Lung Cancer Test Can Cut Deaths, Study Finds

Screening smokers for lung cancer can dramatically reduce the number of deaths from this catastrophic disease, according to new research that contradicts current medical practice.

As many as 172,000 new cases of lung cancer develop each year, and the vast majority are detected only after the tumor has grown so large that it is virtually untreatable. As a result, the five-year survival rate for lung cancer is only 12% to 15%.

The new techniques allow tumors to be detected much earlier, when they are easily treatable, and as a result, the five-year survival rate can go as high as 80%. In addition to saving lives, widespread screening could eventually save $1.5 billion a year in medical costs by eliminating costly cancer treatments, according to the researchers from the Cornell University Medical Center in New York City, whose study is reported in tomorrow’s Lancet, an international medical journal.

The conventional wisdom has long been that screening for lung cancer is not worthwhile because tumors are not detected early enough for treatment to be effective. But that wisdom is based on clinical tests that used conventional X-ray images to look for tumors.

The new research used sophisticated computed tomography (CT) scanning to examine those at high risk--primarily long-term smokers.

The findings “are the most significant breakthrough for lung cancer diagnosis and treatment options in decades,” said Pegg McCarthy, executive director of the Alliance for Lung Cancer Advocacy, Support and Education.

“We’re thrilled,” said Dr. Claudia Henschke, the lead researcher. “It’s like going from the Middle Ages into a new millennium.”

But other scientists cautioned that the technique needs further study before its use can be widely recommended. For one thing, the scanning techniques used to check the lungs give false alarms in a large number of cases, which then require further tests.

The screening is also more expensive than conventional X-rays, and large-scale use would require a considerable initial investment.

Patients enrolled in the study, however, express few doubts. When researchers late last year performed a lung scan on Father Thomas Conellan of Vero Beach, Fla., for example, they found a very small lesion in his right lung, no larger than a rice grain. Last December, after a needle biopsy showed the lesion was cancerous, but that it had not yet spread to his lymph nodes, doctors removed a small section of his lung.

“Now I’m swimming and exercising” and feeling great, he said.

Beginning in 1993, the Canadian and American Early Lung Cancer Action Project began enrolling 1,000 current or former smokers who had smoked at least a pack a day for 10 years or longer. All were over 60.

Each participant was given a conventional lung X-ray as well as a 20-second low-dose CT scan.

X-rays revealed only seven tumors in the patients studied, only four of which were early Stage 1, meaning that they had not spread. By contrast, the CT technique revealed 27 tumors, and 23 of them were Stage 1.

The patients with Stage 1 tumors had surgery to remove the tumors, but required no chemotherapy, irradiation or other treatment. All of them are alive and well today, with no evidence of recurrence, Henschke said.

The CTs also revealed a significant number of what turned out to be benign nodules, but the researchers developed a relatively simple way to distinguish them from dangerous lesions.

When small nodules were found, the team waited a month or two and then did another CT scan to determine whether the nodules had grown. Only if a nodule was growing did they perform surgery, Henschke said, eliminating unnecessary operations.

Dr. Robert Smith, director of cancer screening at the American Cancer Society, said Thursday that further trials of the technique should be “a top research priority.” If medical centers begin offering the technique before such trials get underway, he noted, few people will be willing to participate in controlled trials for fear they will be in a control group which does not receive the CT scan.