Can we help?
Follow up on this month's He@lthLINK
Phone Numbers
Directory assistance
(203) 688-4242
Patient information
(203) 688-4177
Adult emergency
(203) 688-2222
Children's emergency
(203) 688-3333
Admitting
(203) 688-2221
Children's admitting
(203) 688-3331
Psychiatric admitting
(203) 688-9907
Mailing address:
Yale-New Haven Hospital
20 York Street
New Haven, CT
06510-3202
|
December 2006
News this month The Early Lung Cancer Action Project (ELCAP) recently completed a comprehensive 12-year study to determine if using a low-dose CT scan of the lungs can help save lives from lung cancer. This study is helpful in raising awareness for the need to detect lung cancer early, which can mean a better chance of survival. More than 174,000 people will be diagnosed with lung cancer this year, with only 16 percent of patients being found at a stage early enough to treat. Most cases of lung cancer are found too late, and while there are still available treatments, there is no hope for cure. On Oct. 26, the ELCAP study was reported in the New England Journal of Medicine. It determined that an annual CT screening can detect lung cancer that is curable. The study also reported that when patients with early stage disease were treated immediately, their 10-year survival rate was good. “There isn't a specific early detection tool for lung cancer, one of the most deadly cancers for both men and women.”
The study screened 31,567 asymptomatic people at risk for lung cancer, from 1993 to 2005. More than 27,450 follow-up screenings were done from 1994 to 2005, seven to 18 months after the previous screenings. The subjects were 40 years old and up, and at risk for lung cancer because of a history of cigarette smoking, exposure to asbestos, occupational chemicals or second-hand smoke. The median age was 61. Screenings are often used for early detection of breast cancer and colon cancer, among other diseases. Many cancers can be treated successfully if detected early, and screenings such as colonoscopies have proven helpful. There isn’t a specific early detection tool for lung cancer, one of the most deadly cancers for both men and women. In many instances, the cancer is found in an advanced state when a cure is not possible, and treatment is aimed at diminishing symptoms and buying time. The study resulted in the diagnosis of lung cancer in 484 patients. Of those patients, the Journal reported that 412 had clinical stage I lung cancer, the least advanced form of the disease. Three hundred and two participants who had stage I lung cancer and who had surgery within one month of diagnosis had a 92 percent survival rate after 10 years. Eight participants with the disease didn’t receive treatment and died within five years. “The question remains whether early detection in patients is effective enough to justify screening large groups of asymptomatic people.”
In 1993, ELCAP launched a study of early diagnosis of lung cancer in smokers through a CT scan. More than 80 percent of the patients diagnosed with lung cancer had stage I disease. The question remains whether early detection in patients is effective enough to justify screening large groups of asymptomatic people. In deciding about using CT scans for screening, ELCAP recommends considering the outcome of treating a cancer detected on the screen. In this study, the estimated 10-year lung cancer survival rate among the study’s 484 patients was 80 percent. Among the patients with stage I lung cancer it was 88 percent. This is just one of several studies under way on lung cancer. Other studies focus on the fact that more women than ever are getting lung cancer. Doctors don’t know why. Some studies suggest that women may be more susceptible through genetic predispositions, but other studies contradict that. Doctors are still trying to figure this out.
Physician Referral Online A free and confidential service Physician Referral Online Request an appointment 203-688-2000  Yale-New Haven was recognized this year by U.S. News & World Report for its cancer services. |
|
 Study underscores the need for lung cancer screening tool The media has given a great deal of coverage to the recent ELCAP study on lung cancer. ELCAP has done a lot of good work in the past 12 years and that’s exciting, because not much good news has been reported over the last 40 years on lung cancer. Nevertheless, many questions remain. I’m happy that the study puts the spotlight on lung cancer. While we’ve made huge strides in early detection of breast and colon cancers, there is a tendency to blame lung cancer on smokers. We’ve all but said, “Smokers cause this themselves.” "I'm happy that the study puts the spotlight on lung cancer."
Many experts are studying the ELCAP results and trying to get answers to the remaining issues. I think we should leave it to organizations such as the American Cancer Society or the National Institutes of Health to provide us with more answers before we start routinely screening people. The main problem with the study lies in the fact that it fails to answer who should get this test. The study wasn’t set up to answer this question. It was established to see if early CT screens look like they might work. Do we screen smokers? Only heavy smokers? People who smoke and have been exposed to asbestos? The line isn’t clear as to who would benefit from this, and smokers certainly shouldn’t feel the need to get a CT scan. Since we don’t know who should be screened, I’m worried that people might be motivated by fear rather than rational thought. If the chance of lung cancer for an individual is truly low, the benefits of a scan may not outweigh the risks of the scan itself. It is easy to understand this if we take it to an extreme: would anyone consider a CT scan to screen a child? Of course not, because the chance of harm from radiation exceeds the benefit a child would get from a screening. We have to get a better handle on relative risks to know when it makes sense to screen. The cost of the screening is also an issue — a complex issue. In general, it costs much less to cure early lung cancer than to treat it at a later stage. It might make sense to do CT scans, at least on high-risk people. On the other hand, screening CT scans for low-risk people may add a lot of expense without achieving a tangible benefit. Aside from deciding who to screen, the study also raises questions about radiation exposure during a CT scan. People need to remember that while it is a good diagnostic tool, “low-dose” CT scans still expose people to radiation. If you need a test each year, the risk of radiation may outweigh the benefit. In addition, more than 50 percent of the people screened will have a nodule detected. There are many reasons for nodules, and most aren’t cancerous or need further action. Some tumors are so slow growing or low-grade that they require no treatment. However, with human nature, most people will become anxious if they learn that they have a nodule of any kind. The CT scan may cause more anxiety than needed. In most instances the nodules are not very worrisome and doctors will recommend another scan in a year. Some people may have trouble coping with the anxiety and unnecessary fear during the year. "While we've made huge strides in early detection of breast cancer and colon cancer, there is a tendency to blame lung cancer on smokers."
That’s also why I think it is most important to have a good idea of the risk of lung cancer by taking into account all the factors. We have tended to focus only on age and smoking in the past 40 years as the causes of lung cancer, but several other factors put people at risk, including exposure to asbestos or radon, diet or family history. For now, I think this is exciting news regarding lung cancer, but we haven’t answered all the questions yet. Dr. Detterbeck is chief of thoracic surgery at Yale-New Haven Hospital, surgical director of the Thoracic Oncology Program at the Yale Cancer Center as well as professor of surgery at the Yale School of Medicine.
|
