By Dr. VERONICA SIKKA
For the first time, several top cancer organizations are recommending that smokers and former smokers ages 55 to 74 years who have smoked at least one pack of cigarettes a day for at least 30 years get an annual low-dose CT (LDCT) — a three dimensional X-ray — to look for lung cancer.
The recommendations, put forth as a collaborative effort by the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network, were released this morning. They appear in the Journal of the American Medical Association.
Each year, more Americans die from lung cancer than from breast, colon, and prostate cancers combined. It has held its position for years as the second most common cancer for both sexes in the United States. Only prostate cancer is more common than lung cancer in men. Breast cancer is the most common cancer in women.
If detected early enough, lung cancer can be treated and survival chances improved. Despite this, until now there had been no formal recommendations on screening tests for this deadly cancer.
“We now have an important and critical tool to screen for the most common cancer in America, and can reduce the mortality through this screening,” says Dr. John Deeken, assistant professor in the division of hematology/oncology at Georgetown University in Washington, D.C.
Still, the question of whether every person at high risk for lung cancer should get an annual low-dose CT scan is not so simple. Since the type of CT scan used exposes the patient to radiation, albeit a low-level dose, there is a small health risk posed by this screening.
If doctors detect a questionable cancerous mass through a CT scan, they may have evaluate it further through a minor surgery called a biopsy. In this procedure, a doctor will take a sample of the tissue for further testing to determine if the mass really is a cancer. While some of these may be cancerous, there are always a certain number which are not — meaning that the detection and subsequent surgery may not have been technically necessary.
The new recommendation also begs the question of who will be paying for the test itself.
“The cost of LDCT is currently not covered as a standard test,” says Dr. Chao Huang, lung cancer specialist at the University of Kansas Cancer Center. “Therefore, it is difficult to recommend this test when patients may be burdened by the cost of this test year after year.”
“The key question is when will more insurance companies, and most importantly Medicare, start paying for these screening tests,” Deeken says.
And then there is the issue of how many Americans will fall under the guidelines — and whether the resources exist to screen all of them.
“We currently do not have the infrastructure to manage the potential number of patients that would qualify for screening,” Huang says.
These issues aside, one thing is clear: screening CTs have been shown to save lives. Dr. Keith Mortman, associate professor of clinical surgery at Georgetown University School of Medicine, explains that a major study in 2010 called the National Lung Screening Trial found a 20 percent reduction in lung cancer deaths in patients who were screened with low-dose CT scans as compared to those who got chest X-rays.
Dr. Herbert Kressel, a radiologist at Harvard Medical School, says that in light of this, the recommendation is a step in the right direction.
“Lung cancer is an important health problem with a poor prognosis when it is discovered at an advanced stage,” Kressel says. “This study is important in further highlighting the importance of low dose CT screening for patients at high risk for lung cancer.”