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Wednesday, July 30, 2014

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House Calls / Dr. Michael Schwartz

Updated 1:48 pm, Friday, February 7, 2014
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Lung cancer is the second most common form of cancer diagnosed, affecting more than 200,000 Americans each year. Approximately 150,000 people die each year from the disease. Although the majority of cases are caused by cigarette smoking, between 10 and 20 percent of the cases are discovered in nonsmokers as well. Unfortunately, by the time a cancer is discovered, it is usually quite advanced and difficult to treat.

A national study was performed to determine if chest X-rays or CAT scans of the lung would be a strong indicator of detecting early lung cancer. The study looked at smokers who were between the ages of 55 and 74 and who were characterized as heavy current or former smokers. Each group received either a yearly chest X-ray or a low-dose computed tomography lung cancer screening (LDCT). After several years, the death rate of the group that underwent CT scans was approximately 20 percent lower than the chest X-ray group. In addition, the CT scan detected a significantly higher number of "suspected" cancers allowing for earlier intervention and treatment.

The LDCT is usually performed in a hospital or radiology office. The patient lies on a table and is asked to hold his breath. The test takes about 30 seconds. There are no needles; no discomfort. Once completed, patients will receive a report of their CT scan results. For patients with a normal result, a yearly follow-up CT scan should be ordered. In patients who have some nonspecific abnormalities, a three- or six-month follow-up is suggested. Finally, in those patients with suspicious nodules or lesions, further immediate testing or procedures should be ordered.

The five-year survival rates for lung cancer are significantly lower than those for breast cancer, prostate cancer and colon cancer. Thus, early detection is imperative. The use of this technique may result in cancers being detected at a much earlier stage, allowing for better treatment options and a potentially higher long-term survival rate.

In light of this new information, screening guidelines suggest that any patient between the ages of 55 and 74 who has smoked the equivalent of at least 30 pack years (i.e., one pack a day for 30 years; or two packs a day for 15 years) and is still smoking or quit smoking within the last 15 years should undergo a yearly LDCT. Additionally, if a patient is over 50 years old with a 20 pack year smoking history and a family history of lung cancer they may also be a candidate for this test.

There are some potential concerns associated with CT scans including radiation and the potential for radiation associated malignancies with repeated exams. However, the radiation with each exam is quite low; equivalent to about half the radiation one receives on a yearly basis from naturally occurring background radiation at sea level. In addition, the expense of the exam is often a major concern. However, all the current studies suggest that the benefits far outweigh the risks of having the LDCT.

Some facilities do not charge for the test. Norwalk Hospital in Connecticut is offering the test for free as long as patients meet the testing criteria. Dr. James S. Bauman, the director of the Lung Cancer Early Detection Screening Program at Norwalk Hospital and Norwalk Radiology and Mammography Center, with respect to this free testing, stated, "We felt that there was still a significant patient population that was not availing themselves of the test, and that cost was still a barrier for a number of patients, in particular the least affluent in our county who have the greatest tendency to be habitual smokers. Therefore, in October 2013 we initiated the free LDCT program and the number of people who have taken advantage of it has widely exceeded our projections. We have probably scanned just short of 1,000 individuals at risk."

Bauman said given the overwhelming results indicating LDCT testing saves lives, Norwalk Radiology will continue to offer the test for free for patients who meet the criteria. In addition, he is encouraged by the fact that patients get more out of the test than just evaluating the lungs.

"We are providing a calcium score to identify those at risk for coronary artery disease, we identify and comment on patients with other types of lung disease including emphysema and lung scarring and we have even found other forms of cancers in patients undergoing screening," he said.

Finally, Bauman encourages women to undergo these tests as well.

"Women are highly aware and concerned with breast cancer and mammography. However, lung cancer kills more women each year than breast, ovarian, uterine and cervical cancer combined. Unfortunately, the number of cases for women with lung cancer are increasing compared to men, who have stabilized or slightly declined over the decades," he said.

Lung cancer screening via the LDCT appears to be a big step in saving lives. While there are a few medical organizations who question the validity of the study as well as the need for continued yearly screening, most well respected organizations including The American Cancer Society, The American Lung Association and The American College of Chest Physicians all recommend screening.

For more information on whether you should be tested, contact your physician today and breathe a little easier.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at www.drmichaelbschwartz.com