June 29, 2011 Current and former heavy smokers can now be screened more effectively for lung cancer. Results from the National Lung Screening Trial (NLST) revealed that detecting small lung cancers with computed tomography (CT) reduces lung cancer specific mortality by 20 percent.
Prior to the trial, lung cancer, often diagnosed in the later stages of the disease, had shown no benefit from screening because screening with standard chest X-rays did not detect cancers early enough. The trial, funded by the National Cancer Institute (NCI), is the driving force behind a new program offered at The University of Texas MD Anderson Cancer Center.
MD Anderson's Lung Cancer Screening Program teams experts in thoracic surgery, radiology, pulmonary and clinical cancer prevention who have developed a step-by-step program to better detect, treat and educate high-risk individuals against lung cancer.
"Our program is unique because we do more than a comprehensive lung CT screening exam," said Therese Bevers, M.D., medical director of MD Anderson's Cancer Prevention Center. "We offer preventive options to help reduce their risk for cancer. Based on the findings from the screening lung CT, we guide people through the diagnostic evaluation and, if needed, treatment."
MD Anderson is offering screening to current or former smokers 50 years of age or older who have smoked the equivalent of one pack of cigarettes a day for at least 20 years. In addition to screening, the program offers access to other services through the Cancer Prevention Center, including risk assessment counseling for those found to not have lung cancer and low-cost tobacco cessation programs to help smokers quit.
MD Anderson's program is based on initial findings reported last fall from the NLST. The findings, scheduled to be published in the June 29 New England Journal of Medicine, revealed a 20 percent reduction in lung cancer deaths for participants who received the low-dose helical CT scan compared with those undergoing a standard chest X-ray.
Clinical Trial Results Add Weight
MD Anderson was one of 33 sites involved in the national trial and one of 10 sites that collected biomarkers to use in NLST secondary trials. More than 780 MD Anderson participants were enrolled in the trial. The trial randomized 53,000 current or former smokers -- ages 55 to 74 -- into two screening groups to compare and examine lung cancer mortality.
"This is a major finding for lung cancer patients and health care policy in the United States," said Reginald Munden, M.D., a professor in Department of Diagnostic Radiology and lead investigator at MD Anderson on the trial. "The goal of our lung cancer screening program is to improve the health of lung cancer patients."
Munden hopes the trial results will pique the interest of current smokers to join a smoking-cessation program. Because many former smokers are at a high risk for developing lung cancer, MD Anderson hopes to draw that population to the screening program as well. "We had a tremendous amount of interest in the trial when it first opened, and we anticipate there will be more people asking to be screened with the release of the trial findings," said Munden.
The Costs of Saving Lives
As promising as the findings are, not all smokers and former smokers are recommended for lung cancer screening. There are certain risks associated with screening, including radiation exposure and false positives that may require additional testing and discomfort.
"Now that we have scientific proof that screening a specific high-risk group can reduce mortality in lung cancer patients, the benefits of the screening outweigh the risks for those people," said Bevers, who was MD Anderson co-investigator on the national trial.
Cost can be a barrier to screening, because insurance companies do not cover the expense of lung cancer screening. Previous studies did not prove a benefit to X-ray screening. With the challenging economy and rising costs of medical care, the out-of pocket expense may deter some from getting screened, and the screening results could lead to further tests that may involve additional costs.
MD Anderson is charging $400 for a lung cancer screening, but experts consider this worth it if it will reduce the number of lung cancer deaths. "There are more costs associated with treating lung cancer," said Munden.
The trial also includes a cost-effective analysis. Researchers are comparing the cost of lung cancer care to the cost of covering lung cancer screening. "If the analysis demonstrates a reduction in the cost of lung cancer care, then the adaptation will be rapid," said Munden.
Results from the cost analysis are expected to be released later this year.
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- The National Lung Screening Trial Research Team. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine, 2011; DOI: 10.1056/NEJMoa1102873
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