November 22, 2010
Earlier this month, the big news about the 20% reduction in lung cancer in a high-risk population that took part in the National Lung Screening Trial (NLST) has been widely covered by the media. In the wake of the announced positive results of early detection of lung cancer with spiral CT scans, a number of commentators have commented on the potential harms of engaging in lung cancer screening.
While there are critical issues that relate to the risk of screening, another dimension of screening has been largely ignored. If there is a 20% mortality reduction through screening, one may speculate that if screening were implemented among this high-risk group, then 32,000 fewer Americans would die of lung cancer over the next year. It is likely there are a number of smokers and former smokers in the US that are in the age group (55-74) and tobacco-exposure range (30 pack years) evaluated in the national CT-based screening trial.
Given the lethality of lung cancer, these tobacco-exposed individuals are likely to be quite eager to learn about plans for national implementation of lung cancer screening. Clearly there are issues with implementation such as cost, logistics and safety. The medical community knows that the results of the trial need to be published and expert bodies such as the US Preventive Services Task Force need to critically examine the evidence. However, the public in general and at-risk individuals in particular expect that this public health opportunity will be approached with a sense of urgency. Some may muse about the potential for screening harm and that is important. Some of us too are concerned about the unremitting lethality of lung cancer, that will kill more Americans this year then the next four most common cancers combined.
In the meantime, what may an at-risk individual consider? Consistent with American Cancer Society and US Preventive Services Task Force existing recommendations, people considering lung cancer screening should talk to their doctors. These heavy smokers and former smokers need to learn about the risks and benefits of screening relative to their personal medical situation. They need to know that lung cancer screening management is new and it is complicated.
The best chance for good care is to go to an established multi-specialty medical center (not a store-front screening clinic!) that is committed to providing excellence in all aspects of detecting and managing early lung cancer. Right now, there are only a limited number of these centers. But the strength of the evidence compels us to work with all due haste to deliver high quality lung cancer screening services across the country and then to treat individuals appropriately if lesions are detected. It is truly a matter of life or death.
Editor’s Note: Dr. Mulshine is a member of the Prevent Cancer Foundation’s board of directors and Co-Chairman of the Foundation’s Scientific Review Panel.