By: Jenny Park, PharmD Candidate c/o 2015
Lung cancer takes away the lives of about 160,000 individuals annually, which is more than a quarter of all cancer deaths.1 The U.S Preventive Service Task Force is now recommending lung cancer screenings for heavy smokers which could save up to 20,000 lives a year (or about 13% of total deaths).2 It is recommended that heavy smokers get a low dose CT scan once a year. However, the scans are expensive and cost over $300 per scan. This creates a dilemma in which many are left wondering if these diagnostic and preventative procedures are worth the extra cost burden on the US health care system.
According to the NIH-funded National Lung Screening Trial (NLST), lung CT scans were more effective in lowering mortality related to lung cancer than chest X-rays. The NLST included more than 50,000 former smokers and current smokers ages 55-74 who smoked a pack a day for thirty years. Individuals were randomized and given a scan between a low-dose spiral CT scan and a chest X-ray. They received annual scans for three years and then monitored for an additional five years.3 This study showed a 20% greater reduction in deaths with CT screenings compared to X-ray screenings.Adenocarcinomas and squamous cell carcinomas were detected early in both trial arms; however, these cancers were detected more frequently by the low dose CT scan.4
This trial did include some drawbacks such as false positives for CT scans in which 39% of smokers tested positive, and 95% of the these turned out to actually be false positives. For X-ray screening, it has been calculated that screening 287,000 high-risk individuals can prevent 521 deaths, but there will be an additional 24 deaths due to radiation exposure.5 Radiation exposure associated with a low dose CT is much lower than a regular CT scan. However, the long term effects of exposure to radiation from low dose CT scans cannot be measured and have not been studied yet. Despite some of these drawbacks, the US Preventive Service Task Force is the fifth organization to recommend lung cancer screenings.
The Task Force grades lung cancer with a “B.” A level B indicates that screening is recommended and that the net benefit from screening is moderate. Lung cancer is on the same level as breast cancer for women between the ages 50-74.6 For every 320 people screened for lung cancer, one life is saved. It takes about 900-1900 mammograms to save one life from breast cancer. Going further, it takes 500 colonoscopies to save one person’s life from colon cancer. Compared to the latter two, lung cancer screening is more effective.
The task force will take about another six months to come to a final conclusion, but according to the lines of the chairman, “a small proportion of a big number is still a big number. And 20,000 lives is a lot of people.”6 Although insurance will not pay for lung cancer screenings, once the Task Force’s final recommendation is issued, this will change the standard of care and costs for patients. Medicare patients will be reimbursed and other insurances will cover these procedures. Under President Obama’s Affordable Care Act, those eligible will receive the scan without a co-pay.
Despite these pending changes, screening is not a substitute for smoking cessation. The most effective way to prevent lung cancer is to stop smoking and avoid any form of tobacco. Tobacco also increases the risk for several other cancers which equates to about 443,000 tobacco related deaths per year.7 Director Dr. Harold Varmus of the National Cancer Institute states that “screening should not give smokers a false sense of security. The main message is still clear.”1 However, that still does not discount the benefits of screening. Even though prevention may remain the most effective method to save lives from lung cancer, screenings pave the road for early detection and carries great potential to continue to save numerous lives.
- Tavernise S. Task force urges scans for smokers at high risk. New York Times. http://www.nytimes.com/2013/07/30/health/task-force-recommends-screening-for-heavy-smokers.html?ref=health&_r=1&. Accessed September 21, 2013.
- Vox F. The huge but essential cost of lung scans. Bloomberg View website. http://www.bloomberg.com/news/2013-08-19/the-huge-but-essential-cost-of-lung-scans.html. Accessed September 21, 2013.
- Lung CT scan for cancer: should you be screened? Mayo Clinic Web site. http://www.mayoclinic.com/health/lung-ct-scan/CA00086. Accessed September 21, 2013.
- NIH-funded study shows 20 percent reduction in lung cancer mortality with low-dose CT compared to chest X-ray. National Cancer Institute Web Site. http://www.cancer.gov/newscenter/newsfromnci/2011/NLSTprimaryNEJM. Accessed September 21, 2013.
- Lung cancer screening with CT scans recommended for heavy smokers. Boston website. http://www.boston.com/lifestyle/health/blogs/daily-dose/2013/07/29/lung-cancer-screening-with-scans-recommended-for-heavy smokers/RH8O8lHzp5zqf0onnfJMqJ/blog.html. Accessed September 21, 2013.
- Knox R. Panel urges lung cancer screenings for millions of Americans. NPR Web Site. http://www.npr.org/blogs/health/2013/08/22/206693913/panel-urges-lung-cancer-screening-for-millions-of-americans. Accessed September 21, 2013.
- Simon S. New lung cancer screening guidelines for heavy smokers. American Cancer Society Web Site. http://www.cancer.org/cancer/news/new-lung-cancer-screening-guidelines-for-heavy-smokers. Accessed September 21, 2013.