New Study Says Early Screening May Prevent Lung Cancer Deaths
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JIM LEHRER: Now, detecting and treating lung cancer, the most deadly of all cancers. A study in this week’s issue of the New England Journal of Medicine said screening could save the lives of many thousands of smokers, but some in the medical community have doubts.
Our health correspondent, Susan Dentzer, is here to explain.
Susan, first of all, give us the basic numbers on the deadliness of lung cancer.
SUSAN DENTZER, NewsHour Health Correspondent: Well, Jim, cancer is the number two of killer of all Americans. And lung cancer is the deadliest of the cancers.
Essentially this year, 174,000 people will be diagnosed with lung cancer; 163,000 will die. In fact, more will die of lung cancer than the next five deadliest cancers combined, including breast and colon cancer. So it’s a very deadly condition.
And with 45 million current smokers in the United States and an equivalent number of former smokers, we’re going to have lung cancer with us in big numbers for a long, long time.
JIM LEHRER: OK, so now this new study. Who did it, and what did it find?
SUSAN DENTZER: The study grew originally out of Weill Cornell Medical Center in New York, where a prominent researcher, Claudia Henschke, decided to get going several years ago on this study to find whether you could do for lung cancer what we’ve done for many other cancers, which is to say, “Detect them early, find cancers when they’re small before they’ve spread, and, therefore, treat them effectively and save lives.”
JIM LEHRER: Which has not been the case for lung cancer up until now?
SUSAN DENTZER: Which has not been the case. In fact, most lung cancers, far and away most of them, are found at late stage when patients are finally symptomatic, have symptoms. They’re coughing, they’re coughing up blood. And basically, for those people, 85 percent of people who are diagnosed with late-stage cancer are going to be dead within five years, as distinct from, say, breast cancer, where we’ve established, through mammography and other screening techniques, we can find breast cancers early and really save lives. At least that’s what we believe.
So the issue was, could we do that for lung cancer? So they set up this large study. It’s international, seven countries, including the United States, 38 centers. And a total of 31,500 people were screened with sophisticated, current generation CAT scanners, which essentially…
JIM LEHRER: Were these all smokers or former smokers?
SUSAN DENTZER: Yes, they were a minimum of 40 years old and a minimum of a pack-a-day habit for 10 years, most of them. There were also some people who had occupational exposure to asbestos or other things, but by and large the majority, the vast majority were heavy smokers.
So these people get screened with sophisticated, current generation CAT scanners, which can essentially find a nodule in your lungs when it's the size of a rice grain in about 20 seconds or less. And of all of those people, those 31,500, 484 were found to have lung cancer. Now, what's really important is...
JIM LEHRER: They'd already had lung cancer?
SUSAN DENTZER: To have early-stage lung cancer.
JIM LEHRER: Early stage.
SUSAN DENTZER: And what's important about that is not just that it was found; it's what happened afterwards. Once nodules were found, first of all, they were watched to see if they really were lung cancer. Then, if it looked like they were growing, then those patients were biopsied. Once they were biopsied, then most of them got surgery.
And if you followed that entire process, at the end of it, what the study said was that four out of five of those patients were still alive several years later and the projections are that at least four out of five of them are going to be alive 10 years later. That's very different from the current situation where most are going to be dead within five years.
Problems with early detection
JIM LEHRER: Now, some in the medical world have some problems with this. Why? What's their problem?
SUSAN DENTZER: Yes, because this is not -- this is a huge study and an important study, but it is not the so-called gold standard of a randomized clinical trial, where half the patients would get the screening and the other interventions and half would not.
Those kinds of studies can shed much more light on the hardcore truth of: Did you really extend people's lives by doing this? Did you not do a lot of unnecessary surgeries that ended up killing people? Did you, for example, not just show people that they had cancer sooner than they thought so they spent more of their last years knowing that they cancer? You strip out all those illusions in a randomized, controlled trial. This is not that kind of a trial.
So some people say we really have to wait until a federally funded trial now under way, which is randomized, controlled, comes up with results to make broad-scale recommendations that everybody should be screened and that insurance companies should pay for this, et cetera. So that's really where the doubt is.
JIM LEHRER: And you say there is a study under way that would do this? Like when? When is it going to be finished?
SUSAN DENTZER: Well, that's the problem. The results at the earliest will be in 2009 or 2010, at which point half a million more Americans will be dead of lung cancer. So a lot of people say, "Look, this is a big study. There's reason now even for some individuals who are heavy smokers, who are 50, 60 years old. There's reason to go to your doctor and say, 'Should I be screened this way? Should I go to a center that really specializes in this and be carefully screened to see if I have lung cancer?'"
Working with the results
JIM LEHRER: It's the old meanwhile question. What do we do while the results -- and so, as a practical matter, is the end result of this likely to be in the interim people coughing, and going to their doctors, and say, "Give me that new MRI or that new CAT scan?" Are they available? Can it be done?
SUSAN DENTZER: Yes. In fact, one could go on the Web site for this project, which is http://www.ielcap.org/, for International Early Lung Cancer Action Project, and find the centers in the U.S. that are involved in this trial and screening now.
JIM LEHRER: Are they expensive? Are these CAT scans expensive?
SUSAN DENTZER: The cost has really radically declined in recent years. You can get a CAT scan of this type now for a couple of hundred dollars, so it's getting into the range of a mammogram. And a lot of people will point out that we did mammograms for years with a lot less evidence than this that they really did end up extending lives.
JIM LEHRER: And the bottom line, whatever -- there are some doubts and there are some other things -- is that this is in the good news category?
SUSAN DENTZER: It certainly is in the good news. In fact, we were told that, when the results were discussed last week at a big meeting of this project in New York, people were in tears because this is the first really good news of early detection and extending lives, it is believed, or it's certainly the biggest news.
And, in fact, if this is proven to be correct that early screening really does over time save lives, it could result in the single biggest decline in cancer mortality ever.
JIM LEHRER: A very, very lay question here. It seems so simple. Why in the world didn't they try this before? Lung cancer has been killing people at the highest rate for years.
SUSAN DENTZER: That's a great -- it's obviously a wonderful question. And people will say, "Well, there's been a lot of stigma around lung cancer, a sense that, well, if you have it, you brought it on yourself because you were dumb enough to smoke." That's played a role.
JIM LEHRER: Right, right, take your punishment.
SUSAN DENTZER: Right. And also, frankly, the technology is much better now than ever before. Chest X-rays aren't very good ways of detecting early lung cancer. These sophisticated current generation CAT scanners are really good ways of finding nodules.
And, of course, the big issue is: Could we do this all effectively? We have a not very good, very fragmented health care system, with a lot of people out there who don't know how to do the kind of careful screening and follow-up that needs to be done. But now we've shown that, at least in the 38 centers around the world, that's possible, and perhaps in the future many more.
JIM LEHRER: Say the Web site again?
SUSAN DENTZER: It's http://www.ielcap.org/.
JIM LEHRER: http://www.ielcap.org/.
SUSAN DENTZER: http://www.ielcap.org/.
JIM LEHRER: Thank you, Susan.
SUSAN DENTZER: Thanks, Jim.