July 29, 2013 | by Tami Dennis
Lung cancer specialists have been waiting years for the news. And on Monday it came. The U.S. Preventive Services Task Force proposed annual screening, using low-dose CT scans, for people at high risk for lung cancer.
“Lung cancer is the leading cause of cancer death in the United States and a devastating diagnosis for more than two hundred thousand people each year,” task force chairwoman Virginia Moyer, M.D., M.P.H., said on the task force's website. “Sadly, nearly 90 percent of people who develop lung cancer die from the disease, in part because it often is not found until it is at an advanced stage. By screening those at high risk, we can find lung cancer at earlier stages when it is more likely to be treatable.”
The recommendation, posted along with the agency's final evidence report, comes in draft form for now. But the draft itself is significant, as is the reasoning behind it. A bulletin announcing the proposed recommendation stated:
"After reviewing the evidence, the task force determined that you can reach a reasonable balance of benefits and harms by screening people who are 55 to 80 years old and have a 30 pack year or greater history of smoking, who are either current smokers or have quit in the past fifteen years. A 'pack year' means that someone has smoked an average of one pack of cigarettes per day for a year. For example, a person reaches 30 pack years of smoking history by smoking a pack a day for 30 years or two packs a day for 15 years."
The goal is to find lung cancer – when it’s treatable – among those most likely to have it. And a key phrase in the statement is "reasonable balance of benefits and harms."
“When patients are detected at Stage 3 or 4, those patients unfortunately are generally not curable. That’s why we have 160,000 people a year dying of lung cancer," said Dan Raz, M.D., surgical director of Lung Cancer and Thoracic Oncology at City of Hope and an outspoken proponent of lung cancer screening for high-risk populations.
“What lung cancer screening means for patients is that they, on average, will have their lung cancer detected at a much earlier stage, typically at Stage 1, as opposed to – most commonly – Stage 3 or 4, where most patients are currently being detected,” Raz said.
In short: “Stage 1 lung cancer patients can be cured."
Those are bold words. And true. "Depending on how small the tumor is, we see anywhere from 70 to 90 percent cure rates," Raz said, "and so if you’re a patient with lung cancer and you get diagnosed with CT screening, the chances are you will be cured of your lung cancer.”
In the video above, Raz explains not only how CT screening improves the chances of survival, but also the cost-effectiveness of the procedure – and where people should be screened. He recommends, for example, that people at high risk of lung cancer consult the Lung Cancer Alliance for a recommended screening center. (Yes, City of Hope is a recommended screening center.)
The experts doing that screening are equally pleased, and relieved, by the task force’s proposal. “The recommendation has been painfully slow in coming out, and there’s been resistance by the academic world because of the likely large costs to the general health care system,” said Arnold Rotter , M.D., chief of computed tomography in the Department of Diagnostic Radiology at City of Hope. “But this is the correct thing to do.”
He added: “The truth is, if you use the I-ELCAP data [the International Early Lung Cancer Action Project], you can extrapolate and realistically say that people who get screened, if they have a lung cancer, they can reduce their mortality rate 80 percent.”
As for cost-effectiveness of the procedure, and the downside of screening, Rotter said he’s confident that the amount of unnecessary callbacks – false positives, people requiring additional screening – can be reduced.
The task force is now accepting comments on the recommendation, which the task force will consider as it prepares its final recommendation. The comments from lung cancer specialists will come as no surprise.
For more about screening, visit our lung cancer screening page.