Screening for lung cancer good news and cautionary words

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  • <B>KEMH Consultant oncologist</B> Dr Tu Tu Aung-Hillman

    KEMH Consultant oncologist Dr Tu Tu Aung-Hillman

Lung cancer claims more lives in Bermuda than any other type of cancer. In 2009, 21.7 percent of those who died from cancer in Bermuda had lung cancer.

Bermuda is not unique in this regard lung cancer is the biggest cancer killer all over the world, but amid that harsh statistic came some good news a few weeks ago.

Results of a long-term study in the US suggest that screening for lung cancer with a CT scanner could help prolong life by as much as 20 percent.

The study and its results were published in the New England Journal of Medicine last month.

The news has been particularly exciting to oncologists and radiologists working with CT scans. Dr Edgar Griffith from the Brown Darrell Clinic, home to the most powerful CAT scanner on the Island, said he has already been working with the Lahey Clinic in Boston to develop an on-Island service plan.

The study had a large sample with over 53,000 people enrolled. All were deemed to be at high risk for the disease having smoked at least a pack of cigarettes a day for at least 30 years. All participants were between 55 and 74-years-old and none had shown symptoms of the disease.

Participants were randomly placed in two groups, one that was scanned with what is called a “low dose” CT scan, (this is a scanner that uses low amounts of radiation) the other group received chest X-rays.

In both instances physicians were looking for tumours or abnormal cell growth in the lungs. Participants were screened for five years and then followed by the researchers for another two years.

The results proved that the CT scanner was better than x-ray at detecting cancerous growths in the lungs.

It wasn’t surprising news because CT scanners take three-dimensional images. Simple logic suggests that you are more likely to find something if you have the ability to see it in different planes instead of just flat as is the case with X-rays.

So this study’s importance is that it has proved this long assumed theory. In practical terms you would think it’s now a good way to screen for lung cancer and that CT scanning for lung cancer would happen as routinely as mammograms do in screening for breast cancer.

Dr Griffith said early detection of lung cancer is the best hope for a patient beating the aggressive disease. Lung cancer killed his mother so fighting it has particular importance to him.

“We are looking at offering the option (CT scan) to physicians and to those that feel they are at high risk,” he said. “We are working with our affiliates at Lahey to get a programme on board to offer to people that fall into that category. A programme that will get them good reporting on the CT scan and also good follow up on the scan,” he added.

But consultant oncologist at King Edward VII Memorial Hospital (KEMH) Dr Tu Tu Aung-Hillman said it’s premature to routinely screen for lung cancer in this way. According to her there are still some big issues that need to be addressed.

A major one is the fact that the screening tends to give a positive reading. In the study, 96 percent of those who were screened had something detected in their lung which was later found not to be cancer. These are called false positives. The problem with them, according to Dr Aung-Hillman, is that they impact patients’ mental wellbeing causing them to worry unnecessarily. They also become expensive as follow-up procedures, which may include surgery, have to be done.

“And it’s not just cost,” she said, “but also the radiation exposure. What will be his future cancer incidence? Because he’s already a smoker he’s already at risk. Is it being increased,” she added.

In fact the researchers included these concerns in a discussion section of the written study. They also noted that decisions on who should be eligible for the screening would have to be determined.

“For example, although there are currently only about seven million persons in the United States who would meet the eligibility criteria for the NLST (National Lung Screening Trial), there are 94 million current or former smokers and many more with secondhand exposure to smoke or other risk factors,” the study read.

And then there’s the fact that the CT scanners used in the study are much older than the ones used in Bermuda. Both Dr Griffith and Dr Aung-Hillman agreed that the scanners used at the Brown Darrell Clinic and at KEMH are more sensitive and therefore more likely to give an even higher rate of false positive readings than the 96.4 percent seen in the study.

Dr Aung-Hillman said she would discourage the scan for anyone who does not show any symptoms of lung cancer. She said in her opinion it is more cost effective to promote smoking cessation programmes and support groups.

When you consider that a CT scan in Bermuda costs about $1,500, it’s easy to see the curb-healthcare-costs side. But if you’ve been a heavy smoker, or if you’ve breathed in a lot of secondhand smoke, maybe as a bartender or as the spouse of a smoker, you are at high risk for developing lung cancer. Dr Griffith said he feels such people’s only real hope is to detect the disease early.

“The good thing is it’s better than what we had before. It also shows that follow up is helping to keep people alive,” he said. “This chance becomes greater the earlier the cancer is detected.”

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