By James Mulshine, MD

Question:
I have heard that computed tomography (CT) scans are a good way to find lung cancer early. I was a smoker for many years and was wondering if I should get one just to be sure?

Answer:
Since former smokers remain at greater risk for developing lung cancer compared to nonsmokers‚ it is prudent to consider the best way to monitor for the potential development of a lung cancer. Research teams from New York and Tokyo have impressive results using spiral CT scans to detect early lung cancer (these are not the electron beam scans commonly advertised on the radio or in newspapers). Even though spiral CT scanning is widely available‚ its use as a screening tool for lung cancer is still in clinical trials. Large screening trials are being developed in many nations to fully evaluate these important findings. Until the results of such studies are available over the next 10 years‚ it is not possible to determine the exact benefit of this new detection tool.

Having said that‚ spiral CT is considered by many to be the most promising test ever for lung cancer‚ so there is significant enthusiasm about its prospects.
Nevertheless‚ vast experience with screening for other cancers has taught us much about the complexities of cancer screening. Screening can result in false positives‚ resulting in additional testing‚ or false negatives‚ resulting in false assurances and potential delays in needed care.

Since lung cancer is a disease with an unsatisfactory outcome using current diagnostic approaches (15% of patients have a five-year survival rate)‚ an individual at high risk for lung cancer interested in newer approaches for lung cancer detection should find a center with a commitment to integrated management of early lung cancer detected by screening tests. Such a center should be anchored by relationships with an array of other lung cancer specialists who know and understand the challenges of lung cancer screening. Such a team would include radiologists‚ pulmonologists‚ and thoracic surgeons. Additional expertise‚ including radiation oncology‚ medical oncology‚ and surgical oncology may be required to deliver optimal care.

It is clear that spiral CT in the hands of skilled professionals can find considerably smaller cancers. Only time will tell whether this enhanced capability will result in reducing the mortality burden of lung cancer. Over the next decade‚ people at risk for lung cancers should discuss these issues with their personal physicians and make their own decisions in this promising but uncharted area.

Definitions:

pulmonologist: a physician who specializes in diseases of the lungs.

spiral CT scan: a detailed picture of areas inside the body. The pictures are created by a computer linked to an x-ray machine, which scans the body in a spiral path. It is also called helical computed tomography.

To learn more about spiral CT scaning and to see if it is right for you, visit
the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE): www.alcase.org or call 800-298-2436.