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Jewish World Review April 12, 2001 / 19 Nissan, 5761

Michael Woods

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Consumer Reports

A new test for lung cancer -- AFTER all those years of living dangerously, you've stopped smoking cigarettes and climbed on the healthy lifestyle bandwagon. You know that the risk of lung cancer starts dropping as soon as you quit, and slowly returns to normal. Still... .

Maybe you're among the 46 million Americans who still smoke. You know that cigarettes cause 8 of every 10 cases of lung cancer. You're worried, and your family is worried.

Should people in those situations get regular medical "screening" tests in hope of easing fears about lung cancer, or diagnosing the disease in an early and more curable stage?

Screening tests are medical examinations like mammograms for breast cancer or the PSA blood test for prostate cancer. They usually are given to people with no symptoms of a disease in an effort to catch the disease in an early and treatable stage.

Groups like the American Cancer Society (ACS) constantly urge people to get screening tests for other kinds of cancer. Yet no organization recommends routine screening for lung cancer.

Lung cancer screening tests have been in and out of favor since the 1940s, when doctors often advised smokers to get a regular chest X-ray.

ACS does not recommend either for or against screening, because of a lack of evidence that X-rays and other traditional tests save lives.

That situation may be changing, thanks to development of new technology - low-dose computerized tomography (CT) - that can detect much smaller tumors than those visible with regular X-rays. Low-dose CT is a variation of the familiar CAT scan, which produces three dimensional computer-enhanced body images used to diagnose many diseases.

Low-dose CT has gotten lots of media attention as hospitals and medical groups put the scanners into service. It even has led the ACS to begin re-evaluating its "no-recommendation" policy on screening.

An effective screening test could have great benefits, considering lung cancer's terrible impact on society.

About 164,000 new cases occurred in 2000, according to the ACS. The disease killed about 157,000 people - more than cancer of the colon, breast, and prostate combined.

When lung cancer is found and treated early (before spreading to other areas of the body) about 42 percent of patients live at least five years. So few patients are diagnosed early, however, that the overall five-year survival rate is barely 14 percent.

Studies of low-dose CT patients diagnosed with small lung tumors, in contrast, project five-year survival rates of 80 percent. Other newer methods also are available for early detection of lung cancer, including molecular screening of lung cells and fluorescence bronchoscopy.

Some medical experts, however, have reservations about using low-dose CT on a wide basis until more research is done. Dr. Edward Patz, of Duke University, led one group that reviewed the status of low-dose CT late last year in the New England Journal of Medicine.

They drew on 50 years of studies, dating to the 1950s, which involved tens of thousands of smokers in the United States, Europe and Japan screened with chest x-rays, sputum (mucus coughed up from the lungs) analysis, and other measures.

The group argued that low-dose CT's ability to spot very small tumors may not be the answer. Evidence suggests that in lung cancer, people may have small tumors, but advanced disease that already has spread widely in the body. If so, low-dose may not reduce the death toll from lung cancer, they said.

With the life at stake being their own, ex-smokers and current smokers have every reason to discuss low-dose CT and other screening tests with their doctors right now. Then decide if the test makes sense in your own circumstances.

Michael Woods writes for the Toledo Blade. Comment by clicking here.


© 2001, SHNS