For the nearly 100 million smokers and ex-smokers in the United States, the news that CT scans could reduce the risk of death from lung cancer represents a huge step forward in early cancer detection. As things currently stand, 85 percent of those diagnosed with lung cancer will die from it. But this latest study conducted by the National Cancer Institute found that routine CT scans can detect lung cancer caused by heavy smoking, potentially reducing lung cancer deaths by 20 percent.
Need to Know’s Jackeline Pou spoke with the Dr. Leonard Lichtenfeld, deputy chief medical officer for the national office of the American Cancer Society, about what this new study could mean for millions of Americans at risk for getting lung cancer.
Jackeline Pou: The study found that CT scan screening of smokers and ex-smokers for lung cancer can reduce lung cancer deaths by 20 percent. Why is this a significant finding?
Leonard Lichtenfeld: This is the first randomized clinical trial that has shown screening can reduce the risk of death from lung cancer in heavy smokers. It provides the clearest evidence that we may be able to reduce deaths from a disease that is the leading cause of cancer deaths in women and men in the United States, and which has shown little progress in effective, life saving treatment.
Pou: After reading about this study many, people will probably request a CT scan from their doctors. Who would you recommend a CT scan screening for lung cancer? What about ex-smokers and people exposed to second hand smoke? Non-smokers?
Lichtenfeld: First, this study doesn’t give us any information that would be useful in making a recommendation for non-smokers or smokers with less than 30 pack years of smoking history (a pack year is the number of packs smoked daily for one year). Consequently, if someone has smoked less than that, or stopped smoking more than 15 years ago, or is a non-smoker who works in a place where others are allowed to smoke, this study would offer no guidance as to whether or not CT scans would be beneficial in reducing the risk of death.
The American Cancer Society has not issued a formal recommendation based on this study, since the report is still preliminary and more detailed information is forthcoming. That said, we understand that people who fit the same smoking pattern as examined in this study would possibly be interested in getting screened.
At this time, we would advise those people and their families to speak with their health professionals regarding the risks and benefits of getting screened. Keep in mind that many smokers have other diseases, such as advanced lung disease and heart disease. They may have other illness which would prevent them from being treated effectively for lung cancer with surgery, radiation therapy, chemotherapy or a combination of those treatments.
Another consideration is that many of the smokers screened in this study had abnormalities that did not turn out to be cancer. They still had to undergo additional studies, which may have been as straightforward as another lung scan or as complicated as chest surgery. These additional studies are not without risk.
As a result, any decision to get screened for lung cancer is still an individual one. Hopefully, we will be able to provide clearer recommendations once we have further details about the results of this study.
Pou: CT scans are generally considered higher risk because patients are exposed to a higher dose of radiation. If CT scans are more frequently used for the detection of lung cancer, could this expose people to unnecessary risk?
Lichtenfeld: The question of risk from the radiation of a CT scan is an important one, and will clearly be addressed as part of the analysis of this study. One of the points to keep in mind is that this study does not provide us information at this time regarding when a heavy smoker should start getting screened, or how often. We might have a better answer to these questions once the data from this study has been analyzed, and that in turn would give us a better idea of the total radiation exposure and the risk of that exposure.
These screening scans are considered to have a low dose of radiation relative to other CT scans. However they have more radiation than chest x-rays–which are not effective in reducing the risk of lung cancer. The other thing to keep in mind is that once a lesion is seen, there is a possibility that additional higher dose chest CT scans may be recommended as part of the follow-up procedures.
Ultimately, the question of the risk from radiation will likely factor into recommendations made by organizations such as the American Cancer Society. Until that time, it is one of the factors that people need to consider before embarking on a screening program for lung cancer.
Pou: Would most insurance plans cover CT scans? Or will they have to pay out of pocket?
Lichtenfeld: It is too early to say what the positions of insurance plans, Medicare and Medicaid will be with respect to paying for these screening scans. The Centers for Medicare and Medicaid Services has indicated they will be examining the data from the study and then determine what their next steps will be. In the absence of firm guidelines from organizations like the American Cancer Society and the United States Preventive Services Task Force it is unclear how private insurance plans will respond to the results of this study.
What we do know is that there is much we don’t know about this study, including whether or not there are specific sub-groups of smokers who benefit more than others, and the risks of procedures designed to find out whether a lesion is truly cancer, among other considerations. Perhaps even more important is that we don’t know at this point when people should start getting screened and how often and how long they need to get screened to achieve the most life-saving benefits from lung CT scans.
Pou: CT scans are very expensive — who would end up paying the cost if all smokers and former smokers have routine CT scans to screen for lung cancer? Wouldn’t such screening add greatly to rising health care costs?
Lichtenfeld: Although it is always difficult to talk about cost when it comes to saving lives, this clearly has become an increasing concern for many. It is likely that screening will lead to an increase in health care costs for a period of time, but it is also important to weigh that against the lives saved and what will happen to costs over time assuming there is a more general recommendation that such screening should become routine for certain people at risk.
This is going to be the topic of further research in this study, but it may be many months until that analysis is completed.
Pou: How do CT scans work? What do they tell doctors? What additional tests are needed after someone finds out they have lung cancer?
Lichtenfeld: CT scans have been widely used in medical practice since the 1970s. They provide a more detailed, multi-dimensional view of the body when compared to the traditional X-ray. CT scans use multiple X-ray beams “shot through the body” that are then analyzed by a computer to give a picture of various organs, such as the heart, chest, abdomen and brain.
Over the past several decades, the scans have become much more sophisticated, much quicker to perform and with lower doses of radiation. CT scans have been relied on more frequently by doctors in the evaluation and treatment of their patients, particularly those with cancer.
Pou: How have doctors generally detected lung cancer?
Lichtenfeld: The sad reality is that most of the time the patient’s symptoms lead to a diagnosis of lung cancer. Chest X-rays are not effective in finding lung cancer early enough to consistently save lives, and information provided by the National Cancer Institute revealed new data which supported that unfortunate reality. When lung cancer is found on a chest X-ray or CT scan done because a patient has symptoms, it is usually not “early.”