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Detecting lung cancer using low-dose CT scans

Lung cancer takes a terrible toll. It is the leading cause of cancer in the U.S., with about 171,000 new cases diagnosed this year. Nearly 159,000 men and women will die from it. These numbers have leveled off recently, but we don’t expect them to improve much. It’s important to note that about 90 percent of lung cancers are directly related to cigarette smoking.

Lung cancer does not usually cause symptoms in the early stages and there have been no good screening tools to detect it early, when it is most treatable. So the vast majority of patients present with cancers that have spread to lymph nodes or other parts of the body. As a result, the overall cure rate for these patients is only about 14 percent.

A survivable cancer if caught early
However, for early stage cancer, five-year survival rates approach 70 percent. If there was a way to detect the disease earlier, tens of thousands of lives could be potentially saved. So there’s been a long-standing interest in developing ways to detect lung cancer early.

No calls for screening
Because a chest X-ray may not be sufficiently sensitive to identify an early lung cancer, there have not been calls for widespread screening for lung cancer. Only a small number of organizations, such as the American Thoracic Society, have advocated screening. They recommend middle-aged smokers have an annual chest X-ray.

Compelling information
This particular study by Dr. Henschke is important because it suggests recent advances in radiographic imaging may play a role in detecting disease earlier. This information is very compelling. In general, the new CT equipment works more rapidly, thus exposing the patient to lower doses of radiation than standard CT, and it seems to have the capacity to identify disease.

It’s reasonable to expect that using low-dose CT scans will identify patients at more curable stages. What does that mean for the average person concerned about lung cancer today? A low-dose CT scan offers the opportunity for patients who get an annual screening to do something this year to potentially improve their chances of survival.

Cure vs. cost
When any new type of procedure is introduced, the first question asked is whether it works. That’s a medical question that can be answered by performing clinical trials that evaluate this screening tool, like one study being done at Yale.

The next question—whether it will be widely used—is based partly on costs. These issues are societal questions and will be addressed differently in different countries. At the moment the CT scan for lung cancer screening is not covered by insurance in the U.S. So those people wishing to have it done have to pay for it themselves.

Eventually, these costs will have to be compared with the tremendous physical and emotional cost of caring for patients with advanced lung cancer cases.

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Dr. John Murren is a medical oncologist specializing in lung cancer at Yale-New Haven Hospital and an associate professor of internal medicine and medical oncology at Yale School of Medicine. He is affiliated with the Yale Cancer Center.