The Turning Point: Lung Cancer

The controversy "to screen or not to screen" for lung cancer is over. The focus must now be on who to screen and how to screen most efficiently and effectively.

The National Cancer Institute (NCI) validated that low-dose CT screening can save lives of those at high risk for lung cancer. Under the new leadership of NCI Director Harold Varmus the results of the National Lung Screening Trial were made public this week. The results were profound -- low-dose CT screening can indeed reduce the number of lung cancer deaths in a high risk population -- by as much as 20 percent -- which translates to tens of thousands of lives saved per year.

For a community that receives few words of support or encouragement -- this is the turning point.

Lung cancer is the leading cause of cancer death in both men and women nationwide -- more than breast, prostate, colon, and pancreatic cancers combined. It is the leading cause of cancer death in every ethnic group. Our military is at even higher risk. After four decades of the "War on Cancer" lung cancer's five-year survival rate is still only 15 percent, research is still underfunded and patients are still being blamed for their disease.

Few people realize that nearly 80 percent of new lung cancer cases are former smokers or people who have never smoked. While tobacco control and prevention will always be the foundation of effective public health policy on lung cancer, screening can reinforce the message to those struggling to quit and help those who already have.

The survival rates for breast, prostate, colon, and cervical cancers would not be as high as they are today without screening. The screening protocols for these cancers are not perfect and they are costly -- but they are the best available and have been embraced and supported by public and private entities. The national experience with these screening regimens can help guide our way forward with lung cancer now.

Our challenge now is to determine who to screen and how to screen. If best practices are implemented correctly, not only can lives be saved but cost benefits can also be realized. According to NCI's own economic research, lung cancer is the highest cost in every cancer cost category: Medicare cancer costs, productivity losses due to cancer mortality, life years lost, and the value of lives lost to cancer. NCI's research estimates that by 2020, lung cancer will account for a third of the estimated $1.4 trillion in cancer costs. However that the NCI analysis also determined this could be cut by a third if lung cancer mortality were reduced by just 2 percent a year.

We must move swiftly to develop and implement quality standards and guidelines so that patients will receive the maximum benefit at the lowest possible risk. We must incorporate a mechanism for adapting imaging innovations and costs savings into the guidelines. And we must more fully integrate imaging with molecular research.

We cannot afford to delay. Looking forward over the next two decades, according to an analysis published in the Journal of Clinical Oncology last year, lung cancer incidence overall is projected to rise by 52 percent, with even more startling increases of 74 percent among African-Americans, 99 percent among American-Indian and Alaskan Natives populations, 156 percent among Asian and Pacific Islanders and 177 percent among Hispanics.

Clearly the status quo on long cancer cannot be allowed to continue. NCI's validation of lung cancer screening offers a new pathway forward for reducing lung cancer mortality in a high risk population. It will require government policy makers, researchers, doctors, advocates and industry to work as a united and committed front. Let all agree to take full advantage of this remarkable moment of time in cancer research.