SCREENING FOR LUNG CANCER

Marie Kaplan, BS RN

Should people who are asymptomatic be screened for lung cancer? How

about screening for asymptomatic smokers since 80% to 90% of lung cancer is

caused by smoking? According to The American Cancer Society, "Lung cancer

is the leading cause of death in both men and women. The 5 year survival rate

for all stages of lung cancer is 14%. If lung cancer is found early, before it's

spread to lymph nodes or other organs, the average survival rate is 48%.

However, only 15% of lung cancers are found at this early localized stage" I am

among the fortunate l5%.

Because of my recent lung cancer experience I am concerned about the

need for lung cancer screening. In March of 1995 I was asymptomatic when I

saw my doctor for a routine yearly physical. My lung X-ray showed cancer in my

right lung, and a subsequent CT scan showed cancer in my left lung. I was

initially diagnosed as having late stage metastatic cancer. After six months of

unsuccessful chemotherapy, I went to City of Hope National Medical Center in

Duarte for a second opinion and the diagnosis was changed to early stage

cancer. They decided the cancers in both lungs had started simultaneously.

Synchronous cancer in both lungs is unusual and many people do not realize it's

possible I had 2 surgeries and I'm still well.

Yearly X-rays

Both my family doctor and lung surgeon believe so strongly in lung

cancer

X-rays they themselves undergo them yearly. Why then, in spite of the frightening statistics, do so few doctors believe in regular lung cancer

screening? My lung surgeon pointed out that cancers in certain areas of the

lungs do not show up on X-ray, but this is just part of the story.

A review of the literature showed that in the 1970's The National

Cancer

Institute conducted 3 large U. S. long range randomized cancer screening

studies. A 4th study was done in Czechoslovakia. All the trials showed the

ability to diagnose lung cancer early, but MORTALITY REDUCTION WAS NOT FOUND IN ANY OF THE STUDIES. Therefore, at present, guidelines from groups such as The American Lung Society, The American Cancer Society, and

The American Thoracic Society do not advise routine lung cancer screening.

The 1990 journal CA gives figures from two American Cancer Society

surveys. They show only 40% of physicians indicated they ever screened asymptomatic high risk individuals for lung cancer. 96 to 98% of these same

physicians screen for breast, cervical, prostate, and rectal cancers. As a result the vast majority of lung cancer patients are symptomatic on

diagnosis which is too late for curative surgery.

Questioning assumptions

In March of 1997 CHEST magazine aplanpublished an article on the

research of Dana Farber Cancer Institute reanalysing and questioning the idea

that lung cancer screening is not indicated because no randomized trial showed

a reduction in mortality. Perhaps the wrong question is being asked and

mortality is not necessarily the most reliable measure of the effectiveness of lung

cancer screening. Dana Farber Cancer Institute says that if you screen you pick

up more early stage disease and people will live longer. They say, "Serious

reconsideration should be given to the question of whether periodic chest X-rays

should be recommended for individuals with high risk for lung cancer.

I feel that asymptomatic people, particularly smokers, should have

regular

screening for lung cancer. Mass screening may not be economically feasible,

but screening on an individual basis can be life saving."

Bibliography

990; 40:7Ginsberg, Robert J., Vokes, Everett E., Ralim, Adam, (1967), "Cancer

Principles and Practice of Oncology", 5th Editiion, Volume1, page 876, Lippincott-Raven

Murphy, Gerald P. MD, Lawrence, Walter Jr. MD, Lenhard, Raymond E. MD, (1995), "American Cancer Society Textbook of Clinical Oncology" 2nd Edition,

pages 190 and 220-234

Strauss, Gary M. MD, Gleason, Ray E. Ph'd, Sugarbaker, David M. FCCP, (March 1997), "Screening for Lung Cancer, Another Look A Different View",

CHEST, 111, pages 754-68.

Official Statement on Screening, American Thoracic Society/European Respiratory Society (March 1997), "Pretreatment Evaluation of Non-Small Cell

Lung Cancer", American Journal of Respiratory Critical Care Medecine

"Cancer Facts and Figures", 1997 Booklet from the American Cancer Society

American Cancer Society, "1989 Survey of Physicians' Attitudes and Practices in

Early Cancer Detection" CA Cancer J Clin 17-101`