Smoking is the number one cause of lung cancer and lung cancer is the leading cause of cancer related deaths in the United States. (More than breast, colorectal and prostate cancer combined!) A proper medical history should always include a smoking history and medical care should include therapies (and ongoing encouragement) to stop if a patient is still smoking. But what about screening and follow up? Despite advances in diagnosis, staging and treatment, only 18% of patients with lung cancer are still alive five years after diagnosis.There is an understandable goal by all of us to do better…
An article published in the November 6 issue of the New England Journal of Medicine has provided data that helps improve smoking mortality statistics; it demonstrates the efficacy of screening with low-dose CT scans of the lungs. The National Lung Screening Trial (NLST), enrolled more than 50,000 persons at 33 US centers. They included individuals who were 55 to 74 years of age with a smoking history of at least 30 pack years. (That means that they smoked one pack for 30 years or two packs for 15 years or, and I am not sure how one does this…3 packs for 10 years.) They included both current smokers and former smokers who had quit within the previous 15 years.
The findings were very significant. There was a 20% reduction in lung cancer mortality with low-dose CT scan diagnosis and treatment versus those who were diagnosed with lung cancer by simple chest x-ray. In absolute terms, this translated to approximately three fewer deaths from lung cancer per 1000 high risk persons who underwent low-dose CT scanning.This is as great a benefit as that reported for breast cancer mortality with annual mammography screening among women 50 to 59 years of age.
There were false positives…(The scan can pick up abnormalities that are not cancer). To decrease the false positive results and unnecessary biopsies and/or surgery, participants found to have a nodule were followed with additional CT screening and only when a lesion got bigger or more worrisome was a biopsy performed. In the end, relatively few of the surgeries (24%) were performed in patients who had benign nodules.
What also got my attention was the fact that screening with low-dose CT was much more cost-effective among women then among men. Scanning was also more likely to have a mortality impact in the groups with the highest risk of lung cancer such as those who were still smoking and those who were older.
And now a very recent headline: Medicare just announced that they “will cover annual screenings for lung cancer for older Americans with a long history of heavy smoking”. They “will extend coverage for CT scans to Medicare beneficiaries who smoked at least a pack a day for 30 years or the equivalent, even if they quit as long as 15 years ago”. According to their announcement the scans will be free for recipients and “the coverage would apply to beneficiaries through age 74.”
Bottom line: If you are a former smoker of the equivalent of one pack of cigarettes a day for 30 years or, heaven forbid, you are a current smoker and you’re over the age of 55, talk to your physician about getting a low dose CT scan of your lungs. Based on the recent studies and the fact that Medicare has announced that they will pay, this should be affordable (if you are not yet on Medicare) or free if you are 65 or older. Too bad the cost of future CT scans are not charged to tobacco companies every time they sell a pack of their poison!