New statistical model research published last week in the New England Journal of Medicine (NEJM) indicates that more lives could be saved if low-dose CT lung cancer screening was used more often for more types of patients. It also adds support to advocates for greater use — and payor coverage — for the test; advocates like the Lung Cancer Alliance (LCA).
Instead of merely screening 55- to 74-year-olds with 30-pack-year smoking histories, the research suggests that expanding that pool could be a good idea.
“Someone who is 50 years old and has had a 20-pack-year history, has a family history, or has occupational exposures is one example,” says Laurie Fenton Ambrose, president and CEO of the LCA. “They fall into a lung cancer risk category that would benefit from this kind of early detection.”
Soon after the NIH published National Lung Screening Trial (NLST) data in 2011, the LCA worked to develop a national framework for lung cancer screening and its continuum of care. The research in NEJM only adds fuel to this effort. “It was, and is incumbent upon us to make sure consumers have a right to know they could be at risk,” says Ambrose, who has headed the LCA for the past eight years.
Even in 2013, Ambrose laments that politics and prejudice tend to cloud what should be strictly clinical considerations based on solid data. “If this were breast cancer, brain cancer, or pancreatic cancer, this [new guidelines for low-dose CT] would not be delayed,” she says. “It goes back to a stigma that has long been held for the lung cancer community—and that is because you smoked, you deserve to die.”
Ambrose and other advocates believe low-dose CT is clearly “the only thing that has been scientifically validated to detect lung cancer at an early curable stage.”
However, the American Cancer Society (ACS) urged caution when it issued its low-dose CT lung cancer screening recommendations in January because it is unknown what the effects of cumulative radiation from having low-dose CT lung cancer screening every few years might be. The ACS also pointed out that follow-up tests may require even larger doses of radiation and, when an invasive test like a lung biopsy is called for, carry a small risk of serious complications and, in rare cases, death in people who may not even have had lung cancer in the first place.
Advocates for the test, like Ambrose, feel that this concern may be overly cautious because medicine has advanced at a rapid pace since the NLST research was done. “It’s confounding to us, because the evidence is so clear,” says Ambrose. “We have the technological progress since the NLST—which includes surgical advancements, the work-up of algorithms, and protocols to manage suspicious nodules.”
This week, a new study in the ACS journal Cancer itself partially backed up Ambrose’s contention, estimating that 12,000 lives could be saved simply using the more conservative NLST criteria for low-dose CT scanning, which are the same as the screening criteria recommended by the ACS. Click here for the abstract.