Lung Cancer Screening
We’re just a few months away from celebrating an important milestone that will certainly go unnoticed by most people reading this blog. It was almost four years ago that the U.S. Preventive Services Task Force(USPSTF) issued its recommendation that high-risk individuals get screened for lung cancer. As journalist Elizabeth Whittington observed on Curetoday.com, this is the same “expert” panel that recommended we pull back the reigns on mammography screening and the prostate-specific antigen (PSA) test because they reasoned that the harms might outweigh the benefits. It’s worth mentioning that prostate and breast cancer are #3 and #5 leading cause of cancer deaths respectively in U.S.
At the time, the USPSTF's recommendation was major news, and it was estimated that lung cancer screening in the at-risk population would save 20,000 lives annually. Skin and breast cancer are the two most commonly diagnosed cancers (an estimated 255,180 new cases of breast cancer will be diagnosed in the United States this year), yet more people will die from lung cancer in 2017—about 155,870—than the other four leading causes of cancer deaths combined. Source: (breast cancer (41,070), prostate cancer (26,730), colon and rectal cancers (50,260) and pancreatic cancer (43,090)
Now that we’re almost four years removed from that important recommendation, it’s worth seeing if screening has really had a positive impact.
Recently, a small but important initiative out of Augusta, Georgia found more than a 100 percent increase in the cancer rate following screening than has been observed in previous studies. The initiative, conducted by researchers at the Augusta University’s Georgia Cancer Center, pointed towards the need for “ongoing, accessible, free screening” for those at greatest risk, defined as adults aged 55 to 79 years old who have no signs or symptoms of lung cancer but have a history of heavy smoking, a current smoker or someone who quit within the past 15 years. In 2013, the USPSTF defined "heavy smoking" as essentially smoking a pack of cigarettes every day for 30 years (or two packs for 15 years, and so on). These standards haven’t changed.
In the Georgia trial, 398 people signed up for the screening, 350 qualified and 264 received a combination of positive emission tomography (PET) and computed tomography (CT) scans. About 3 percent of the 264 screened had lung cancer, and most significantly, 75 percent of those were caught early. Excluding those patients who presented with early symptoms, like persistent cough or shortness of breath, the rate of patients with no symptoms was 2.2 percent, twice the rate previously observed. Earlier studies found a 14 to 20 percent decrease in lung cancer deaths (about one life saved for every 320 people) following LDCT screening.
As I point out in my book, An Empowering Guide to Lung Cancer, catching the disease early, ideally before symptoms surface, can increase the overall survival rate by as much as 90 percent. The one screening downside: Since more people are being tested, there will almost certainly be a jump in the number of false-positives (where a scan shows cancer when there is none) and increased radiation exposure (although minimal) from the imaging scan. Therefore, people who don’t fall into the high-risk category should not be screened because the risks may outweigh the benefits (some 20 percent of lung cancer patients never smoked). Some people have also raised the concerns about the cost of screening. This is a non-issue in my opinion. I can confidently say that cost of screening is far less than the healthcare costs—not to mention the stress and aggravation—associated with treating advanced lung cancer.
So, if you meet the criteria, please consider lung-cancer screening. It really is a matter of life and death.