Lung cancer screening comes of age

Jonathan Daniel, M.D.Jonathan Daniel, M.D.
Thoracic surgeon, Providence Cancer Center

Published December 2012

Lung cancer is the No. 1 malignancy-related killer in America, responsible for more deaths each year than breast, prostate and colon cancers combined.

Symptoms usually appear when the disease is advanced; in fact, only about one in four patients presents early enough for successful surgical resection.

As with colonoscopy or mammogram screening, the overall death rate of this disease could be lowered if these tumors were detected at an early stage when intervention can bring a cure.  
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In the past, lung cancer screening using standard chest films showed little benefit. The advent of improved computed tomography imaging, however, now allows detection of early primary tumors, and with limited exposure to radiation.

The National Lung Screening Trial, a randomized study of more than 53,000 patients at 33 centers, compared high-risk patients screened with low-dose CT versus standard chest X-ray. As reported in the New England Journal of Medicine, CT screening reduced lung cancer-specific mortality by 20 percent.

Further, new minimally invasive techniques (navigational bronchoscopy, thoracoscopic and robotic surgery, and stereotactic body radiation therapy) at centers focusing on dedicated thoracic surgery and oncology have led to improved outcomes for patients with lung cancer. The safety, quality of life and recovery for these patients have been dramatically enhanced, and treatment options are now being extended to those once thought to be at too high a risk for treatment.

Who should be screened?
The American Association for Thoracic Surgery and the International Association for the Study of Lung Cancer offer these guidelines:
  • Annual screening should begin at age 55 for smokers and former smokers (within the previous 15 years) with a 30-pack-a-year history of smoking. Annual screening may continue to age 79. The peak incidence of lung cancer is 70 years.
  • Low-dose computed tomography is the screening technology of choice; a chest X-ray alone should not be used.
  • Younger patients with a 20-pack-a-year smoking history should be screened if they have an additional risk factor that produces a 5 percent risk of developing a lung cancer over the next five years.
  • After surgical resection, patients should receive a baseline CT scan at six months followed by CT surveillance at least once a year. This is due to the possibility of recurrence and the increased risk for a second primary malignancy.
In cases of an indeterminate or positive scan, the patient should be cared for by a multidisciplinary team (thoracic surgeons, radiologists, pulmonologists and oncologists) to ensure appropriate intervention and treatment. Providence Health & Services-Oregon is implementing a multidisciplinary lung cancer screening program statewide.

Providence providers are encouraged to submit cases or imaging questions to the Providence Multidisciplinary Thoracic Oncology Conference. To learn more, call 503-215-6724 or email me.