The Scan Smokers Must Get with Dr. William Tester, Medical Oncology Director, Einstein Cancer Center
There are two things that smokers can do to reduce their chances of dying from lung cancer. First, and most importantly: quit smoking. Second, get a CT scan of their lungs. A study conducted by the National Cancer of Health and published in the New England Journal of Medicine shows that CT scans can reveal what chest X-rays cannot: early-stage lung tumors. The National Lung Cancer Screening Trial monitored 53,454 smokers from 33 medical centers across the United States. Dr. William Tester, director of the Einstein Cancer Center, explains what this means for people at high risk of developing lung cancer.
Who is considered high risk?
“They are defined as ‘30-pack smokers,’ which means that you smoked one pack a day for 30 years or two packs a day for 15 years,” Tester says. “Those are the people at most risk for developing lung cancer. Exposure to asbestos and radon also put people at risk, but to a lesser extent than smoking. A family history of lung cancer does not put people at risk – unless they also smoke. In those cases, the smoking is more significant than the family history. If there is a genetic link to lung cancer, we haven’t found it yet.”
What does the new study reveal about screening for lung cancer?
“The National Lung Cancer Screening Trial enrolled heavy smokers who were at high risk for developing lung cancer,” Tester explains. “All of them had screening – either a chest X-ray or a CT scan. We already knew that chest X-rays have little value, but we didn’t know if CT scans would be more effective. This study shows that they are. This is a milestone in screening for lung cancer. We can now detect tumors when they are 1 centimeter. The earlier we find the tumor, the faster and better we can treat it.”
But lung cancer is incurable, so ...
“That’s not true,” Tester says. “In fact, that is one of the biggest and most dangerous myths about lung cancer because some smokers think, ‘Well, I probably already have lung cancer and there’s nothing medicine can do for me so I might as well keep on smoking.’ But here’s the truth. Patients with Stage I lung cancer have better than a 60 percent survival rate. That’s why it is critical for us to find those tumors early.”
What are the treatments and survival rates of different stages?
Patients with Stage I and II undergo surgery, Tester explains. If lung cancer is Stage III, treatment depends on the patient’s health and history and the tumor’s characteristics. Sometimes the treatment is surgery, then chemotherapy. In other cases, oncologists recommend chemotherapy and radiation without surgery. “Stage III lung cancer we treat with the curative intent and there is still a 20-30 percent survival rate,” Tester says. “If the cancer is Stage IV, it is incurable. We usually use chemotherapy to slow its progress and alleviate symptoms.”
What is the new screening recommendation for “30 pack” smokers?
“They should get an annual spiral CT scan,” Tester says. “It is very important that smokers get this message, because this is the only effective way we have to find those small tumors.”
In fact, Tester says that this screening for lung cancer beats the effectiveness of mammograms in finding breast cancer. “For women older than 50, we’d need to do 1,000 mammograms to prevent one death from breast cancer,” Tester says. “But for high risk smokers we need to do 350 CT scans to prevent one death from lung cancer. Of course, our goal is to prevent every death from every kind of cancer. So the message is: get screened.”