Lung cancer kills more Americans than breast, prostate and colon cancer combined. But unlike those other cancers, there's no agreed-upon screening test to catch lung cancer when it's early and can be curable. A study in this week's
Lung cancer kills more Americans than breast, prostate and colon cancer combined. But unlike those other cancers, there's no agreed-upon screening test to catch lung cancer when it's early and can be curable. A study in this week's New England Journal of Medicine may help change that. But experts disagree about when the evidence will be strong enough to recommend that people at risk of lung cancer get the screening test, called spiral CT.
Spiral CT is a computerized X-ray scan that takes hundreds of detailed pictures of the chest in the space of three seconds. It can spot lung tumors smaller than a pea.
Seven years ago, a group at Cornell University published one of the first big studies suggesting that spiral CT might be used to screen the lungs of smokers and former smokers for signs of lung cancer, long before symptoms appear. Now the same group is publishing results on more than 31,000 patients from around the world.
Dr. Claudia Henschke, who heads the Cornell group, says spiral CT turned up nearly 500 lung cancers.
"The overall survival was 80 percent," says Henschke, "which is quite dramatic compared to what the rates are in the U.S.... Only about five percent of the people who are diagnosed with lung cancer eventually are cured of it. So that's a tremendous improvement."
The results look even better among the great majority of patients in the study diagnosed with early-stage lung cancer. Based on results so far, an impressive 92 percent of them are projected to be alive ten years after diagnosis.
"I think our study gives compelling evidence that screening is useful and can be done responsibly now," Henschke says.
Henschke is the most prominent enthusiast for lung cancer screening. Others in the medical community are just as enthusiastic. Dr. James Mulshine of Rush University in Chicago, a veteran cancer-prevention expert who sits on Henschke's advisory board, calls the new results a landmark.
"In one fell swoop, you go from 15 percent, five-year survival to 92 percent, 10-year survival," Mulshine says. "That's amazing. Claudia's result is spectacular. The question is, is it generalizable? And should it be the basis of public health policy changes?"
Mulshine says the new results should force a public debate on that question.
"This is a very strong suggestion that lung cancer screening can conform to the kind of experience we've had with colon cancer and breas