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Is the Spiral CT Scan a Good Idea for Lung Cancer Screening?

separator The death of Peter Jennings from lung cancer, and then the news right afterwards that Dana Reeve, widow of Christopher Reeve, has lung cancer, has made a lot of people a little bit nervous about getting the disease themselves. Lung cancer is the leading cause of cancer-related death in this country, among both women and men. According to estimates by the American Cancer Society, there will be 172,570 cases of lung cancer diagnosed this year, and 163,510 people will die of the disease.

Researchers believe that about 90 percent of the most common types of lung cancer are caused by smoking or by inhaling secondhand smoke. Even after you quit smoking, you’re still at increased risk of developing lung cancer, although the risk does decrease with time.

Lung cancer causes about 29 percent of all cancer deaths. The five-year survival rate for lung cancer is about 15 percent. The problem is that most people who are diagnosed with lung cancer have already begun having symptoms and their cancers are more advanced or have spread (metastasized) to other parts of the body.

Can you detect lung cancer before symptoms begin?
Generally, traditional X-rays of the lungs can detect tumors that are about the size of a quarter or larger. In most cases, at this point the tumor has reached a more advanced stage and patients have already begun having symptoms. This is why X-rays aren’t used to screen for lung cancer. Symptoms of lung cancer include:

  • Persistent cough
  • Sputum that contains blood
  • Chest pain
  • Frequent pneumonia or bronchitis

Remember, a screening test is done to detect cancer before it causes symptoms. Common cancer screening tests include mammograms, to detect breast cancer, and colonoscopy, to detect cancer of the colon.

A newer screening test, called the spiral CT scan, is able to detect lung tumors as small as the diameter of a soda straw. During the test, the CT machine rotates around you to produce an image of your entire chest in about 20 seconds.

There are medical professionals who believe that eventually, it will become common for long-time smokers older than 60, including those who have quit smoking, will be good candidates for the spiral CT scan. In ongoing clinical trials testing the effectiveness of the CT scanner, tumors have been found before they have begun to cause symptoms. But there haven’t been enough large, long-term clinical trials that have proven that this type of screening will improve survival for patients.

Concerns about spiral CT scanning
In addition to there being no proof that spiral CT scans can extend life expectancy for lung cancer patients, there are other reasons to exercise caution with the scans, including:

  • Overdiagnosis—The spiral CT scan can detect tiny tumors that would never be life-threatening.
  • False positives—The scan can detect small nodules that do not turn out to be cancerous.

In both of these instances, doctors would need to conduct further testing to determine whether the findings of the CT scanner do indicate cancer. That means that patients have to undergo needle biopsies of lung tissue or even surgical removal of a nodule.

There’s also the issue of cost. The spiral CT scan can cost from $250.00 to $1,000.00. Until there’s clear evidence, produced from large clinical trials, that using the spiral CT scan for cancer screening does, in fact, save lives, it won’t become a common cancer screening tool.

Source:
The American Cancer Society; The National Cancer Institute; The New York Times, “What an Extra Eye on Cancer Can do for You,” 16 August 2005.



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