The report in the New England Journal of Medicine (NEJM) this week that low-dose CT scanning of smokers reduced deaths from lung cancer is a major step forward in the cancer research world – and really, in the world at large, considering the high human and financial toll that this disease imposes.
Lung cancer remains the nation’s number one cancer killer, claiming more lives than the next three most common cancer killers — prostate, breast and colorectal cancers – combined. In the U.S. alone, over 157,000 people died from the disease in 2010. That’s more than 3,000 people per week.
One reason for this devastating toll is that no reliable screening test has existed to detect the disease in its early stages. Most cases are diagnosed only after symptoms appear. If lung cancer could be diagnosed before symptoms appear, the cure rate should be much higher.
The article in the NEJM shows there is reason for hope. A study conducted at 33 cancer centers nationwide, including Winship, enrolled more than 53,000 people at high risk of developing lung cancer between August, 2002 and April, 2004. They were randomly assigned to receive either low-dose CT scanning or a chest X-ray as a means to detect lung cancer. Data were collected on the participants through 2009. The findings were significant. Deaths from lung cancer were reduced by 20 percent in the group who underwent the low-dose CT scans.
If we could reduce lung cancer mortality in the U.S. by 20 percent, we’d be saving 30,000 lives a year.
Even so, the findings published in NEJM may not result in an immediate change in CT scan screening guidelines for lung cancer. Screening guidelines of any kind require additional study and evaluation. Further analyses of this trial will also be required.
We have made tremendous strides in the treatment of lung cancer, but we also know that the real breakthroughs will happen when we are able to prevent its development or establish the earliest possible diagnosis. The dialogue on how best to implement low-dose CT scan screening for lung cancer should begin now.
Walter J. Curran Jr., MD
Executive Director, Winship Cancer Institute of Emory University
Associate Vice President, Cancer, Woodruff Health Sciences Center
Chair of Radiation Oncology