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Panelists Agree Strategy Must Include Low Dose CT Screening for Those Most at Risk for Lung Cancer
Tuesday, May 17, 2011 [Washington, DC] — A united call for a comprehensive plan to address lung cancer by leading public health and medical experts was the result of a national forum entitled, “Out of the Shadows: Lung Cancer and Screening”, co-hosted by Lung Cancer Alliance (LCA) and Legacy® on May 9th, at the Kaiser Family Foundation in Washington, DC with support from leading national organizations committed to veteran’s health, women’s health and minority and immigrant health. The panel was moderated by Susan Dentzer, Editor-in-Chief of Health Affairs and on air analyst on health issues for the PBS News Hour, who lost her own sister to lung cancer.
Panelists included Cheryl Healton, Dr. PH, President & CEO of Legacy®; Christopher Lathan, MD, MS, MPH, Medical Oncologist & Faculty Director, Cancer Care Equity, Dana-Farber Cancer Institute; Claudia Henschke, PhD, MD Professor of Radiology, Mount Sinai Medical Center; Barbara Camping, MD, F.R. C.P.C., Professor of Medical Oncology, Thomas Jefferson University and Hospitals, James Mulshine, MD, Vice President & Associate Provost for Research, Rush University Medical Center; and, Dan Miller, MD, Professor, Surgical Director-Thoracic Oncology Program, Emory University Hospital.
“It was an extraordinary discussion on many levels,” noted Laurie Fenton Ambrose, LCA President & CEO who opened the program. “Our panel represented the best in public health and tobacco control, oncology, radiology and thoracic surgery. Their discussion helped the listening audience understand lung cancer’s impact on various communities, the gaps and challenges in public health strategies and opportunities to cure this deadly disease – now.”
Fenton-Ambrose also noted that federal legislation authorizing a coordinated and comprehensive plan to address all aspects of lung cancer, The Lung Cancer Mortality Reduction Act, had been reintroduced last month with bipartisan support in both the House of Representatives and United States Senate.
Last November, the National Cancer Institute (NCI) ended a 53,000 person trial which demonstrated that smokers and former smokers over age 55 screened for lung cancer with CT scans had 20% fewer lung cancer deaths than those screened with chest x-rays. By contrast, mammography screening reduces overall breast cancer deaths by 15%.
“The NCI’s finding is one of the most important public health events in my lifetime,” said Dr. Healton. She emphasized, “This is not a minor shift at the margins of public health. This is a transformational event that provides an opportunity to save thousands of lives almost immediately.”
The NCI’s results confirm research initiated by Dr. Henschke and the International Early Lung Cancer Action Program (I-ELCAP) in 1993. Using a more detailed protocol which incorporates imaging advances and research findings as they occur, the I-ELCAP consortium has found early diagnosis of lung cancer among high risk using low-dose CT scanning followed by early treatment options would have even significantly higher mortality benefit.
Dr. Henschke also incorporates smoking cessation help for current smokers in her ongoing CT screening research programs which now includes other lung diseases in addition to lung cancer and biomarkers in former, never and current smokers.
“Treatment and cure of lung cancer should be considered part of the continuum of care that all victims of tobacco products deserve,” stated Dr. Lathan.
Dr. Mulshine, pointed out that CT screening for lung cancer provides a “teachable moment” for the entire public health system. “CT imaging of the chest has also been shown to provide a significant tool for evaluating the risk of dying of coronary artery disease,” he said.
Dr. Mulshine continued: “This type of calcium scoring risk analysis has also been reported using CT images acquired for lung cancer screening. So despite the daunting implementation challenges, spiral CT gives a broad window into the early stages of all three major tobacco-related diseases with the third disease being COPD. Thus the integration of spiral CT into preventive strategies from smoking cessation through personalize molecular therapies provides an unprecedented opportunity to improve outcomes in smoking-exposed populations. And there is emerging data to suggest that the public health benefit of lung cancer screening could be delivered in a surprisingly affordable fashion”
Dr. Miller noted the advent of surgical innovations, such as Video Assisted Thoracic Surgery (VATS), which have allowed for dramatic improvements in outcomes for patients undergoing surgery for lung cancer. “It is important that patients and their families are educated on the various surgical techniques that are available for the treatment of lung cancer, said Dr. Miller. If we can detect lung cancer earlier, especially when it can be removed with minimally invasive techniques such as VATS, we can dramatically improve the survival of patients with lung cancer, and also reduce the pain and recovery time after surgery, as well as the costs associated with the surgical treatment of lung cancer. This offers the best chance for cure”.
Dr. Barbara Campling, currently at Thomas Jefferson University and Hospitals, spoke of the higher incidence and mortality rates among veterans. She outlined recent strides in improved care delivery in the VA system and also expressed confidence in the VA system’s ability to devise high quality lung cancer screening programs for veterans at risk for the disease.
Given the potential of CT screening for reducing lung cancer mortality, panel members focused on issues that could maximize the public health benefit. As with any cancer screening service there are numerous, complex safety and related implementation issues.
Dr. Lathan also noted that there is an important social justice issue around the risk of uneven deployment, particularly among low income, minority and immigrant communities who are disproportionately impacted by all cancers, including lung cancer.
These issues are critical to define in preparation for the upcoming United States Preventative Service Task Force (USPSTF) review of the scientific evidence, since that review will ultimately determine whether screening will be covered by Medicare and public and private insurance.
In addition to the live audience, the event was webcast and viewed by over 1,800 people last week. The webcast is still available for viewing and can be accessed by going to LCA’s homepage at www.lungcanceralliance.org and click on “View Webcast.”
Lung Cancer Alliance is the only national organization focused solely on providing support and advocacy for those living with or at risk for lung cancer. Lung Cancer Alliance is committed to reversing decades of stigma and neglect by empowering patients, elevating awareness and changing health policy. Follow Lung Cancer Alliance on Facebook, www.facebook.com/lungcanceralliance.
Legacy® is dedicated to building a world where young people reject tobacco and anyone can quit. Located in Washington, D.C., the national public health organization helps American live longer, healthier lives. Legacy develops programs that address the health effects of tobacco use, especially among vulnerable populations disproportionately affected by the toll of tobacco, through grants, technical assistance and training, partnerships, youth activism, and counter-marketing and grassroots marketing campaigns. The foundation’s programs include truth®, a national youth smoking prevention campaign that has been cited as having contributed to significant declines in youth smoking; EX®, an innovative public health program designed to speak to smokers in their own language and change the way they approach quitting; and research initiatives exploring the causes, consequences and approaches to reducing tobacco use. The American Legacy Foundation was created as a result of the November 1998 Master Settlement Agreement (MSA) reached between attorneys general from 46 states, five U.S. territories and the tobacco industry.