Can CT scans for smokers save thousands of lives?
Special correspondent Dr. Emily Senay speaks with Dr. Claudia Henschke of Mount Sinai Hospital. Dr. Henschke is a leading expert in lung cancer screenings.
Dr. Senay is an Assistant Clinical Professor in the Department of Preventive Medicine at Mount Sinai, and Dr. Henschke is a Professor of Radiology and heads the Lung and Cardiac Screening Program. Other than both being employees of Mount Sinai, they do not work together in any capacity now nor have they in the past.
The USPSTF recently gave a high recommendation to low dose CT scans for lung cancer. If the task force finalizes the grade for this screening, private healthcare insurers will be required by the Affordable Care Act to cover it with no copay. Their conversation starts with that premise. According to the Centers for Disease Control and Prevention, in 2009 over 158,000 Americans died from lung cancer, and 90 percent of those deaths occurred because the cancer was found too late.
Dr. Claudia Henschke says many of those lives could be saved if early low-dose CT scans became regular practice.
During the early 1990’s when x-rays were the preferred method to detect lung cancer, Dr. Henschke decided to study whether CT scans could do a better job. She estimates that approximately 70 to 80 percent of those who develop lung cancer could be saved.
Other experts say that significantly overstates the benefits of lung cancer screenings. A recent National Lung Screening Trial (NLST) showed only a 20 percent reduction in lung cancer mortality. The American Cancer Society (ACS) uses the NLST as the basis for their guidelines:
High risk patients must be aged 55 to 74 years and in fairly good health, have a smoking history equivalent to a pack a day for 30 years, and currently smoke or have quit within the past 15 years.
“Figuring out how many lives will be saved in the real world is difficult,” says Dr. Richard Wender, the incoming Chief Cancer Control Officer of the American Cancer Society. Dr. Wender says there are too many variables in the medical world.
“Not everyone will be treated in same center and that makes a difference; the quality of CT scans can vary and that makes a difference. So whenever we have screening studies come out, it is quite appropriate to release it to the public with a lot of care and caution.” And the caution exists because CT scans are so sensitive that they detect the smallest noncancerous lumps. Critics have argued that over screening could lead to misdiagnosis or unnecessary procedures.
“Any screening program has benefits and potential harms. So it’s where you put the weight. What is the potential benefit, and what is the potential harm?”
According to Dr. Henschke, “When you do a CT scan, you find many nodules. So we’re providing information beyond just lung cancer. But the lung cancer is very important because, if you find it early, you can cure a very high percentage of it.”
Now, under a little-known provision of the Affordable Care Act, low dose CT scans for high-risk patients might soon be covered by both private insurance providers and Medicare, should the U.S. Preventive Services Task Force finalize the screening’s high grade. And although Medicare regularly provides coverage for preventive services given high grades by the U.S. Preventive Services Task Force, it is not required to do so.
“There’s no debate about whether lung cancer screenings provide true benefits,” said Dr. Wender of ACS.
“It is true that we need some caution and there are some drawbacks to screenings, but people who fall into the high-risk group should have the choice to be screened.”
UPDATED on Oct. 10, 2013 at 6:11 PM EST to reflect more detailed language about the above web-exclusive interview.