Lung can­cer re­port of­fers a mix of good and bad news

Orlando Sentinel - - EXTRA HEALTH & FITNESS - By Amy Nor­ton

More Amer­i­cans are sur­viv­ing lung can­cer in re­cent years, but very few peo­ple at high risk are get­ting the rec­om­mended screen­ing.

Those are the high­lights from the lat­est “State of Lung Can­cer” re­port from the American Lung As­so­ci­a­tion (ALA), pub­lished in Novem­ber.

There are pos­i­tive trends, in­clud­ing the sur­vival num­bers: Com­pared with a decade ago, the five-year sur­vival rate among lung can­cer pa­tients was 26% higher in 2015. And fewer Amer­i­cans are being di­ag­nosed with the dis­ease. Over the same pe­riod, new lung can­cer cases de­clined by 19%.

Then there’s the bad news: Most Amer­i­cans with lung can­cer are still being di­ag­nosed at a later stage, when the odds of a cure are low. So even now, only about 22% of all lung can­cer pa­tients sur­vive for five years.

That’s de­spite the fact that screen­ing for lung can­cer is avail­able and rec­om­mended for cer­tain high-risk peo­ple: adults aged 55 to 80 who are cur­rently heavy smok­ers, or who quit within the past 15 years.

That guide­line was is­sued in 2013 by the U.S. Pre­ven­tive Ser­vices Task Force, a gov­ern­ment­funded panel of med­i­cal ex­perts. The American So­ci­ety of Clin­i­cal On­col­ogy

(ASCO) has sim­i­lar rec­om­men­da­tions.

Yet in 2018, the ALA re­port found, only 4% of el­i­gi­ble Amer­i­cans were screened for lung can­cer.

Why? In gen­eral, it takes time for new screen­ing rec­om­men­da­tions to make their way into prac­tice, ex­plained Dr. An­drea McKee, a med­i­cal ad­viser to the ALA.

But with lung can­cer screen­ing, McKee said, there are also some spe­cific ob­sta­cles. Us­ing CT scans for that pur­pose is “com­pletely new,” she noted, and the re­sources are not nec­es­sar­ily in place in a given lo­cal area.

Be­yond lo­gis­tics, though, many Amer­i­cans — in­clud­ing doc­tors — may not have all the facts on lung can­cer screen­ing.

“There’s a lot of mis­in­for­ma­tion out there, in the me­dia and even in the med­i­cal lit­er­a­ture that doc­tors read,” McKee said.

One is­sue re­lates to “false pos­i­tives” — where a screen­ing test in­cor­rectly sug­gests can­cer is present.

The odds of a false pos­i­tive with CT lung can­cer screen­ing are “quite low,” McKee said: “There’s about a 10% chance on the first exam, and then it goes down af­ter­ward be­cause the ra­di­ol­o­gist has that first (scan) to use for com­par­i­son.”

Yet some re­ports have stated that the false pos­i­tive rate is as high as 96%, McKee said. There have also been in­ac­cu­rate re­ports that CT screen­ing car­ries a sig­nif­i­cant risk of “over­diag­no­sis” — where a per­son is di­ag­nosed and treated for a can­cer that would not have been fa­tal. That’s an is­sue with a dis­ease like prostate can­cer, which is of­ten slow-grow­ing and may never cause harm.

“But lung can­cer is gen­er­ally a very ag­gres­sive dis­ease,” McKee said. Re­search sug­gests that the risk of over­diag­no­sis from screen­ing is 3%.

On the other hand, screen­ing could save many lives, McKee said. About 8 mil­lion Amer­i­cans qual­ify as high risk for lung can­cer, ac­cord­ing to the ALA. If even half were screened, the group estimates, more than 12,000 deaths from lung can­cer could be averted.

The fact that only 4% of el­i­gi­ble Amer­i­cans were screened in 2018 is “ter­ri­bly dis­ap­point­ing,” said Dr. Nathan Pen­nell, a lung can­cer ex­pert with ASCO. Pen­nell, who prac­tices at the Cleve­land Clinic in Ohio, was not in­volved in the re­port. He pointed to an ad­di­tional rea­son for the low screen­ing rate. “Peo­ple are afraid to be screened,” Pen­nell said, “be­cause they think lung can­cer is a death sen­tence.”

As of Jan­uary 2019, Med­i­caid pro­grams in 31 states cov­ered lung can­cer screen­ing, the ALA re­port found. Twelve states did not, and seven had no in­for­ma­tion avail­able.

JIM COLE/AP

The ALA estimates that more than 12,000 deaths from lung can­cer could be averted with ad­di­tional screen­ing.

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