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U.S. panel urges CT scans for heavy smokers

January 02, 2014

People at high risk for lung cancer, including current and former smokers, should receive yearly screenings, according to a new report from the U.S. Preventive Services Task Force.


The yearly screening for healthy adults between the ages of 55-80 at high risk for lung cancer, was documented in the latest issue of the Annals of Internal Medicine published on Monday.


Dr. Wilson Mertens, vice president and medical director of Cancer Services at Baystate Medical Center, offers his thoughts on the new task force recommendations.


Q. What do you think of the new screening guidelines?

A. Mortality is reduced by 20%, so if properly performed, lives can be saved. However, a scan alone, or any screening tool, never saved a life by itself. It requires careful assessment of results and patient management that replicates the pivotal study that demonstrated CT screening benefits, including appropriate patient selection and careful management of results. This is not something just anyone should have, and it is not something just any doctor or hospital should offer. And it is no substitute to the discontinuation of tobacco use.

Also, keep in mind that about 96% of scans with an abnormality ultimately did not reveal cancer in the study. Many of these patients could be subjected to invasive tests, so the expertise of the physicians and institutions managing this, and their rigorous adherence to guidelines and standards of follow up, will be key to enhance benefits and reduce risks, which could be substantial.


Q. Are these guidelines long overdue?

A.  Not really. We had to wait until we had compelling data. Never assume that a screening test has no harm associated with it. Past lung cancer screening efforts, with less sophisticated imaging, tended to increase mortality. The United States Preventive Services Task Force (USPSTF) gave this a grade of “B,” so while benefits outweigh risks, it is moderately effective.


Q. How will these new guidelines help patients?

A.  The USPSTF indicated that the scans should be offered only to people at especially high risk: those who smoked a pack of cigarettes a day for 30 years or an equivalent amount, such as two packs a day for 15 years – and who are between the ages of 55 and 80.


Q. Who will it help the most?

A. People who are within 15 years of quitting tobacco use, or who are still smoking, and who fit the above findings.


Q. Why is lung cancer the deadliest?

A. Lung cancer often spreads to distant organs early in the course of treatment, limiting the number of patients eligible for cure by surgery or stereotactic body radiotherapy. And, tobacco-associated lung and heart disease limits the number of patients who would be candidates for or tolerate a lung operation.


“It is imperative that there be a multidisciplinary team behind any screening program that evaluates and deals with the findings based on the evidence and guidelines.  The reason lung cancer is so deadly is that it is diagnosed in late stage 85% of the time. Therefore, the treatment we have to offer is not effective for a cure.  If we can diagnose these cancers earlier, as screenings should do, we will have a better chance of treating our patients for a cure,” added Dr. Gary Hochheiser, chief, Division of Thoracic Surgery at Baystate Medical Center.


Baystate is the only area facility offering board-certified minimally-invasive thoracic surgeons and stereotactic body radiotherapy – both of which are key to treating small cancers for cure. Molecular analysis of all eligible lung cancers for more targeted therapy is routine at Baystate Health.