Lung scans are proposed for smokers

New technique can detect tumors at curable stage


Death rates from lung cancer could be greatly reduced if smokers and ex-smokers routinely underwent CT scans of their lungs, doctors are reporting today.

The scans use a new technique that is far more sensitive than conventional chest X-rays and can detect tumors when they are small enough to be cured.

Now, routine chest X-rays and other screening tests for lung cancer are not recommended, even for smokers, because the tests cannot identify tumors early enough to save or even prolong patients' lives.

"We're saying that we could change survival from 12 or 15 percent to 80 percent," said Dr. Claudia Henschke, division chief of chest imaging at Cornell Medical Center in Manhattan and the primary author of a study in the British journal Lancet.

"There are 172,000 new cases a year. Think of 12 percent or 15 percent survival, compared to 80 percent."

The screening techniques studied in the research are already available, but only at a few medical centers. The researchers said they had been approached by smokers and former smokers, including some of their hospital colleagues, seeking the screening.

"This is a very important study that has major clinical implications in the near future," said Dr. John Minna, a lung cancer specialist and the director of the Hamon Center for Therapeutic Oncology Research at the University of Texas Southwestern Medical Center in Dallas.

"It dramatically shows the time has come to reopen lung cancer screening trials in current and former smokers using the new CT technology."

Minna, who was not involved in the study, also praised the authors for including women, who were 46 percent of the study subjects.

"Women had been excluded from all previous screening studies," he said. "This is vital, since 1.6 times more women die of lung cancer than breast cancer each year in the U.S."

Lung cancer is the leading cause of cancer death in the United States, killing 160,000 people a year, more than the combined total of the next three causes: colon, breast and prostate cancer.

Survival rates for lung cancer patients have been dismal because the disease typically is detected after it has begun to spread. It causes no symptoms in its early stages, and even tumors picked up by chest X-rays are generally so advanced that treatment cannot cure them or even do much to prolong the patient's life.

Henschke's study, conducted with researchers from New York University and McGill University in Montreal, included 1,000 people who were smokers or former smokers, 60 or older.

None had symptoms of any illness, though all had smoked cigarettes for at least 10 pack-years, meaning a pack a day for 10 years, or two packs a day for five years.

The participants were given both chest X-rays and CT scans, using a new technique called helical low-dose CT scanning that takes only 20 seconds. The CT scans clearly picked up tumors that the chest X-rays missed: the scans identified 27, and the X-rays only 7.

Of the 27 identified by scans, 23 were stage I, meaning early tumors that had not spread. But the X-rays identified only four stage I cancers.

Pub Date: 7/09/99

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