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Catching a silent killer: Low-dose spiral CTs may find lung cancer earlier

Network - Fall 2013

By Mary Brolley

Lung cancer strikes fear into people’s hearts.

Although rates of tobacco use — the major cause of the disease — have plummeted since the 1970s, lung cancer is still the leading cause of cancer-related deaths for men and women in the United States and worldwide.

The American Cancer Society estimates that in 2013, 26% of cancer deaths in women and 28% of those in men will be due to lung cancer. The disease takes a long time to develop, and it’s often detected in later stages, when it’s more
difficult to treat.

But thanks to research conducted partly at MD Anderson, there’s now an effective screening method to catch lung cancer at an earlier stage.

“We knew that chest X-rays didn’t identify early stage lung cancer,” says Therese Bevers, M.D., professor in Clinical Cancer Prevention. “We needed another option.”

Luckily, evidence — some of it gathered at MD Anderson — was growing that low-dose spiral CT scans might be the answer.

Spiral CT scans effective with less radiation

In the early 2000s, MD Anderson researchers began contributing data to the
National Lung Screening Trial.

Involving more than 53,000 current and former heavy smokers aged 55 to 74, the trial compared the effects of two screening procedures for lung cancer — low-dose helical (or spiral) computed tomography (CT) and standard chest X-ray — on lung cancer mortality.

It found 20% fewer lung cancer deaths among participants screened with low-dose spiral CT. And due to increased detection of other dangerous conditions, the scans lowered death from all causes by more than 6%.

Because of these findings, the U.S. Preventive Task Force has issued a draft recommendation for the low-dose CT screenings for those who:

  • Are 55 to 74 years old
  • Have a 30-pack-year history of smoking (one pack a day for 30 years, two packs a day for 15 years, etc.) 
  • Smoke now or have quit within the last 15 years

On the cusp of a breakthrough

Could these tests someday be as routine as colonoscopies, Pap tests and mammograms?
Bevers thinks so. She remembers when MD Anderson patients and researchers were part of the massive lung screening trial. Its findings will be far-reaching, she says.

“These low-dose CT scans pick up not just smaller cancers, but other conditions that have effects on mortality, such as aortic aneurysms,” she says.

Anissa Lewis, program coordinator in Diagnostic Imaging, says MD Anderson does about 200 of the low-dose CT scans a year, but she expects those numbers to rise with increased screening requirements mandated by the Affordable Care Act.

“There are other reasons people develop lung cancer — secondhand smoke, air quality, occupational hazards. But we’re starting with screening heavy smokers,” she says.

“Early detection is brand spanking new,” Lewis says. “Catching these lesions at stage 1 or 2 is remarkable. Phenomenal.”

Though just two insurance companies currently cover the $250 procedure, the task force’s recommendation may convince more of them to do so. A soon-to-be-released cost benefit analysis will likely bolster wider acceptance and spur a willingness to pay for the scan.

Meanwhile, for current smokers or recent quitters (those who stopped smoking in the past year) who are screened, MD Anderson’s Tobacco Treatment Program has options to help them quit.

Still smoking? Get help to quit

Maher Karam-Hage, M.D., associate professor in Behavioral Science, treats patients who come to the Cancer Prevention Center for the screening, then seek help to quit smoking.

“Ask smokers whether they want to quit, and 70% say yes,” he says. “Forty percent of them have tried at least once in the past year, but only 5% manage to quit on their own.”

“We can increase the quit rate greatly. With counseling and medications, 40%-50% of our patients quit and are still off cigarettes at 6 and 9 month follow-ups.”

To help smokers, MD Anderson offers smoking cessation programs for patients, employees and even the general public.

“We counsel smokers and help them quit,” Karam-Hage says. “We say, ‘It isn’t just about cancer. All smokers damage their lungs, their breathing, their cardiovascular health.’”

“Two-thirds of smokers will develop a disease. That’s a given,” he adds.

“We offer them ways to quit.”

Want to quit smoking? Call the Tobacco Treatment Program at 713-792-7848 if you’re a patient or MD Anderson employee. Others may call 713-792-2265 to find out about participating in free clinical research studies.

© 2015 The University of Texas MD Anderson Cancer Center