New guidelines published in the Journal of National Comprehensive Cancer Network (NCCN) recommend that certain high-risk groups can benefit from lung cancer screening with low-dose CAT scan. The guidelines were developed after a study sponsored by the National Cancer Institute and published in the New England Journal of Medicine indicated that screening can reduce lung cancer mortality by 20 percent.
“This is good news because chest X-rays are inadequate at picking up lung cancer at an early stage,” says Rudy Lackner, MD , a thoracic surgical oncologist at The Nebraska Medical Center. “A CAT scan, on the other hand, can detect lung cancer nodules in stage 1a when the cure rate can be as high as 90 percent or more. However, currently only about 25 percent are found in the earliest stages. Approximately 75 percent of lung cancer cases are found in stages 3 and 4, when cure rates drop to 5 percent and lower.”
The guidelines recommend that individuals ages 55 to 74 that have smoked a 30-pack history should be screened. This is equivalent to a half pack a day for 60 years, one pack a day for 30 years or two packs a day for 15 years.
Because of these new recommendations, some of the major insurers are now covering this screening, says Dr. Lackner.
If a patient falls into this high-risk group, the pros and cons of lung cancer screening should be discussed between the patient and his or her primary care doctor. If a CAT is ordered and nodules are found, the patient should be referred to a lung specialist to determine whether they need to be biopsied or watched. About 50 percent of the population will have lung nodules from exposure to things like fungus or respiratory tract infections, but only 2 percent of these individuals will have cancerous nodules, says Dr. Lackner.
“Whether we biopsy the patient will depend on factors such as the size of the nodules and whether the nodules are increasing in size and multiplying,” says Dr. Lackner. “If the biopsy is negative, we will follow the patient for a minimum of three years.”
If no nodules are found, a CAT scan is recommended every year until age 74, says Dr. Lackner.
“The most challenging aspect of this screening is determining what should be done if nodules are found,” says Dr. Lackner. “This is where our expertise comes into play. We have a long track record of performing lung cancer screenings and treating lung cancer patients.”
Current data indicates that the chance for long-term survival improves when the medical team involved is dedicated to lung cancer treatment. The Nebraska Medical Center is unique in the region in that it has the only team of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, case managers and nurses dedicated to the treatment of lung cancer. Dr. Lackner works side-by-side with Apar Kishor Ganti, MD , a hematologist/oncologist specializing in lung, head and neck cancers, Karen Trujillo, MD , who with Dr. Lackner, are the only thoracic surgical oncologists in Nebraska with practices limited to cancers of the chest. The other members of his team dedicated to the care of lung cancer patients include oncologists Anne Kessinger, MD , and Alissa Marr, MD , radiation oncologist Weining (Ken) Zhen, MD , pathologist William West, MD , and radiologist Matthew DeVries, MD .
The Nebraska Medical Center is also a member of the NCCN and Dr. Lackner serves on the committee that developed the lung cancer screening guidelines.
Lung cancer is the most common cause of cancer deaths in both men and women in the United States and is the most preventable. It causes more deaths in women than breast, cervical, uterine and ovarian cancers combined.