CT Screening Might Raise Lung Cancer Survival Rate

Lung cancer detected by computerized tomography scans can be cured at a high rate, according to a study published in the New England Journal of Medicine, the Wall Street Journal reports.

For the study, researchers for the International Early Lung Cancer Action Program screened more than 30,000 smokers, former smokers and people exposed to secondhand smoke (Seward, Wall Street Journal, 10/26). The scans found 484 cases of lung cancer, 412 of which were Stage 1, during which the cancer has not spread and can be cured by surgery.

Stage 1 patients who underwent surgery had an estimated 10-year survival rate of 88%. Among the 302 patients who underwent surgery within one month of being diagnosed, the rate was 92%. Eight patients who were diagnosed with Stage 1 lung cancer but declined treatment all died within five years (Kotulak, Chicago Tribune, 10/26).

Typically, the five-year survival rate after a diagnosis of Stage 1 lung cancer is 49.5%. The researchers said the CT scans detected the cancer earlier and allowed patients to begin treatment sooner than they would have otherwise, according to the Journal (Wall Street Journal, 10/26).

Lung cancer is the leading cause of cancer death in the U.S., killing about 162,000 U.S. residents annually. Only about 15% of all lung cancer patients survive five years after the disease is diagnosed (Brown, Washington Post, 10/26).

Claudia Henschke, lead author of the study and a professor of radiology at Cornell University's Weill Medical College, said, "This is the evidence that we needed to really take annual screening of smokers into the mainstream." Henschke added, "There really needs to be consideration of integrating this into the health care system."

Robert Smith, director of screening at the American Cancer Society, said the findings might spur the group to re-evaluate its neutral guidelines regarding screenings for lung cancer.

Laurie Fenton, president of the Lung Cancer Alliance, said current screening practices reflect the perception that smokers are at fault for their cancer. Fenton said, "It's hard to demand the same level of compassion and support as other cancers. Mammograms, colonoscopies -- you don't see the same doubts about those tests as you do for CT scans of the lungs" (Wall Street Journal, 10/26).

Critics of the study note it was conducted without a control group, and therefore, it is not possible to determine whether outcomes for patients who received the CT scan were really improved. According to the Washington Post, although the research "clearly shows that the interval between diagnosis and death was longer in screened patients, it does not definitively show they lived longer -- a subtle difference with significant public health consequences" (Brown, Washington Post, 10/26).

Elliott Fishman, a professor of radiology and oncology at Johns Hopkins Hospital, said, "Everyone knows we can pick up things better with screening. But is picking up the same thing as curing? If I pick up a tumor that is one centimeter today and you live five years, or I pick it up four years later and you live one year, it's the same thing."

In a few years, the completion of an ongoing study conducted by the National Cancer Institute might provide "[m]ore definitive answers about the value of CT testing," the New York Times reports.

For that study, researchers randomly assigned about 55,000 participants -- smokers or former smokers -- to have annual CT scans or chest X-rays. Because many scientists have concluded that X-rays are ineffective at detecting early-stage lung cancer, that group can serve as the control in the NCI study (Kolata, New York Times, 10/26).

Several broadcast programs reported on the study:

• ABCNews' "World News Tonight": The segment includes comments from Tim Johnson, ABCNews medical editor (Johnson, "World News Tonight," ABCNews, 10/25). A related ABCNews story is available online. Video of the segment is available online.
  


• CBS' "Evening News": The segment includes comments from Henschke; Harvey Pass, a physician at New York University Medical Center; and a U.S. resident whose lung cancer was detected by a CT scan (LaPook," Evening News," CBS, 10/25). A transcript and video of the segment are available online.
  


• NBC's "Nightly News": The segment includes comments from Henschke and a U.S. resident whose lung cancer was detected by a CT scan (Bazell, "Nightly News," NBC, 10/25). Video of the segment is available online.
  


• NPR's "All Things Considered": The segment includes comments from Denise Aberle, a researcher for a federally funded study of annual CT scans and X-rays for smokers at the UCLA Medical Center; Henschke; James Mulshine, a cancer prevention expert at Rush University and member of Henschke's advisory board; and Ned Patz, a radiologist at Duke University (Knox, "All Things Considered," NPR, 10/25). Audio of the segment is available online.