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Letter: Screening For Lung Cancer

Peter Chow for local2 sault ste. marie
May 7th, 2012 at 11:19am



This article is a column or editorial.
The opinions expressed here are solely those of the author and do not necessarily reflect those of LOCAL2.

letter to the editor headlineSeveral studies, capped by the 2011 National Lung Screening Trial (NLST) in the US, have concluded that annual low-dose CT screening in high risk smokers (patients age 55 and older with at least 30 pack-years) could significantly reduce mortality from lung cancer. Compared with chest x-rays, CT scans detect smaller, earlier stage cancers, offering the possibility of more effective curative treatment.

Lung cancer is by far the biggest cancer killer. Every hour of every day in Canada an average of almost 3 (2.9) people are diagnosed with lung cancer and 2.3 patients die of lung cancer. Deaths from lung cancer in men surpass the total from the next 3 leading cancers (colorectal, prostate and pancreas). In women (lung cancer is increasing in women while decreasing in men) deaths from lung cancer exceed the total of the next 2 most lethal cancers, breast and colorectal.

The NLST found a 20% reduction in lung cancer mortality, a reflection of the increased sensitivity of CT over X-ray. But the specificity problem remains. In the NLST, 95% of positive screens by CT were determined to be false, that is due to non-malignant lesions. Most of these false positives engendered only additional imaging exams, but a minority required biopsies, and in some cases, surgical resection, before the lesions were determined to be benign.

A joint evidence review by four organizations the American College of Chest Physicians, the American Society of Clinical Oncology, the National Comprehensive Cancer Network (NCCN) and the American Cancer Society concluded that CT screening in high risk patients has definite, significant value, but stopped short of a definite recommendation, due mainly to the specificity problem. This is the same problem with screening programs for breast, prostate and colorectal cancers.

Last November, in light of the NLST findings of a 20% reduction in lung cancer mortality, the NCCN issued an endorsement, with less reservation, for CT screening for high risk individuals. The viewpoint on screening is shifting

We screen for breast cancer, colorectal cancer and prostate cancer. Screening for lung cancer in high risk patients is overdue. The issue holding it back will be the false positive rate and the extra health care costs generated. The ministry of health will decide how much a 20% increase in cure rate of lung cancer in high risk patients is worth, a very difficult sell with today's financial constraints. I would suggest that the government double or triple the price of cigarettes to make up for the extra costs created by lung cancer screening - and decrease smoking at the same time.

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