Oncologists and radiologists across the country have high -- albeit, in some cases, tempered -- hopes that low-dose spiral computed tomography will be an effective tool in identifying cancerous tumors and nodules. When found early and surgically removed, lung cancer has up to a 90 percent cure rate.
The spiral CT is a rapid, non-invasive test that uses low doses of radiation -- as much as 30 to 50 percent less than regular CT -- to provide three-dimensional images of the lungs in a matter of seconds. The scan, which is not covered by insurance, typically costs $300 and up. Patients interested in getting the test must have a referral from their primary care physician.
"Certain patients, especially current and former smokers, would benefit from this," said Dr. Philip Linden, chief of the division of thoracic surgery at UH and associate professor of surgery at Case Western Reserve University School of Medicine.
Linden, who oversees UH's thoracic oncology program, performs biopsies -- a procedure that removes a piece of tissue from a tumor or nodule, found by CT, for further examination -- and diagnoses and treats lung cancer.
Because the American College of Chest Physicians, the American Cancer Society and other major medical groups have never issued guidelines for lung-cancer screening, and because insurance does not cover CT for that use, it has not been standard practice for primary physicians to refer their at-risk patients for a CT scan.
But that might change.
For five years, the National Cancer Institute's National Lung Screening Trial followed more than 53,000 current and former heavy smokers between the ages of 55 and 74 who smoked at least a pack a day for 30 years or more. They were given either a spiral CT or a chest X-ray once a year for three years starting in August 2002.
The NCI announced the preliminary results in November 2010: That spiral CT scans caught malignant tumors and nodules earlier, reducing the risk of dying from lung cancer by 20 percent in middle age and elderly smokers.
The medical community is eagerly awaiting more trial details, which are expected to be reported later this summer in a major medical journal.
"When we initially heard about the study, it was very hush-hush," said Dr. Robert "Chip" Gilkeson, director of cardiothoracic imaging at UH and professor of radiology at CWRU School of Medicine. "We said, 'We're not sure this is going to work.' "
Once the first bit of NLST data were released, UH started to develop a screening program.
"With the amount of detail [in a spiral CT], we can see these small lung cancers and lung nodules with much more confidence and detail," Gilkeson said.
Using electronic medical records, UH will identify potential candidates (estimated to be less than 5 percent of the general population), and also will count on primary care physicians to refer patients appropriately. People who receive the spiral CT scan also will receive smoking cessation information.
After six months UH will assess its lung cancer screening program to gauge its effectiveness.
For years the Dana-Farber Cancer Institute in Boston had offered spiral CT for lung cancer screening to patients referred by their physician. In January, Dana-Farber made it more readily available to people who met the same criteria set forth by the national study.
"We haven't gone out there to try to aggressively market this," said Dr. Bruce Johnson, Dana-Farber's director of thoracic oncology. One reason is because it is unclear if insurance will reimburse for the test in the future. Another reason: "The [study data] is not published," he said.
The initial release of the NLST data does not have everyone rolling out a lung-cancer
The Hospital of the University of Pennsylvania, one of 30 NLST sites, is waiting to see more study results before it implements a program.
"Until that's completed, we can't really know if this will be viable as a screening test," said Dr. Drew Torigian, assistant professor of radiology at Penn. "We're getting things in place and we may offer it for the same groups of patients [as the study]."
The Cleveland Clinic is holding off on developing a screening program as well.
More questions, such as cost-effectiveness, the number of study participants in whom cancerous lung nodules were found, and even the optimal age at which to start and stop screening, first need to be answered, said Clinic pulmonologist Dr. Peter Mazzone.
The chance of a CT scan picking up a small spot on the lung increases as a person ages, he said. "Ninety-nine percent of [the spots] are only scars."
That increases the possibility of a patient undergoing unnecessary tests, he said, only to find out that a spot is not dangerous.
Even with the drawbacks, the idea that there is an effective screening test that might decrease a person's risk for developing late-stage lung cancer is significant.
"This is some of the most exciting news we've had in ages," Mazzone said.