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Changes to Lung Cancer Screening Guidelines

Posted Date: 12/31/2013
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Lung cancer is the leading cause of cancer deaths in this country—more deadly than ovarian, prostate, colon and breast cancers combined. The guidelines on who should consider screening are changing, with the US Preventive Services Task Force citing these changes in its published recommendations in the Annals of Internal Medicine. The task force now saying CT scans of the lungs should only be offered to those considered to be high risk, those who have smoked a pack per day for 30+ years or an comparable amount (2 packs per day for 15 years), and who are between the ages of 55 and 80.

There are studies that suggest that lung cancer screenings may find cancers earlier, when it may be treated more successfully, and thus save lives. But other studies suggest that the benefits of screenings may be outweighed by the number of benign conditions they reveal, which may then lead to invasive testing and exposure to unnecessary risks and stress for the patient.

If your doctor suspects you might have lung cancer, he or she will likely use imaging tests such as X-rays or CT scans, sputum cytology or a biopsy to make a definitive determination. This is where one of the major advancements in our approach to the disease comes into play: molecular diagnosis of lung cancer.

Dr. Thomas Forlenza 

 “We’ve been making good progress in the molecular diagnosis of lung cancer,” says Dr. Thomas Forlenza, Director of Oncology at Richmond University Medical Center. “That translates into better treatment options and more targeted treatments. People are living longer and better lives.”

Before molecular diagnostics, clinicians categorized cancer cells according to their pathology—basically, their appearance under a microscope. With molecular diagnostics, cancers can be categorized using technology such as mass spectrometry and gene chips. These allow clinicians to find mutations in the tumor’s DNA makeup, or look at levels of specific proteins it contains, and then determine how those genes and proteins are interacting in a cell. Oncologists believe that in time, all cancers will be diagnosed with these types of techniques.

This level of understanding of a tumor has tremendous implications for treatment, says Dr. Forlenza. Some lung cancer treatments can be designed to target the characteristics of the specific tumor, and these “targeted therapies” improve the outlook for many patients.

Smoking cessation

The main cause of lung cancer is smoking, which is responsible for the vast majority of cases, although the disease does occur in people who never smoked nor had exposure to secondhand smoke. Radon, occupational exposure to carcinogens and air pollution can also be causes, and some cases of lung cancer are never traced to any cause.

But smoking remains the major issue, and new research demonstrates how deadly it is. An Australian study, which followed 200,000 people for four years, showed that the risk of premature death from smoking is even higher than previously thought. Doctors had thought that smoking was responsible for half of all smokers’ deaths; the study suggested that as many as two-thirds of deaths in current smokers can be attributed to tobacco.

“Smoking still has not been effectively addressed,” Dr. Forlenza says. “We need more smoking cessation programs.” Staten Island, which has one of the highest smoking rates in the New York area, offers one called ASSIST, the Anti-Smoking Staten Island Support Team. If you smoke, or know someone who does, know that such cessation programs, as well as counseling, medications and nicotine replacement products have all helped people quit successfully.