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Study: Lung scans show promise for early detection

By Miriam Falco
CNN

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CNN -- Anyone who's had a loved one die of lung cancer has probably asked, why isn't there a way to screen for that disease? Especially as National Breast Cancer Awareness Month winds down, millions of Americans have been reminded that mammograms save lives. If it works for breast cancer, why can't something like that be done for the No. 1 cancer killer?

A study in this week's New England Journal of Medicine suggests that it can.

Using computed tomography, doctors at New York-Presbyterian Hospital/Weill Cornell Medical Center screened more than 31,000 patients at high risk for lung cancer before they had any symptoms. They found Stage 1 lung cancer in 412 people. The 10-year survival rate for this group was estimated to be 88 percent. If the patient had surgery within a month of diagnosis, the survival rate was 92 percent. That compares with a standard one-year survival rate of about 40 percent, according to the American Cancer Society. (Watch cancer experts' thoughts on lung scans -- 2:20 )

"We found that we could detect lung cancer in its earliest stage when it's really most curable in 85 percent of those people with lung cancer," said Dr. Claudia Henschke, a professor of radiology and the lead author of the study. "That's an astounding figure."

Doctors have long debated the value of lung cancer screening, but previous studies did not conclusively prove that finding lung cancer early meant patients survived longer. Plus, false positives can often lead to invasive procedures which can add risk and costs, especially if the nodules turns out to be benign.

While most experts agree that this week's results are encouraging, they don't think this study alone will lead to computed tomography, or CT scans, being the standard for lung cancer screening because the study did not have a comparison group.

The American Cancer Society said the findings "show real promise" for reducing lung cancer deaths but noted the study's lack of a control group. The cancer society suggested the results of other, ongoing studies are needed before a decision is made on making CT scans standard procedure. "Health policy isn't made on the basis of one study, or by one organization," the group said.

Dr. Norman Edelman, chief medical officer for the American Lung Association, echoed the cancer society's concerns.

He says an official recommendation for the scan should be based on research such as that being conducted by the National Institutes of Health. Its National Lung Screening Trial is examining more than 54,000 patients nationwide.

Dr. Kay Vydareny is the principal investigator for the NIH project at Emory University, says that although the new study results are encouraging, "the main question not yet answered is: Does screening for lung cancer decrease the number of patients dying from the disease?"

One major concern in detecting lung cancer is that screening can lead to false positives.

Dr. David Johnson, past president of the American Society of Clinical Oncologists and lung cancer specialist at Vanderbilt University, is concerned about the invasive procedures that often follow CT scans to determine if what has been detected truly is cancerous. He's said that when CT scans are done, even though there's a greater than 50 percent chance that an abnormality will be found, fewer than 10 percent of those turn out to be cancer. "But one cannot tell that by looking at a CT scan alone," he said.

So researchers and oncologists are eagerly awaiting the results of the National Lung Screening Trial, hoping they will help experts determine whether CT scans are the way to go for screening lung cancer patients. Those results aren't expected until the end of the decade. Vydareny worries these just-published results may lead some participants to drop out of the NIH trial.

One thing many experts agree on, 85 percent of lung cancer in the United States is smoking related, so the best way to prevent lung cancer is to never start or stop if you currently smoke.

Vanderbilt's Johnson says he's a proponent of screening, but that the data are insufficient for a universal recommendation. However, he does think there are individual cases where CT scans may be useful.

"If you are a former smoker or if you are a current smoker that plans to stop, I think it is reasonable to discuss the options with one's physicians."

If the patient and physician believe a CT scan is appropriate, then the American Cancer Society's Director of Cancer Screening Dr. Bob Smith advises that patients "need to find a doctor who specializes in CT scans for lung cancer, rather than just offering lung screening among many other things."

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