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Is lung-cancer screening worthwhile?

 
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Free



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May 12, 2006

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PostPosted: August 10, 2006 8:34 PM    Post subject: Is lung-cancer screening worthwhile? Reply with quote

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Is lung-cancer screening worthwhile?

Lung-cancer screening using new technology can help you find out if you have lung cancer before it grows and spreads.

Quote:
ConsumerReportsMedicalGuide.org can help you find treatments for lung cancer that aim to get rid of the cancer or simply alleviate symptoms.
Subscribe to ConsumerReportsMedicalGuide.org today to get ratings of surgery, radiation therapy and chemotherapy for lung cancer. Find out which treatments are best for lung cancer and more than 100 other medical conditions.


A 55-year-old artist came to see me for evaluation of blood-count abnormalities that turned out to be merely the aftermath of a viral infection, so our conversation quickly turned to a more worrisome topic: the fact that she had smoked a pack of cigarettes a day for 30 years. She had quit five years earlier, and now she wanted to know whether she should be screened for lung cancer.

I walked her through the current incomplete state of our knowledge on this subject.

Lung cancer kills more Americans every year than breast, colon, cervix, and prostate cancers combined. The risk of developing the disease increases the longer and more heavily people smoke, especially if they’re still at it past age 50. Quitting helps a lot, but it takes five years after quitting for the risk to start dropping, and it doesn’t fall back to the level of never-smokers for at least 20 years, if ever. My patient was thus still at fairly high risk.

Survival statistics remain stubbornly dismal. Only about 16 percent of patients are still alive more than five years after their initial diagnosis because most don’t discover they have cancer until it has already spread to nearby lymph nodes or other organs. That’s too bad, because half of patients whose lung cancers are diagnosed before they spread survive at least five years, and those with the very smallest tumors may have even better survival rates.

But studies of screening with regular chest X-rays have found that they miss too many small tumors to reduce the overall lung-cancer death rate appreciably.

Detecting early lung cancer

Now there’s another lung-cancer screening option: a technology called spiral CT scanning, which produces a much sharper, more-detailed image of the lungs than a regular X-ray, with about the same radiation exposure as a mammogram.

More than a half-dozen studies around the world have shown that this test is better than a regular X-ray for spotting lung cancers when they’re small and localized enough to be removed surgically. In a February 2006 report in the Archives of Internal Medicine, researchers from a major long-term study of spiral CT screening, the International Early Lung Cancer Action Program (I-ELCAP), reported that thus far, 85 percent of cancers found by the screening had not metastasized to nearby lymph nodes or other tissues. As encouraging as this is, the I-ELCAP study isn’t a randomized controlled trial that could prove for certain that spiral CT screening saves lives in the long run. Just such a study, involving 50,000 people and conducted by the National Cancer Institute, is under way now and may eventually answer that question, but results are years away.

Moreover, the screening has a downside: finding too many abnormalities. Scars from noncancerous smoking damage or old infections can be difficult to distinguish from malignancies. In the I-ELCAP study, only about one-eighth of suspicious nodules turned out to be cancer. But all suspicious findings require follow-up with additional scans, often just months apart, or a lung biopsy, a procedure that itself carries some risk of lung collapse or infection—not to mention the attendant anxiety. Moreover, once you’ve made the decision to screen, the test must be repeated every year to be of any benefit.

Should you seek the test?

Based on research to date, we’re still not able to specify the type of smoking history that calls for screening. For now, the best advice is that if you ever smoked regularly, ask your doctor whether screening might be appropriate for you. If you decide to go ahead, try to get the screen as part of a clinical trial. That way, the doctor performing the screening will be experienced in interpreting and following up on the results.

The I-ELCAP study is still enrolling patients; a list of centers can be found at www.ielcap.org. Some of the centers offer free screenings while others charge up to $350 (most insurers won’t cover the initial testing, considering it’s still experimental, though they’ll likely cover any follow-up testing).

And of course, if you are still smoking, quit. Smoking is a direct cause of roughly 87 percent of lung cancers.

After some discussion and thought, my patient elected to have a spiral CT scan as part of the I-ELCAP study. It showed early signs of emphysema but no suspicious nodules. While the jury is still out on making lung-cancer screening a routine test for smokers and ex-smokers, my patient is happy to have had the test and will continue with yearly screening.


http://www.consumerreports.org/mg/free-highlights/manage-your-health/lung-cancer-screening-worthwhile.htm?AFFID=HNARSIC5

Do you guys thing lung cancer screening is worthwhile? Has anyone here had it done? Was it a precautionary thing? What kind of screening should we get? I am interested in seeing what damage I have done to myself and seeing if I can do anything to reverse it as much as possible. Or to at least catch any damage in time to do something about it. Discuss if you guys want...
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shevie



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PostPosted: August 10, 2006 9:38 PM    Post subject: Reply with quote

The biggest problem with any of the methods of lung screening (X-ray, CAT, PET, MRI) are the number of false positives. Scar tissue from smoking or pulmonary infections could show up as a possible cancer. The only real way for the doctor to know for sure is a biopsy.

I would think a screening test would be a good thing. Just don't get excited if it does come back positive. Your doc would have to give direction if that happened.

Shevie
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Free



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PostPosted: August 10, 2006 11:00 PM    Post subject: Reply with quote

See that is how I read the article as well. And I mean what are they going to do if something pops up? Biopsy a bunch of different areas of your lungs? ... because I would imagine that more than one 'spot' would show up.
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Barbara K.



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PostPosted: August 12, 2006 10:38 PM    Post subject: Reply with quote

Very Happy I do not think I would opt for the early screen test because of the unrealiably of it maybe falsly testing positive. At my age and health I have enough other medical issues to think about that are more pressing. It is an interesting article though, thanks for posting it.

Blessings,
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Free



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PostPosted: August 13, 2006 11:08 AM    Post subject: Reply with quote

But if things are caught early enough you have a better chance of survival. Does anyone think that makes it worthwhile?
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Deb



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PostPosted: August 23, 2006 8:28 AM    Post subject: Reply with quote

Free,

OMG, that's all I've been talking about with my Husband for the past several days. Ok, so we've quit but, what if we have a tumor or something going on in our lungs right now? Sounds like I'm pretty paranoid but I really can't help it. I've seen to much lung cancer lately that it scares the crap out of me.

The past several days, I've felt a tightening in my chest, a little cough, maybe I'm just imagining it or thinking ok I've quit, now I'm safe I will not get lung cancer or with my luck, I'll get it now that I've quit, brings me back to should I go get an xray or would my doctor think I'm a hypocondriac. I've even noticed my Husband (whom still smokes btw) coughing during the night and I keep telling hime maybe he ought to go get an xray too.

Am I just paranoid or what? The worst is (now my imagination is running wild I know) I think, if I was ever tested and found out it was positve, I'd probably run out and by a pack. Is this sick or what? Embarassed

I'm glad you brought this subject up because, it's been haunting me for a while now.

Deb
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Free



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PostPosted: August 23, 2006 11:23 AM    Post subject: Reply with quote

I am just so much more aware of my health now that I have quit. It is like I value it more now for some reason. I'd like to get checked out just so I can do whatever is needed to try and restore or maintain my health as much as possible. No matter the results ... no smoking ... that would just make it worse. But after reading the article I am wondering if it is even worth it. The testing doesn't look very accurate. It is confusing.
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Kissimee



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PostPosted: August 23, 2006 4:27 PM    Post subject: Reply with quote

Free...I don't believe in early screening...they say each day, your lungs heal ...every day so tomorrow will be a little better...

I think I will keep the vision that my lungs are healing and I won't have that problem...until it really shows up.

Just my two cents.

Tracy Smile
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kannprint



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PostPosted: August 26, 2006 8:21 PM    Post subject: Reply with quote

I totally agree with Tracy. Why borrow trouble?
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Simone



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PostPosted: August 27, 2006 10:52 AM    Post subject: Reply with quote

It's all a bit scary but I am going for X-Rays soon .
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Free



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PostPosted: August 27, 2006 11:12 AM    Post subject: Reply with quote

Keep us posted Simone. I'm interested in the process. I'm praying for the best for you.
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Simone



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PostPosted: August 28, 2006 3:12 AM    Post subject: Reply with quote

I wil Free may as well as my Mum (a non smoker ) has Emphysema & has had for years as Dad smoked like a chimmney until 15 years ago & btw his lungs *thank God* are fine so I worry a bit .Such a shame poor Mum with her heart disease has the emphysema as well Sad

But will let you know soon as I can get an appointment Rolling Eyes
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