1992 with Claudia Henschke, M.D., and her colleagues at Weill Medical College of Cornell University. Frustrated with the dire prognosis for most lung cancer patients, the Cornell team looked at screening methods to find cancers before they become so deadly.
Earlier studies had shown some potential for finding lung cancers through X-rays, but the technology was insufficiently sensitive. So Henschke decided to evaluate CT scanning - a technology three to four times as sensitive as X-rays in detecting cancers. With an initial group of 1,000 heavy smokers, she began ELCAP. (And as more researchers from other institutions signed on, the group turned global, becoming I-ELCAP.)
Because the study does not have a large funding source, participants in I-ELCAP must pay for the more-than-$300 CT scans themselves, Grannis said. “Despite that, the study has accrued over 35,000 people,” he said. Nearly 500 lung cancers have been detected so far. At City of Hope, new CT scanners used in the study are so precise that physicians can accurately measure the size of any discovered lesion in the very first scan, eliminating the need for patients to return for a second, high-dose scan, Grannis said. The radiation dosage in a CT scan ranges from that of a standard chest X-ray to about three chest X-rays. The risk from the radiation dose is equivalent to smoking one pack of cigarettes in an entire lifetime, researchers said.
Beginning this spring, the group will start a second study evaluating regular CT screenings for surveillance among smokers or former smokers who have already had treatment for cancer of the esophagus, lungs or head and neck. They are at high risk for a second tumor.
Grannis advocates early detection through scanning. For example, he co-authored a consensus statement in the April 2005 issue of Chest that recommends that physicians discuss screening with their patients at high risk for lung cancer (current or former smokers). When possible, such patients should be encouraged to join clinical trials that offer screening.
Finding Lung Cancer Early
More than 85 percent of the men and women diagnosed with lung cancer today are diagnosed in a late stage, after symptoms occur and when there is a low chance of cure. With early detection, more than 80 percent of cancers can be found in the earliest stage.
If 80 percent of cancers were consistently detected in the early stage, and 70 percent of those cancers were cured, 56 percent of patients diagnosed with lung cancer would survive, according to I-ELCAP researchers.
Participants in City of Hpe's lung-screening study must...
- be between 40 and 75 years old.
- be a current or former cigarette smoker.
- have smoked at least one pack of cigarettes a day for 10 years or the equivalent (for example, half a pack per day for 20 years or two packs a day for five years).
Several other requiremetns apply. To learn more, visit www.cityofhope.org/lungscreen and www.ielcap.org.