(June 2011) A groundbreaking new study finds early lung screenings of smokers and former smokers can save lives. Thomas Lynch, MD, director of the Yale Cancer Center and physician-in chief for Smilow Cancer Hospital at Yale-New Haven, calls it “the most important breakthrough in the treatment of lung cancer in 50 years.”
The study, conducted at UCLA as part of the federally-funded National Lung Screening Trial (NLST), finds that there is a greater than 20 percent reduction in lung cancer mortality among those who were screened at early stages of the disease.
Thomas Lynch, MD
Researchers compared low-dose heilical computed tomography scans (CT scans) with traditional chest X-rays in 53,000 current and former heavy smokers aged 55 to 74 at 33 sites. Participants were required to have a smoking history of at least 30 pack-years and were either current or former smokers without signs, symptoms, or history of lung cancer. Pack-years are calculated by multiplying the average number of packs of cigarettes smoked per day by the number of years a person has smoked.
Results were published online in the June 30 issue of the New England Journal of Medicine.
Dr. Lynch says the study shows the CT scans can be a preventive tool that is as important to treating lung cancer as mammograms and colonoscopies are in treating breast and colon cancers. The study’s authors note that any harm from exposure to radiation during the screenings could not be measured directly. But radiation exposure associated with low-dose helical CT in the NLST is much lower than that associated with a regular diagnostic CT.
Roy Herbst, MD
Roy Herbst, MD, chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital says, "This is a historic study, showing for the first time the benefit of screening to improve lung cancer survival. As a result, tertiary care centers like Yale can now begin to screen former smokers and carefully evaluate and monitor any abnormalities found." Since late diagnosis is the reason so many people die of lung cancer, catching it early is crucial, Dr. Herbst says.
Frank Detterbeck, MD, surgical director of the Yale Thoracic Oncology Program, says, "With a greater than 20 percent reduction in lung cancer mortality, there are very few single things in our lifetime that will have such a positive impact with lung cancer as these new screening suggestions."
Dr. Detterbeck also issues a cautionary note. "The NLST addresses a very specific population of people. It will be important to continue to monitor the data and evolve our screening and treatment practices in the coming years so that we can maximize the positive impact it will have on lung cancer survival rates."
Frank Detterbeck, MD
He recommends screening be performed at a center that has a surgeon, a radiologist and oncologist who with expertise in interpreting scans and treating cancer with minimally invasive techniques.
Ongoing studies based on the complete NLST data set are ongoing and will focus on cost-effectiveness of low-dose helical CT, provide more information on whether other groups of smokers, such as light smokers or younger smokers, would benefit from screening with low-dose helical CT, and examine the optimal frequency and duration of screening.
More than 94 million current or former smokers are at risk of developing lung cancer, but the disease usually is not detected until it causes symptoms such as a cough, chest pain or shortness of breath.
Previous research into lung cancer screening “picked up a few more lung cancers, but the same number of people died,” Dr. Detterbeck says. “Usually our steps forward are small steps.”
Yale Cancer Center doctors are offering screening for people at high risk of developing lung cancer through the thoracic oncology program at Smilow Cancer Hospital at Yale-New Haven. CT scans are read by dedicated radiologists and any suspicious areas are reviewed by a multidisciplinary team of lung cancer experts.
Talk to your doctor about whether or not you should consider screening. It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms.
For more information, visit the Yale Cancer Center website at www.yalecancercenter.org or call 1-866-CANCER ((203) 785-4191).