Lung Cancer Screening Test Raises Hopes and Sets Stage for Discussion of Guidelines

Lung Cancer Screening Test Raises Hopes and Sets Stage for Discussion of Guidelines The Lung Cancer Alliance is pressing for a full discussion about the guidance on whether people at high risk for lung cancer should undergo screening after a large-scale trial demonstrated a 20% improvement in the survival rate for patients who were checked with low- dose helical computed tomography (CT).

The Washington, DC-based advocacy group said the results of the National Lung Screening Trial (NLST) were “stunning” but that patients considering the procedure should proceed carefully. “Screen- ing for lung cancer is not a simple one-step procedure. It is a process, and a complex one that requires training and experienced professionals using up-to-date, specialized equipment and best manage- ment practices,” Laurie Fenton-Ambrose, president and CEO of the alliance, said in a press release.

The National Cancer Institute (NCI) announced in early November that it would halt the NLST because of the positive results. The trial, which began in August 2002, involved 53,500 current and former heavy smokers aged 55 to 74. The study compared the performance of 2 screening procedures for lung cancer, the low-dose helical CT and a standard chest x-ray, in detecting lung cancers at relatively early stages. Patients were followed up to 7 years.

The NCI said 354 patients who received the CT scan died, significantly fewer than the 442 lung cancer deaths among those in the x-ray arm.

“This is the first time that we have seen clear evidence of a significant reduction in lung cancer mortality with a screening test in a randomized controlled trial. The fact that low-dose helical CT provides a decided benefit is a result that will have implications for the screening and management of lung cancer for many years to come,” Christine Berg, MD, NLST project officer for the Lung Screening Study at NCI, said in a press release.

Harold Varmus, MD, director of the NCI, said a better screening tool could potentially save many lives. He said, however, that tobacco remains the major cause of lung cancer and that efforts to curtail its use should continue.

Lung cancer is the leading cause of cancer death among both men and women in the United States, according to the American Cancer Society (ACS). Cigarette smoking among adults has decreased dramatically from 42% in 1965 to about 21% in 2009, but many high-schoolers are using tobacco products, the ACS said. A 2009 survey indicated nearly 30% of high-school boys and 22% of girls said they had used some type of tobacco in the month before they were polled.