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The Journal Gazette

  • Feldman

Thursday, September 28, 2017 1:00 am

Where there's smoking ...

Task force recommends preventive CT scans

Dr. Richard Feldman

Dr. Richard Feldman is an Indianapolis physician and a former Indiana state health commissioner.

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Attention smokers and former smokers:

A new recommendation from the U.S. Preventative Services Task Force advises that smokers and former smokers at highest risk for lung cancer should be screened with an annual low-dose chest computed tomography scan. The recommendation is only for smokers and former smokers of less than 15 years, aged 55 to 80, and with at least a 30-pack-year history (for example, a pack a day for 30 years or two packs daily for 15 years).

Studies have validated utilizing annual chest CT to find extremely early lung cancers with a chance of surgical cure. A number of medical professional societies have also issued identical or similar position statements. Still, many health care providers have not yet adopted this screening practice as a matter of routine.

The Preventative Services Task Force is an extremely influential body whose recommendations carry significant weight with health care providers, insurance companies and federal policymakers. This extremely scientifically conservative group makes definitive recommendations regarding preventive services only when there is strong scientific evidence to back its positions. Its recommendations can be controversial in the medical community (as with screening mammograms and PSA screening for prostate cancer). But in the case of low-dose lung CT to screen for lung cancer, there is little disagreement.

The use of screening chest CT should now increase significantly. Hospitals are offering very low-cost scans (well less than $100), insurance coverage is now picking up dramatically, and Medicare has begun paying for these.

Each year, more than 200,000 people in America are diagnosed with lung cancer, and 160,000 die from this miserable disease. It is the third-most-common cancer and the leading cause of cancer mortality in the United States. Smoking is of course the main culprit, accounting for 85 percent of all lung cancers. Unfortunately, lung cancer is commonly discovered at incurable advanced stages. Essentially the only current way to beat the disease is to find it early before any spread and to resect it surgically. This is exactly the rationale for yearly screening.

The task force reviewed a number of studies to arrive at its conclusion. It was, however, principally based on a large prospective study by the National Cancer Institute of 53,000 individuals assigned either to CT or chest X-ray screening. Mortality was found to be reduced 20 percent in the chest CT intervention group. The task force projected that if screening were widely implemented, it would result in a 14 percent reduction in lung cancer mortality or about 20,000 of the 160,000 yearly lung cancer deaths.

This benefit is balanced with potential harms including false negative results, some potential for deaths from cumulative radiation exposure, overdiagnosis and incidental benign CT abnormalities that initiate further testing and invasive procedures that can result in complications. The task force considered these downsides and determined the benefits clearly outweighed the potential harms; the lives saved well outnumbered any complications caused by CT screening.

Age, co-morbid illnesses and potential life expectancy are factors to consider before screening; the patient must be healthy enough to tolerate potential lung surgery.

The American Lung Association and the Ad Council have launched the campaign “Saved By The Scan” to raise public awareness of the value of early detection of lung cancer through low-dose CT scanning. 

A final reminder from the doctor: The carcinogenic effects of tobacco are cumulative and dose related, so if you smoke, quit. And the sooner the better.