Perspective on the effectiveness of low dose CT screening for lung cancer from the Medical Director of FMH’s Regional Cancer Therapy Center, Dr. Mark Soberman:
You may or may not know that lung cancer is the leading cause of cancer deaths in the U.S. Approximately 200,000 new cases are diagnosed each year and only 15% of patients will survive long term.
The problem, of course, is early detection. Patients with early stage lung cancer have a much better prognosis, but often symptoms don’t appear until late, so most patients present to their doctors with incurable disease. Patients who did well were typically those who had a chest x-ray or CT scan for some other reason and a lung nodule or mass was discovered.
CT scanner
Until recently, there were no proven methods of screening those at risk for developing lung cancer. Previous studies using chest x-rays and other methods didn’t show any benefit. In the landmark National Cancer Institute sponsored National Lung Screening Trial, low dose CT screening of at-risk individuals identified more patients with early stage disease, resulting in a very significant 20% reduction in lung cancer mortality. That is, the patients who had screening, if a lung cancer was discovered, had a 20% less chance of dying from their cancer. It’s important to note that only certain patients have been shown to benefit from lung cancer CT screening.
Public health studies have demonstrated that, from a population standpoint, low dose CT screening for lung cancer is cost effective. As we try to change our national health care system to deliver value for patients and insurers, that’s a good thing. We need to make sure that things we recommend to our patients provide them benefits at reasonable costs that we, as a society, can afford. Professional societies and groups such as the American Association for Thoracic Surgery, the National Comprehensive Cancer Network, American Society for Clinical Oncology and the American College of Chest Physicians have all endorsed low dose CT screening for lung cancer. The U.S. Preventive Services Task Force is currently reviewing the data and their recommendations will be forthcoming. I expect that, given the evidence, they will endorse CT screening. Currently, only one health insurance plan is paying for CT screening. While this will likely change over time, currently patients must pay for their screening CT scans.
This November, during Lung Cancer Awareness Month, FMH will begin offering low dose screening CT for lung cancer. As per the National Lung Screening Trial, eligible patients will be those:
- age 55-74,
- with a 30 pack-year history of smoking (1 pack a day for 30 years, 2 packs a day for 15 years, or some other similar combination of packs per day multiplied by years smoked),
- either current smokers or those who have quit in the last 15 years.
If there is family history of lung cancer, a history of asbestos exposure or radon exposure, patients as young as 50 or with a 20 pack-year smoking history may be considered for screening. All positive screens or abnormal CT scans will be reviewed by a team of radiologists, pulmonologists and thoracic surgeons, with results and recommendations reported to both patients and their primary care physicians.
CT scans can be expensive, but because patients must pay out of pocket, we are offering the scans at a cost of $99. We are doing this to make this service affordable to the largest number of people in our community. We are doing this because it’s the right thing to do.
No doctor’s order is needed for this test. If you fit the criteria above and you’re concerned about your risk for lung cancer, call 301-694-LUNG (5864) for a preliminary telephone screening and — if appropriate — to schedule your appointment.
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