The Star Beacon; Ashtabula, Ohio

October 28, 2013

Early CT scans for smokers are discovering lung cancers

By BEN SUTHERLY
The Columbus Dispatch

COLUMBUS — Patients with lung cancer fare far better when the disease is found early, not after symptoms surface.

In the past 18 months, central Ohio’s hospitals have debuted screening programs for smokers meant to nip the most deadly of cancers in the bud. The unveiling of the programs comes after a broad national study that found that low-dose CT scans cut the rate of lung-cancer deaths by 20 percent compared with people who underwent chest X-rays.

Eligibility for the screenings - priced at $99 each by local hospitals, which recommend that participants get one a yea for three years - varies slightly depending on where you go.

Mount Carmel Health System and OhioHealth generally offer the screenings to smokers who are ages 55 to 74 who have smoked the equivalent of one pack of cigarettes a day for 30 years (also known as 30 “pack years”).

The hospitals also will screen smokers ages 50 to 74 who have smoked the equivalent of a pack a day for 20 years and have one other risk factor, such as a family history of cancer or exposure to industrial chemicals.

Ohio State University’s program is available to those ages 55 to 79 with a 30-pack-year history. The higher age cut-off is based on a risk model by the U.S. Preventive Task Force, said Dr. Patrick Nana-Sinkam, a pulmonologist who oversees the screening program at the Arthur G. James Cancer Hospital.

For all three programs, ex-smokers must have quit within the past 15 years to be eligible. Those who had quit 16 or more years earlier have not been adequately studied.

The screenings are a real advancement, said Dr. Otis Brawley, chief medical officer of the American Cancer Society.

But he said patients should consult with their doctors before deciding to undergo a screening. And they should know upfront that complications, while rare, can arise from both exposure to radiation during the screening process and from follow-up procedures that can be triggered by the detection of abnormalities, many of which are false positives.

“This screening does save lives ... but we also realize there’s a harm associated with the screening test,” Brawley said.

Nor should patients interpret a clear screening as a green light to continue smoking, he said.

Officials with the three local hospital-based lung-screening programs say smoking cessation is emphasized to participants who still smoke.

Mount Carmel’s lung-cancer nurse navigators, for example, are trained to be smoking-cessation coordinators, said Dr. Brian Hamburg, a pulmonologist who participates in Mount Carmel’s lung-cancer screening program, which started this summer and has screened 38 people as of Oct. 10.

“This is an opportunity to educate them about quitting smoking,” said Dr. Dale Levy, a thoracic surgeon and medical director of the lung-cancer advisory group at OhioHealth.

OhioHealth’s program, which began in July, had screened about 55 people as of Oct. 10.

Nana-Sinkam said about half of the more than 100 people screened so far through the James’ program still smoke. He said one person was found to have lung cancer, which was caught early enough to be surgically removed.

About 15 percent of lung cancers are diagnosed at the earliest possible stage, Nana-Sinkam said. The five-year survival rate drops significantly depending on when the cancer is caught, from as high as

70 percent in the earliest stage to the single digits in latter stages.

“The biggest problem with lung cancer is, about 80 percent of the time, it’s discovered when it’s too late to do anything,” Levy said.

This month, former smokers Brad and Deborah Smallwood of Grove City underwent their second CT screenings in a three-year series of annual screenings at Ohio State.

Nana-Sinkam sat down with them the same afternoon and shared the results: no cancer.

Brad Smallwood, 59, said he smoked about two packs a day for 40 years.

“I’ve had some friends die of lung cancer,” Mr. Smallwood said before his CT scan. “Why wouldn’t you do this? It’s preventive maintenance. Catch it before it gets bad.”

Hospital officials said health insurance rarely covers the screenings, but they expect that to change in light of recent research and recommendations.

Brawley said no screenings currently are offered for the

20 percent of people with lung cancer who never smoked. And computerization of low-dose CT scans might one day result in a lower rate of false positives. “We need to do better,” he said.

The James’ screening program has a research component focused on developing a blood-based test that would complement screenings for lung cancer. The test would help identify biomarkers and assays that indicate a patient is at highest risk for lung cancer, Nana-Sinkam said.

“It’s important to develop tests to better risk-stratify patients.”