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Smoker? Ex-smoker? Cancer group says yearly CT scan may be advisable

January 11, 2013|By Melissa Healy | This post has been corrected. See below for details.
  • A new recommendation urges longtime smokers and those who have quit in the past 15 years to start getting screened for lung cancer at 55.
A new recommendation urges longtime smokers and those who have quit in the… (Jim Cole )

The American Cancer Society on Friday urged smokers who have smoked a pack of cigarettes a day for 30 years -- and those with a similar history who have quit within 15 years -- to talk to their physician about getting a yearly chest CT scan that can detect lung cancer while it can still be treated. Patients as young as 55 and as old as 74 should consider getting the yearly scans if they are considered at high risk for developing lung cancer, the organization announced.

The influential group's recommendation comes in the wake of mounting evidence that low-dose spiral CT scans of the chest are more likely to detect newly established lung tumors than are chest X-rays, which have long been used to diagnose lung cancer. The National Lung Screening Trial, published in 2011, found that, on average, if five people at high risk of lung cancer get a yearly CT scan, the new screening regimen will prevent a single lung-cancer death.

Lung cancer is the leading cause of cancer death in men and women, claiming more lives yearly than breast, colon and prostate cancers combined. In 2009--the last year for which data are available--206,000 Americans got a lung cancer diagnosis and roughly 158,000 patients died of the disease. Cigarette smoking is the most common cause of lung cancer. While it has shown a steady modest decrease in men in the past decade, lung cancer diagnoses in women have remained steady.

The new recommendations come after much debate over the risks and benefits of lung cancer screening. While regular CT scans of the chest can detect lung cancer in its early stages, the practice results in many false alarms. Of the nearly 27,000 study participants who got three CT scans in a recent study, 40% received an abnormal finding that required additional diagnostic tests.

Those tests included a repeat CT scan and far more invasive procedures, such as bronchoscopies and needle biopsies. While 95% of those follow-up tests did not result in a cancer diagnosis, they could cause harm. Fewer than one in 1,000 follow-up tests result in a fatal complications. But by some reckoning, the National Lung Screening Trial showed that for every five to six lives saved by CT screening, one was lost as a result of diagnostic tests that were unnecessary.

In a statement posted on the American Cancer Society's website, chief medical officer Dr. Otis Brawley stressed that not all patients will calculate the risks and benefits of lung cancer screening equally, and that the decision to screen should be made only after a patient has discussed it with his or her physician.

Screening should be done in centers that have expertise and experience in scanning for lung cancer, and where active efforts are being made to reduce false-positives and unnecessary follow-up tests, the American Cancer Society said.

The American Cancer Society noted that the benefits of yearly lung cancer screening were most pronounced among those who are at highest risk of lung cancer--the heaviest smokers with the longest history of smoking cigarettes.

A recent study found that roughly three-fourths of lung cancers have spread throughout the lungs or beyond by the time they are diagnosed. Sometimes when tumors are found at a stage where they are smaller and more confined, lung cancer can more easily and successfully be treated with surgery, radiation and chemotherapy.

Brawley cautioned that as the technology of CT screening improves, so too will the risk that doctors will be able to detect abnormalities that are completely benign or that will never become a deadly cancer, but that will nevertheless prompt worry and additional testing. "For those of us in the medical profession, it's our job to keep these as few and far between as possible," he said.

[For the Record, 4:44 p.m. PST Jan. 11: An earlier version of this online article said the American Cancer Society has urged some smokers to get a yearly chest CT scan. In fact, the group urged those people to talk to their doctors about getting a CT scan.]

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