Put cancer to the test

By John Handy, M.D., thoracic surgeon, director of the Providence Thoracic Surgery Program and co-director of the Providence Thoracic Oncology Program, and Pippa Newell, M.D., surgeon and medical director of the Providence Liver Cancer Program

Mammograms, colonoscopies, PAP smears – these tests are well known and widely used to successfully prevent breast, colon and cervical cancers or to catch them in their earliest, most treatable stages. Just about everybody will, or should, have one or more of these tests routinely in their lifetimes. Hundreds of thousands of people are alive today because of what they discovered – while time was still on their side – through these tests.

Two additional tests offer the same lifesaving power for people at high risk for lung and liver cancers, yet fewer people know about them:

  • Low-dose CT scanning can find small lung cancers while they are still curable, but many people at high risk for lung cancer aren’t aware that this test is now widely recommended and covered by Medicare.
  • Routine ultrasound screening can greatly increase early detection and survival for people at high risk for liver cancer, but the vast majority of people who could benefit from this test don’t even know they’re at risk.

Take a moment to learn about these two important tests.

Affirming the value of lung cancer screening

It’s now well known that the defining risk factor for lung cancer is a history of smoking. We also know that finding lung cancer early offers the best possible hope for successful treatment and cure. Statistics vary depending on how and when they are collected, but in my experience, with today’s treatments, as many as 50 to 80 percent of people whose lung cancers are discovered and treated in the earliest stages can reach their five-year survival anniversaries.

Until recently, however, it hasn’t been clear whether screening for lung cancer made any difference to survival. Traditional chest X-rays proved ineffective, and CT scans, while promising, were still being studied.

In 2011, we finally got the study results we were hoping for. The National Lung Screening Trial compared annual low-dose CT screening to standard chest X-rays in more than 50,000 current and former heavy smokers. It found a clear 20 percent survival advantage for those who had CT screening. Now annual low-dose CT scanning is the standard of care for people at high risk for lung cancer.

Medicare covers annual low-dose CT lung cancer screening for beneficiaries who:

  • Are age 55-77
  • Are current smokers or have quit in the last 15 years
  • Have smoked at least 30 “pack years” (e.g. a pack a day for 30 years, or two packs a day for 15 years)

If this describes you, talk to your doctor about the risks and benefits of lung cancer screening. Learn more ›

A lifesaving screening for liver cancer

For people at high risk for liver cancer, a simple ultrasound screening every six months can maximize the chances of finding cancers when they are still small enough to be cured. However, a large study recently found that less than 20 percent of people who could beneft from these screenings get them.

Why the low screening rates? In contrast to lung cancer, knowing whether you’re at high risk for liver cancer is not always simple. Those who should be screened, according to the American Association for the Study of Liver Disease, include:

  • Anyone with cirrhosis from any cause, including hepatitis C, heavy alcohol use and other causes
  • Anyone with hepatitis B in these groups:
    • Asian men over age 40
    • Asian women over age 50
    • African American and African-born people over age 19
    • People of any age with a family history of liver cancer

Unfortunately, people can carry hepatitis B or C – the leading causes of liver cancer – for decades and have no idea. For this reason, screening needs to begin earlier with a simple blood test for these viruses. Consider being tested for hepatitis B and/or C:

  • If there is a chance you were exposed to either virus through an infected person’s blood – for example, through blood transfusions before 1992, by sharing needles, through sexual contact, or by working in contact with blood
  • If you were born between 1945 and 1965 or you have other risks for hepatitis C
  • If you or one of your parents were born in a country where hepatitis B is prevalent, such as Asia or sub-Saharan Africa, or if you have other risks for hepatitis B

If you’re not sure, consider this a conversation starter. Your doctor can help you determine which tests make sense for you.

These tests provide powerful information. When we can find and treat liver cancers early, two out of three of our patients are alive and well five years later. Compare that to the dismal 16 percent survival at five years for all liver cancers, and screening more than passes the “worthwhile” test.