If you’re over 55 and are a current or former smoker, an influential medical group says you need an annual lung-cancer screening.
An influential advisory panel on Monday recommended that current and former heavy smokers get annual CT scans to check for signs of lung cancer before symptoms emerge, a screening method that the panel said would cut down on unnecessary deaths.
The U.S. Preventive Services Task Force’s recommendation for lung-cancer screening — the first time the panel has endorsed screening for the deadliest form of cancer — targets current and former smokers ages 55 to 79 who smoked the equivalent of one pack per day for 30 years.
The task force believes the screenings would cut down on thousands of lung-cancer deaths each year through early detection and treatment. The panel concluded that the benefits of screening aging current and former smokers outweigh potential harms such as low doses of radiation exposure, unnecessary biopsies or angst from “false positive” results.
The task force assigned a “B” grade to the endorsement, which means the screening will be covered by insurance companies. The Affordable Care Act requires Medicare and private health insurers to cover preventive tests that get the task force’s “A” or ‘B” grades.
The recommendation comes after a large, government-backed study called the National Lung Screening Trial found in November 2010 that low-dose computed-tomography (CT) scans reduced lung-cancer deaths by 20 percent because they detected tumors earlier than chest X-ray screenings.
The favorable results from the national study prompted Arizona hospitals and imaging centers to begin offering low-dose CT scans to current and former heavy smokers over the past two years.
But some clinics said that such screening has been slow to catch on in metro Phoenix, in part because people have had to pay up to $199 out of pocket as insurers have refused to cover these tests. The costs can be higher if additional tests are required.
Medical experts also worry that detecting lung cancer in Arizona could be more challenging because of the prevalence of valley fever, a flulike disease caused by inhaling a fungus found in the soil in Southwestern states. The National Lung Screening Trial did not enroll patients from states where valley fever is found, doctors said.
“There is no question this saves lives,” said Dr. Donald Schomer, chairman of radiology at Banner MD Anderson Cancer Center in Gilbert. “The downside is there’s a very high falsepositive rate. We know our (Arizona) false-positive rates will be even higher” because of fungal spores common here that are detected via sensitive CT scans of peoples’ lungs.
The American Cancer Society estimates that 4,250 Arizona residents will be diagnosed with lung cancer and 2,850 will die of the disease in 2013. More Arizonans are expected to die of lung cancer this year than colon, breast and pancreatic cancer combined.
Nationwide, lung cancer will claim nearly 160,000 lives. Nearly 90 percent of people diagnosed with lung cancer will die of the disease.
The task force said the biggest risk factors are age and smoking, which causes 85 percent of lung cancers. The disease is often diagnosed too late, and the most common screening method, chest X-rays, have been ineffective at detecting lung cancer at its earliest stages.
Dr. Claudia Henschke, a former Arizona State University adjunct faculty member who has long advocated the use of low-dose CT scans to screen for lung cancer, said the task force’s recommendation “is going to save more lives than anything else in the foreseeable future.”
Henschke, a professor of radiology at Mount Sinai Medical Center, published in 2006 a study partly financed by a tobacco company that claimed as many as 80 percent of lung-cancer deaths could be prevented through the use of CT screening.
She said she believes screening of high-risk groups should begin even earlier. She is working with the Phoenix Veterans Affairs system on a study involving smoking cessation and CT screening among veterans beginning at age 50.
Metro Phoenix doctors are hopeful that regular CT screening of high-risk patients will detect more cancers earlier and allow doctors to surgically remove tumors.
“Lung cancer is a silent killer,” said Dr. Elbert Kuo, director of the lung-cancer screening program at St. Joseph’s Hospital and Medical Center in Phoenix. “It has an extremely high mortality rate. By the time you cough up blood or have trouble breathing, you are probably going to die.”
With the task force’s new guidelines, primary-care doctors are more likely to recommend such screening to high-risk patients. And if Medicare and private insurers cover the full cost of screenings without requiring co-payments or deductibles, doctors expect more people will get screened.
“If you look at the barriers right now, cost remains the major barrier,” Kuo said.
St. Joseph’s launched its lung-cancer screening program using low-dose CT scans nearly two years ago. The hospital charges $199 for screening, which includes consultation with a doctor, a lowdose CT scan of the chest and a review by a team of medical experts.
Kuo said among the nearly 200 people his program has screened via lowdose CT scans, about half of those scans have revealed spots, or nodules, that require a closer look. Just two patients have been diagnosed with lung cancer, but the scans have revealed other harmful health conditions such as breast cancer, lymphoma and an aortic aneurysm.
Kuo said valley fever has been a common reason for such spots to show up during the scans. Because of the high rate of nodules found during the scans, Kuo said, his program has adopted a conservative approach before conducting biopsies.
Schomer, of Banner MD Anderson, said he expects that many patients who are screened in metro Phoenix will require more sensitive diagnostic tests to rule out valley fever. Those follow-up tests may include a minimally invasive biopsy or a positron emission tomography (PET) scan that can determine whether a nodule is potentially cancerous.
“We are getting better and better at categorizing whether (tissue) is benign or malignant,” Schomer said. “But we’re still not perfect.”
Patients who have had multiple rounds of testing know the emotional toll it can take.
Jennifer Rico, 50, of Gilbert, went to her doctor when she experienced coughing and chest tightness while competing in tae kwon do. Her doctors initially thought she had valley fever, but a round of testing via a CT scan revealed she had Stage 4 lung cancer.
“It was totally out of the blue,” said Rico, who was in peak physical condition at the time of her diagnosis and has never smoked.
Despite undergoing chemotherapy treatment, Rico has maintained her strength and energy. She continues her job as an engineer at Intel, and she still trains in tae kwon do.
Although she was not considered at a high risk for lung cancer, she favors more widespread screening among groups that are high-risk.
“If it will catch more cancers early, it is a great idea,” Rico said. “I’m not considered high-risk, but they caught it. I am very, very fortunate.”