A Life Saver for Lung Cancer Victims

Lung cancer continues to be a disease with dismal prognosis. Currently in the US, 95% of people diagnosed with lung cancer die within five years. In most of the cases, by the time a diagnosis is made, it is too late. This has prompted constant search for a screening test that will impact survival in patients with lung cancer. We want to be able to do what we have done with mammogram for breast cancer and colonoscopy for colon cancer. For a screening test to be effective, it should have certain characteristics including the following:
1. Be easily doable in every day medical practice.
2. Be able to detect disease early enough to impact survival.
3. There should be good treatment options available for the disease we are screening for.
4. For it to be offered widely, this test should be cost-effective (a technical term for ‘bang for the buck’)
As a part of recently published study, nearly 30,000 smokers, ex-smokers and those exposed to second hand smoke (groups at high risk for lung cancer) were screened for lung cancer with yearly CT scans. This New England Journal of Medicine study shows that 412 study subjects that were found to have stage I lung cancer during surveillance had a 10-year survival rate of 88%. This is far better than survival without surveillance.
Based on this study, all but condition number 4 above for a screening test seem to be met. There is a need for some good cost-effectiveness studies utilizing CT scan for lung cancer screening.
There is a concern that CT scan surveillance gives false positives leading to unnecessary tests. I do not see it as a big point against surveillance. We do expect some false positives with any screening test.
It might be a little while before this test is widely offered, and third party payers agree to pay for it. Till then, if I had a loved one who smokes despite my threats, cajoling and nagging, will I want him or her to have a yearly CT scan? I think, I will.
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