Dr. C. Joseph Bennett, Navigating Cancer, 03/05/13

For years, I have written often about the importance of cancer screening. I have mentioned the fact that through aggressive screening programs, early detection, and better treatments, the number of cancer survivors in this country continues to grow.

We often speak about screening for colon, breast, prostate, cervical and skin cancer, because these screening programs work. But you really never hear about screening for lung cancer, and there are many reasons you do not.

However, the lack of discussion regarding this topic may be coming to an end. Adoption of low-dose computed tomography (LDCT) screening regimens (CAT scans as most of you know this test by), as outlined in the National Lung Screening Trial (NLST), could potentially prevent more than 12,000 lung cancer deaths in the United States each year. This data was recently published online in Cancer.

Researchers from the American Cancer Society estimated the annual number of lung cancer deaths that could be averted by LDCT screening, assuming implementation of the screening regimens adopted in the NLST.

Estimates were based on the screening effect, the U.S. population size, screening eligibility, and the lung-cancer death rate among the population eligible for screening. Note that one important aspect, the cost of the screening, is not mentioned, and I will discuss that later.

The researchers found that, in 2010, some 8.6 million Americans — 5.2 million men and 3.4 million women — were eligible for lung cancer screening. Full implementation of the screening regimen adopted in the NLST would potentially avert 12,250 lung cancer deaths each year, 8,990 in men and 3,260 in women.

But the process to avert these 12,250 deaths from lung cancer would require that 8.6 million CT scans be performed on a regular basis. So, as a basic matter of financial restraints, many question if the cost of screening is worth the savings in lives.

During the past few years, we have heard calls for the discontinuation of screening for breast cancer and prostate cancer due to the fact it costs a lot, and the question of the cost versus the benefit.

Trust me, the cost of mammograms and the PSA blood test is much less that a CT scan, so the economic impact of a screening program for lung cancer will be difficult for our health care system to swallow.

So, while we can estimate that approximately 12,000 lung cancer deaths could potentially be prevented per year through the full implementation of LDCT screening among eligible heavy smokers in the United States, based on our current knowledge of screening, further studies are needed to estimate the number of preventable lung cancer deaths and the cost-effectiveness of LDCT screening under different scenarios of risk, various screening frequencies, and other various screening factors. Some really tough questions will have to be asked and answered.

Dr. C. Joseph Bennett is a board-certified radiation oncologist and a member of the Citrus County Unit of the American Cancer Society. Watch “Navigating Cancer” on WYKE TV at 7:30 p.m. Tuesdays and at 10 a.m. Thursdays. If you have any suggestions for topics, or have any questions, contact him at 522 N. Lecanto Highway, Lecanto, FL 34461, or email cjbennett@rboi.com.