Early detection of lung cancer in older smokers appears to be more effective than quitting, Dutch researchers suggest. The earlier the diagnosis via computed tomographic screening the better the chance that the multitude of treatment options which have recently become available to lung cancer patients will work. Furthermore, CT scans can lead to cost savings in the healthcare system.
Lung cancer is by far the leading cause of death from cancer in the U.S. and worldwide (nearly 20% of all cancer deaths), according to the American Cancer Society. It causes more deaths than breast, colorectal and prostate cancers combined.
The Dutch newspaper Algemeen Dagblad reported findings yesterday from a university research team that smokers over 60 derive more benefit from a CT scan to prolong their life than from a smoking cessation program. Associate Professor Carlijn van der Aalst of the Erasmus MC University Medical Center in Rotterdam told Dutch radio that use of a “CT scan to detect lung cancer early is five to ten times more effective than offering a smoking cessation program. Up to ten years of life can be saved.”
While quitting smoking always helps, especially among young people, its effectiveness is limited among older folks in terms of preventing the development of lung cancer. By the time they’re 60, they are “already in a risk group,” van der Aalst said. And so it’s critical to detect lung cancer as early as possible. In turn, this allows for a better chance of successful medical intervention with the newer treatment modalities. If caught at an early stage, the five-year survival rate is five times higher than when it’s already spread to other parts of the body. Timely detection can also entail long-term cost savings for the healthcare system.
The conclusions Dutch researchers arrived at were informed by a clinical trial involving more than 13,000 high-risk male individuals randomly assigned to volume-based, low-dose CT screening in the Netherlands. Around 2,600 high-risk women also participated in the trial. The smaller number is attributed to the fact that fewer women were eligible because smoking was much less prevalent than among men in that age group.
The study showed significantly reduced lung cancer mortality among those who underwent CT screening compared to those who didn’t. The effects of screening on lung cancer mortality were consistently more favorable for women than for men. Findings were published in the New England Journal of Medicine.
Following this publication, the Erasmus Medical Center in Rotterdam conducted a large-scale pilot survey among the target at-risk group. Specifically, van der Aalst was chief coordinator of a demonstration project in which 400,000 people were invited to participate.
Other European nations such as Germany, Spain, Italy and France have followed suit and pursued similar demonstration projects.
In the U.S., guidelines published by the U.S. Preventative Services Taskforce recommend lung cancer screening for high-risk individuals who don’t have any symptoms of lung cancer. This group includes people between 50-80 years of age, who have a 20 or higher pack-per-year history of smoking and who currently smoke or have quit within the last 15 years. U.S.-based studies demonstrate that early detection with low-dose CT screening can decrease lung cancer mortality by 20% or more among high-risk populations.
People over the age of 60 have the highest risk of lung cancer, in part because they often started smoking in their teenage years. And, as was reported in Forbes in February, there’s a also a socioeconomic element to lung cancer incidence, which enhances the risk among lower-income populations. A higher percentage of this population smokes and is in generally poorer health, too. Dutch clinicians at the Comprehensive Cancer Organization found that this disease occurs two to three times more often among the lowest-earning men in the Netherlands.
At present in the Netherlands CT scans are only performed when individuals present with complaints that may be related to lung cancer.
Van der Aalst wants to see the Dutch government implement a standard population screening among the target high-risk group, similar to the ones done in the Netherlands for colorectal and cervical cancer. People above a certain age and with risk factors such as being a (former) smoker would then be called upon to be examined for precancerous lesions. Dutch researchers recommend carrying out a CT scan for such individuals every two years.
The Dutch Health Council—independent scientific advisory body whose legal task it is to advise the Ministry of Health, Welfare and Sport—is preparing to soon offer its advice on introducing routine lung cancer screening in the Netherlands.
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