As is the case with virtually any form of the disease, early detection and diagnosis dictates the difference between life and death for lung cancer patients. Luckily, lung cancer screening is progressing quickly, and any momentum gained in this regard could mean a much lower mortality rate in patients with this disease.
Before diving into the ways in which screening is transforming, it is important to know what scientists, oncologists and others are fighting against. Here are some general statistics of note:
- The American Lung Association points out that roughly 415,000 individuals have received a lung cancer diagnosis in their lifetime, with more than 224,000 new diagnoses estimated in 2016.
- The organization notes that lung cancer is the most common form of cancer globally, and caused 1.6 million deaths in 2012.
- Americans spent $13.4 billion on lung cancer treatment costs in 2015.
- The American Cancer Society explained that, when lung cancer is caught in the earliest stages, the mortality rate can be far lower.
- About 25 percent of cancer-related deaths are tied to lung cancer, the American Cancer Society noted.
Lung cancer screening is evolving in many direct and indirect ways. Let’s take a look at some of the more notable progressions and changes that have come to fruition in the past few years:
Reasons to Screen
The American Cancer Society explained that screening, specifically low-dose CT (LDCT), was part of a major study known as the National Lung Screening Trial. This report proved that LDCT was more effective than chest x-rays, and might have been the driving force behind this therapy being a standard.
According to ACS, individuals in the study, of which there were 50,000, were far less likely to die of lung cancer if they received LDCT compared to chest x-rays by a margin of 20 percent. What’s more, they were 7 percent less likely to die of other potential causes.
Although this is just one study, it did make it clear that LDCT had substantial benefits that need to be further evaluated. Also important to note here is that the ACS offers specific guidance regarding the types of individuals who should undergo screening. The society argued that individuals 55 to 74 years old who are either smoking or quit within the last 15 years, are in relatively good shape and smoked a high volume of tobacco are the only ones who should be screened.
There are many reasons why screening candidates represent such a small portion of the population.
Hot and Cold
First and foremost, the U.S. Centers for Disease Control and Prevention explained that LDCT screening is the only recommended procedure for lung cancer, and even these methods have high rates of false-positive results. This has been a major factor in the implementation of changes to certain organizations’ policies and structures in the past year since the U.S. Preventive Services Task Force made its recommendation to begin covering such screening procedures.
The most recent example comes from the Veterans Health Administration, which launched a trial and study called the Lung Cancer Screening Demonstration Project. Medscape reported that the implementation process went anything but smoothly, and that the VHA found the screening process to come with greater risks and negative outcomes than advantages. This could impact the CMS stance on the matter in the future.
“During the process of setting up the project, we found that lung cancer screening is far more than just a scan,” said Linda S. Kinsinger, MD, MPH, one of the authors of the study, according to the news provider. “It required developing new materials and ensuring collaboration and coordination between various clinical services and between clinical services and patients.”
Notably, Medscape pointed out that this was the first such carefully monitored implementation process on a large-scale lung cancer screening project. While the results were mostly negative and disheartening, CMS will not be likely to make a major change – nor will the U.S. Preventive Services Task Force reverse its recommendation – until more data has been accrued. Remember, this is only a year old.
However, the study’s authors were in agreement that this particular screening project was anything but positive.
“The findings of the VHA study and my own experience in reviewing the data indicates that LCS [lung cancer screening] is not the slam dunk we were told it would be,” Rita Redberg, MD, MSc, told Medscape. “It is quite clear from this study that a substantial proportion of patients are harmed and many do not get the benefits. Indeed, we are learning more and more that early detection is not always better and that we detect things we do not need to worry about.”
Other issues included high incidence rates of false-positives and the identification of other health problems that skewed results, including pulmonary malfunction and emphysema.
Seattle Cancer Care Alliance echoes these concerns, but did note that when LDCT screening is used properly, it can save lives and prevent individuals from being diagnosed too late. According to the alliance, 75 percent of lung cancer patients are diagnosed with the disease once it has already advanced, metastasized or reached an incurable level.
This is why high-risk patients who fit the guidelines of entities like ACS and SCCA should be screened. Early detection using radiology can – and often does – have a tremendous impact on patient outcomes.
Plenty More to Come
This shows that even the most tried-and-true screening methods leveraged by the nation’s medical facilities and oncology departments will not always be accurate, nor will they be easy to manage in practice. Professionals who are stepping into positions that will come with responsibilities related to lung cancer screening need to keep up-to-date with all of the latest research and literature on the topic.
With the right education and a commitment to staying current on the news, professionals will likely be able to continue improving the outcomes of lung cancer screening endeavors.