Study: CT Scans Could Catch Smokers' Lung Cancer Early

By Andrew Moseman | November 5, 2010 10:22 am

cigarette butteThe results were so staggering that they stopped the study ahead of schedule to get the word out: A giant study by the National Cancer Institute of more than 50,000 heavy smokers has found a 20 percent reduction in deaths among patients who received a CT scan to catch potential cancer as opposed to a simple X-ray.

“This is huge,” said Dr. Reggie Munden, a University of Texas M.D. Anderson diagnostic radiologist who led the research conducted at the Houston cancer center, one of 33 sites nationally. “It’s a massive ray of hope that we can now offer a scientifically proven test to people at risk of lung cancer and pick up tumors before they’re considered lethal.” [Houston Chronicle]

Participants in the study, which began in 2002, had smoked about a pack a day for at least 30 years (or the equivalent—two packs for 15 years). They received a screening via either CT scan or X-ray three times a year. While the X-ray group lost 442 people to lung cancer, the CT group saw only 354 lung cancer deaths.

The technology involved in the screening is called low-dose spiral CT imaging, in which a complete three-dimensional image of the chest cavity can be produced during the duration of one held breath. The technology is much more sensitive than a conventional chest X-ray, but also exposes the patient to much more radiation — about the same amount associated with a conventional mammogram, according to Dr. Denise R. Aberle of UCLA’s Jonsson Comprehensive Cancer Center, the principal investigator of the study. [Los Angeles Times]

Now, though, the NCI’s exciting finding gets into the nitty-gritty of health care: money. A CT scan costs $300-400 or more, and at present, most insurance doesn’t cover the test for a lung cancer screening. That could change based on studies like this, but with millions of smokers and former smokers in the United States, it could add up to yet another gigantic medical expense.

And while the CT scans were a clear success in finding early lung cancer, there’s always the concern of too much of a good thing:

Some expressed concern that the findings might lead to an increase in the number of people undergoing unnecessary screening. The scans found abnormalities in about 25 percent of those screened, but most turned out to be false alarms. “As with any study of screening, there are also potential harms to be considered, such as potential overdiagnosis and needless surgeries,” said Otis W. Brawley, the American Cancer Society‘s chief medical officer. “We have learned from the long-term analysis of other screening tests, such as mammography, that it is important to consider both benefit and harms associated with the test.” [Washington Post]

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Image: iStockphoto

CATEGORIZED UNDER: Health & Medicine
  • Dean

    Costs.

    8 years times 3 examinations times 400 dollars equal 9,600 dollars. Times 25,000 (half of the study group) equal 250,000,000 dollars. To save 90 lives,,,,, ??? Of voluntary smokers.

    What is the long term mortality? Were those 90 lives saved temporarily? By the very nature of the improvement (CT scan) were the X-ray only cases diagnosed later, the CT earlier? Might the two groups equal out given a five year time line, a ten year time line?

    Are the false positives more or less prevalent in X-rays or CTs? False positives can be hugely expensive to no result. Did the CTs reduce or exacerbate?

    I think the study has raised more problems that it solved, moral, and financial.

    Yes, if medical care were instant and of no cost to anyone, rate payers, taxpayers, bill payers, do it. It is not.

  • Kyle

    If it was your family, wife ,mother, child, would you be thinking that it is a financial and moral problem? Or would you have a change in opinion?

  • Al

    Kyle – I am a physician. If it were my family, I would’ve told them to stop smoking. If you are going to smoke and develop lung cancer, why should the American public subsidize your risky behavior? Why should we even subsidize early screening?

    Frankly the only reason I can think of that smoking has not been outlawed is that the governmental revenue from taxing the tobacco giants outweighs the U.S. government’s health care costs related to COPD, lung CA, and the other assortment of smoking-related diagnoses.

  • Deana Ashby

    Al, so let’s NOT give obese people the best care possible because they voluntarily ate to much or how about those who chose to work with risky chemicals, ya know, those known to cause cancer or…hey, doc? How about the football player or boxer…the list of risky behaviors can go on. If you’re a doctor you are in the wrong profession! Most people that come to see you took some sort of risk that lead to them coming to see you…maybe they didn’t wash their hands often enough…get real.

  • Munden

    The comments are interesting. To respond. Dean mortality takes into consideration the time intervals. That is why mortality is used and not survival, which would tend to even out over 10 yrs. The trial also showed a decrease in overall mortality – in otherwords death from causes other than lung cancer. Clearly there is more to learn from this trial than known at this time.

    Al – I am a little surprised at your comments and presummed ability to stop habitual behavoir in loved ones. My parents were heavy cigarette smokers and stopped when they decided not when I told them to. I presume you have no loved ones who are overweight, drink alcohol a little more than moderation, drive cars too fast, engage in risky behavoir, live in a large city? Much like Deana states, there are numerous behavoirs that put a person at risk for potential health care expenses. The fast food industry is certainly coming under major scrutiny now, but the everyday diet of Americans could be considered a problem. And what about second hand smoke or polution from large cities? Without a doubt, the most effective thing we can do is NOT smoke, but that can’t be reversed for those that have already reached a critical point. Screening will decreasd deaths in this group from this awful disease. When the cost effectiveness studies of the NLST are completed, I suspect it will also show that screening for lung cancer also saves a lot of money in treating this disease.

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