High-Risk Smokers Should Get Imaging Scans, Panel Says
Ten million high-risk smokers aged 55 and older should get imaging scans each year to detect lung cancer when it is small and can be treated, according to new recommendations from the U.S. Preventive Services Task Force.
Lung malignancies are the No. 1 cancer killer in the U.S., accounting for more than one in every four cancer deaths each year. While breast and prostate malignancies are both more common, they are less deadly, according to the American Cancer Society. Screening for lung tumors, done properly, could save 20,000 lives each year, said Virginia Moyer, chair of the panel.
The recommendations from the task force, an independent medical advisory group to the government, run counter to its other recent edicts that urge less frequent mammograms, an earlier end to colonoscopies and the abandonment of a common prostate cancer test. Yesterday, a panel convened by the U.S. National Cancer Institute said low-risk growths in the breast, prostate and elsewhere should no longer be identified as cancer and screening efforts to spot them should be reduced.
“There are some cancers that sit around and don’t do anything, and others that are so treatable it doesn’t matter if you catch them late,” said Moyers, who is also vice president of the American Board of Pediatrics. “There is a sweet spot here with lung cancer. It’s a cancer that can be caught early and there is a treatment that makes a difference.”
CT scans aren’t for everyone. They use radiation and can lead to the detection of lesions, such as scars, that are ultimately harmless. Those patients still must undergo a biopsy, which is an invasive test, and perhaps other treatments to rule out malignancies, Moyer said. For those who are at the highest risk for lung cancer, however, the risks outweigh the benefits.
“Lung cancer is a devastating diagnosis for more than two hundred thousand people each year,” she said. “Ninety percent of patients with lung cancer die from it. It’s not been one of those cancers that is easily treated, and we think that’s because patients are diagnosed late, at an advanced stage.”
The CT scans are recommended for people aged 55 to 80 who have smoked a pack a day for 30 years, or two packs a day for 15 years. They apply to those who are current smokers or have quit within the past 15 years. Those who undergo the scans should be in relatively good health and be able to withstand surgery and medical treatment for cancer, should they be diagnosed.
The decision on whether to screen should be tailored to each person’s own risk factors, said Peter Bach, director of Memorial Sloan-Kettering Cancer Center’s Center for Health Policy and Outcomes.
“The benefit of screening at an individual level is both quite small and varies greatly even among people with heavy smoking histories,” he said. “The harms are meaningful, but at least in the high risk group the risk-benefit payoff is probably worthwhile,” Bach said in a telephone interview.
It’s not that the CT scans must be done or even that they should be done, he said. Instead, it’s reasonable for doctors and patients to have a discussion about it, he said.
Bach and his colleagues developed a tool that people can use to estimate their risk of developing and dying from lung cancer within six years, based on their history. It may help people decide if they would benefit from screening, he said.
Screening isn’t a viable alternative to quitting smoking, which is responsible for about 85 percent of all lung cancers in the U.S., the task force said.
“Helping smokers stop smoking and protecting non-smokers from exposure to tobacco smoke are the most effective ways to decrease the sickness and death associated with lung cancer,” said Michael LeFevre, the co-chair of the task force. “Screening for lung cancer is beneficial, but it is not an alternative to quitting smoking.”
The public can comment on the recommendations through Aug. 26. The remarks, observations and suggestions will be taken into account as the group crafts its final recommendation.
Recommendations published in the Journal of the American Medical Association yesterday called for reduced screening and renaming of less-risky lesions that are currently identified as cancer.
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