A heavy smoker for more than 45 years, Fernando Sandoval quit cold turkey after a CT scan revealed he had a tumor in his lung. Nine years ago Sandoval was one of the first people to participate in a clinical trial at UCLA to determine whether a low-dose CT scan can be used as a possible screening tool for the deadliest cancer. Final results from this clinical trial, which enrolled more than 53,000 people at 33 different sites, found low-dose CT screening reduces the number of lung cancer deaths in high risk smokers by 20%.
Sandoval received a regular chest X-ray in 2002 and was told his lungs looked like those of a 40-year-old, even though he had already passed his 60th birthday.
But his wife didn't believe the X-rays because she knew he smoked too much, so she urged him to participate in the clinical trial.
"I owe my life to wife and UCLA," says Sandoval. He was chosen to get his lungs screened with a CT scan even though he had no symptoms of illness. Two weeks later he was told doctors had found a nodule on the bottom lobe of his left lung. "I had surgery and after the surgery I was told we caught it in time." Sandoval says the cancer hadn't spread and he didn't even need chemotherapy.
Early results from this study were first published last November, when the trial was stopped ahead of schedule because the results were so good.
"This is probably the most important thing to happen in lung cancer in a decade," says Dr. Bruce Johnson, who has been treating lung cancer patients for a long time at the Dana-Farber Cancer Institute in Boston. The study results were published in the New England Journal of Medicine on Wednesday.
"I believe that this is not only the best study done on lung cancer mortality, but one of the best studies on cancer screening ever done," says Dr. Otis Brawley, Chief Medical Officer for the American Cancer Society.
Lung cancer is the No. 1 cancer killer in men and women worldwide, yet there's no good way to screen for it.
Dr. Denise Aberle says she believes that since the death rates and overall complication rates were very low, these study results will eventually lead to screening guidelines for lung cancer. She is the national principal researcher for 23 of the 33 testing sites in this trial and a researcher with UCLA’s Jonsson Comprehensive Cancer Center, where Sandoval's cancer was found. "[The study] is the best we could come up with since 1964 when the surgeon general first announced the relationship between cigarette smoking and lung cancer," Aberle says.
Aberle, along with Johnson, Brawley and the study authors acknowledge that the study has some limitations. The people who received CT scans were more likely to have a false positive, which means something was identified that later did not turn out to be cancer. Overdiagnosis is also a concern, meaning some cancers were found "that never would have become symptomatic," according to the study.
Cost also is an issue. While an X-ray is about $50 dollars, the average cost of a spiral CT scan is $300-$400, says Brawley. "But, the average cost of an abnormal spiral CT is about $40,000 to $50,000," he adds. That's because the patient will need surgery and further testing to see if what was found is really cancer.
But the screening is not perfect. In the study, 16 people who had the CT scans died, 10 of whom had cancer and 6 of whom did not. But the overall death rate in this group in the study was very low, about 1% says Aberle. "The [mortality] data for the general population is 4%," she says, which is why she believes the risk-to-benefit ratio is favorable.
Johnson, who is a oard member of the American Society of Clinical Oncologists, agrees. He points to the fact that 20% of the people screened didn't just live longer, but were probably cured of lung cancer because it was detected early.
He says this study shows that "you have to screen between 200-300 to reduce one death in lung cancer," which Johnson says "compares favorably to how mammograms work for breast cancer."
Johnson along with the study authors and the other experts agree there is a much better way to significantly reduce your risk of dying from lung cancer: If you aren't smoking – don't start; if you are smoking – quit.
One thing the cancer society, ASCO and other public health officials will have to grapple with is who should be screened and how to pay for it. This would not be something everyone ought to be screened for, given the limitations of the study. However, heavy smokers and those who quit less than 15 years ago who are between the ages of 55 and 74, just as the 53,000 who participated in the trial, could the be best candidates for lung cancer screening with a CT scan, based on these study results, experts believe.
I smoked for sixty years. My lung cancer was detected by a simple X-ray read by an experienced technician. I then had both a CT scan and a PET scan. ONLY the PET scan is foolproof, but it costs so much that the doctors need to be 99% positive before the insurance company will agree. The important thing about the PET scan is that is will find the cancer anywhere it exists (small cell tumors are very dangerous, they seed very quickly). Like the subject in the story, I had surgery. Removed 3/5 of my right lung. I just had my annual checkup and I'm good to go. I did not require chemo or radiation.
IF YOU SMOKE DON'T ASSUME BECAUSE YOU FEEL GREAT THAT YOU ARE OKAY. AN ANNUAL PHYSICAL WITH A CHEST X-RAY IS CRITICAL FOR LONG-TERM SMOKERS. YOU CAN SURVIVE THIS IN GOOD SHAPE IF YOU GET IT QUICKLY.
PET scans are not foolproof, they use a modified radiotracer that is only reliable for detecting tumors that are greater than 5 centimeters, additionally, PET scans will not find cancer anywhere it exists because the results are not reliable in areas of high metabolic activity, such as the brain. Soon CT screening will be the standard of care for people with significant histories of smoking.
@ Survivor: A technician didn't read your xrays, a Radiologist did. Give credit where credit is due.
Techs perform the study, Radiologists (who are medical docors) read it. Radiologists complete four years of medical school followed by 5 years of residency training and then may decide to pursue another 1-2 years of super specialized training.
Congratulations! Nice to hear a success story.
SCREENING with CT? That is absolutely insane. If that becomes standard of care, the taxpayer will get stuck with the imaging bill for somebody who smoked their lungs away. You can bet that the radiologists are lobbying the biznatch out of this one.
PET examination loses precision at approximately 0.7-0.8 cm. other than that, i use it daily to assess inflammation/infection/tumor on a nodule which has yet to be biopsied.
In WHAT universe did a technician read an x-ray? Not in THIS one! We have those radiologist guys, who happen do be a part of those doctor guys. Remember THEM?
THEN, you claim PET scan, which is fraught with errors.
So, I declare bovine defecation. Were you to announce universal field theory or the cure to idiocy, I'd know better, as you are an idiot. You are only either a shill or a quack without license.
Indeed, you are only worthy of summary execution.
IF you're a long-time smoker, demand a CT scan. My father like this guy in the story, had an X-ray every year for years They never saw anything. Then he started losing a lot of weight and had pain in one of his lungs. He wanted to a lung specialist and with one CT scan, they found he had stage 4 lung cancer. He only lived another 6 months. His oncologist was in disbelief that his doctor never ordered a CT scan in 20 years of seeing him. I think that is akin to malpractice. We pay enough as it for medical insurance why should we also pay with our lives? Not only should CT scans be common practice for heavy smokers, they should be considered part of their physical.
PETCT scanners have spatial resolution with TOF at 2mm. For like 5 years now.
My husband went through the same procedure as you the CT scan and the PET scan. The reason that was explained to us for having both is that they then compare the two by placing one x-ray over the other from both tests to pinpoint exactly where the cancer is. HIs right lower lobe was removed, plus two lymph nodes that were clear. He did chemo, but now has developed more cancer and going through a second round of chemo. The tumor is shrinking so we are praying after this it will be done. And I have to say that all lung cancer is caused by smoking, my husband;s cousin also had lung cancer but it was a rare lung cancer and did not have to take chemo and that was about 10 yrs. ago. Also we had no problem with our insurance company paying for the PET scan as your insurance company has to approve the procedure before it is done.
How could others be benefited like you to do a CT Scan? Is there a program where I can sign-up and participate?
There is no such program; if you have ever smoked, have a family history of lung cancer, ask your doctor, ask your insurance, do whatever is necessary to have a CT scan. The radiologist can detect if there is anything unusual and then you go from there on. I had this detected, after the CT scan I opted for surgery (not PET scan or biopsy) and had 1/5 of my left lung removed. After surgery it was determined it was lung cancer but in incipient form, only 5 mm big. This was in 2003. I have been followed with PET scan and then CT scans every 4 months for five years, then one CT scan a year. This year it was my last one. I am cancer free. The doctors at Dana Farber were the best in the world. I thank them every day.
And, sorry, I forgot: I did not have to go through chemo or radiation. I took the most aggressive way – surgery, just to be sure. The prior year I lost my sister to lung cancer, so I knew better what to do.
Gulu, you'd ONLY get the TUMOR, not any metastasizes. So, you were willing to die a few years later and ignore the guidance of your physician?!
Sorry, but I would follow the advice of several physicians, not go for the carve and hope system.
Ask John Wayne how well it worked out for him!
Oh, you can't. He's DEAD from LUNG CANCER.
The comment from "Survivor" above is correct: only a PET scan will tell you for sure if you have a cancer because it reacts to the metabolic rate of the cells in question, not just producing an image like on an X-ray. If you cannot afford it, your insurance won't cover it, try asking your union if you belong to one or search, network etc. for foundations and others who might help.
Like almost everything else in medicine, nothing is "for sure." There are plenty of other reasons besides cancer a focal area will light up on PET, including inflammation, autoimmune causes, sarcoid, etc.
Andy, that is NOT entirely correct. Metabolic rate is NOT the primary indicator. There are "slow" cancers, there are variable growth cancers. There are cancers that don't respond to the PET indicator. There are MULTIPLE indicators of cellular growth, something only recently discovered, within the past decade.
Sorry, but I'll take the word of any 7 radiologists over your idiocy.
Because, knowledge is power.
CT scans cause cancer. They're like getting hundreds of x-rays in one session. Read what Time Magazine had to say about CT scans in recent years. CT scans should be banned except in cases of trauma. They cause more cancer than they find.
I have heard the same thing. Unfortunately, CT's are one of the best ways to detect cancer. After a lung collapse, my doctors found lung nodules and they recommended that I get a CT every 6 months to make sure they do not change. After 2 I have decided to put them on hold for a while because I don't want the exposure.
I'm sorry, but if you claim the CT scan will cause more cancer than it will catch, you need to back that up with data. That's what real scientists do. They start with a hypothesis and make a study to test the question. You seem to go from hypothesis to fact. You skipped a few steps there, buddy.
It would help if the article defined "low-dose CT" in rads, and defined "standard X-Ray screening" in rads. That's probably one of the most important parts of the report – but it was left out. If a low-dose CT has less rads than a standard X-Ray, then it's less likely to cause cancer than the standard X-ray.
You're right that any ionizing radiation increases cancer risk to some degree, but you wildly exaggerate the degree. The idea that CT scans applied for reasonable diagnostic purposes cause more cancer than they find is ridiculous.
You are RIGHT! BAN ALL IONIZING RADIATION! IT IS EVIL AND OF THE DEVIL!
DEATH IS GOOD! GOD LOVES DEATH!
RELY UPON FAITH HEALERS.
Or be intelligent and rely upon modern science, guided upon consensus of PROFESSIONALS.
Remember THOSE guys? The guys who lose business if they KILL YOU? AS IN BROKE, HOMELESS AND STARVING if they DO NOT get it RIGHT?
FEAR FEAR FEAR FEAR FEAR FEAR FEAR FEAR
STUPID IS DEATH.
I wonder if the new healthcare bil coverage will cover this test
Nope. The GOP decided that DEATH IS GOOD. Survival of the poor is EVIL. THERE IS NO MIDDLE CLASS, ONLY POOR AND LORDS.
According to Radiologists I have talked with, CT exposes a patient to as much radiation as 7 chest X-rays. The risk of causing a lung cancer in a non-symptomatic patient is considered by many to be too great to use as a screening tool just because the person smokes, lives in a house with Radon or has worked with Asbestos at some time in the past.
Are you saying that relying upon the PROFESSIONALS is a GOOD thing? If so, way COOL!
If not, you've only exposed your idiocy.
For medical things, I go to a doctor. For legal things, I go to a lawyer. For network and network security things, I go to me. For banking things, I go to a banker.
Each to their specialty.
I went thru the study at Mayo Clinic, Jacksonville, for the entire duration. I was fortunate to draw the lot for the CT Scan. I have smoked for 50 plus yrs, but feel comfortable that my res lts were reliable!
Is this a rough draft?
The misinformation above is disturbing. Radiation dose from CT scans is highly variable but no matter what data or study you look at they do not cause more cancer than they find. The exact opposite is true. CT scans are the workhouse of all hospitals and medicine. Your dose depends on the CT protocol used and they employed a 'low dose' protocol in this study which uses very little radiation. It is just enough to resolve a lung nodule/lesion which looks like cancer. The study results are encouraging and hopefully insurance companies listen to the science.
Yes, it may help and then again maybe it won't. Truth is, they can't tell you one way or another. This is just another attempt by the medical industry to capitalize on previously developed assets. Truth be told, they're spending next to nothing on research compared to their profits. This is just another scheme to bilk people of their money and inflate their profits on the very same people's pain and suffering..
P.S. Chemo will kill you. It did me, but I was just to darn ornery to stay dead!
You should have a surgeon remove your tin foil hat, it's on a little tight.
Mike's got you pegged, Byrd!
After smoking for 50+ years, my mom's lung cancer was found with a simple chest x-ray. She had no symptoms, but her doctor couldn't believe that no other doctor had every suggested getting an x-ray even though she had smoked for a long time. Luckily hers was caught at Stage I A and required surgery to remove the tumor, but no chemo or radiation. She's doing well now and cautions smokers that if they aren't going to quit, which is very hard, than get the x-ray. Best wishes to all who are going through this.
Mark, i'm glad you have some GOOD news in your life!good to hear you say you're pumped. all our tatbles in life are so personal and no one else knows what it's like. it's all relative to our situation as to what will get us pumped up. i'm glad you stay so positive, as always.doing leaves, have my PhD in leafology so it is a big deal to me. took alot of fall night classes to get it, i am so proud. the strategy, the timing, you know just like getting ready for a big game. (ha,ha).thinking about you as always.Steve
Researches found a way to REBOOT THE BRAIN!!! http://losangeles.ibtimes.com/articles/171797/20110629/reboot-the-brain-after-a-stroke.htm
I too was diagnosed with lung cancer after an x ray.My doctor retired and my new young doctor gave me an xray at yearly physical . The tumor was 6.5 centimeters I felt nothing.I was playing softball 4 days a week ,riding a bike and working full time.
I had 5 sessions of chemo then 40% of my right lung removed,then 2 more chemo sessions.I get pet or ct scans every few months.So far am clean.I was stage 2b as I had several nodules which have shown not to be cancer.Thank god for that xray.
However I was told if I had gotten it a year or so earlier the tumor would have been much smaller.
So far I'm good playing softball again I am 63 smoked for 40 years .
Hang in there everyone
had a lung tumor over 3 yrs ago, couldn't operate because of location, had chemo and rad. now have pet/ct combo every 3 mos (hope it doesn't give me another tumor), and have had 2 or 3 "inflammations" that come and go. so now i constantly worry about what these really are.
is there a way to tell, e.g., blood test, etc., if what the docs are seeing is inflammation or not?
what's the point? the gop health care plan needs more people to just pass away quietly, without expensive treatments. unless of course, you're in the top 1%. pretty soon we can just leave the uninsured ill and weak outside at night to see if they'll make it to the morning, like the spartans. only we'll keep doing it until they do pass on.
Why should I pay for your smoking?
Well, we know Emp isn't for empathy! People get lung, and other cancers, without particular bad behavior. The accusation stands. The GOP cynically waves the false killing granny charge to block a plan than would benefit all (except the insurance industry and wildly profitable portions of the medical establishment). They wan granny to die early the old fashioned way, in pain with curable disease.
My mom was diagnosed with stage 4 lung cancer and died 6 months later at age 64. She smoked in her teens, before the connection to cancer was known. Another friend, non-smoker died of lung cancer at age 42. This is a nasty disease that sneaks up on people, and often has no symptoms until it is too late. Anything that can be done to prevent lung cancer is worth it. I wish this had been an option for my mom...
Something need to be created to offer earlier detection. I lost my mom 2 months ago from small cell lung cancer. It is a horrible disease, and was so far out of control when found, with very little symptoms. We were told small cell is more treatable than large cell lung cancer, but even with chemo she lived less that a year after diagnosis. I pray for those of you thtat have lung cancer, and hope we can detect this disease sooner to save lives.
How about not smoking?
EMP, you shouldn't be so ignorant to believe that all lung cancers are due to smoking. Generations before were not aware of the dangers also.
Emp is a callous idiot who either doesn't know (unlikely?) or doesn't care that the majority of lung cancer occurs in non-smokers.
I am a 37 year old never smoker female who was diagnosed last year with Adenocarcinoma. Mine was found incidentally through a ct of my abdomen. That CT caught a nodule in my right lower lung that with the use of CT scans showed changes over the course of 18 months. I had two PET scans that never lit up....the doctors still don't get that...when they removed my RL lobe the tumor was 3.5cm and was staged a 1B. I had four rounds of chemo after surgery.CT scans saved my life! I never had a single symptom...it was incredibly surreal...to be told you have one of the deadliest cancers and to feel and appear perfectly healthy. By the time you have symptoms it is usually too far advanced. CT screening for lung cancer will save lives! My doctors have told me that I will need one yearly for the rest of my life! I have discussed the radiation exposure with my doctors and sometimes the benefits outweigh the risks!
Wow Jen. I wish my mom's had been caught incidentally like yours. She too has adenocarcinoma, never smoked. She had a chest x-ray which then lead to a CT scan. The CT scan pretty confirmed that she had lung cancer though a PET scan was done afterwards. Unfortunately, hers was caught stage four. She is still fighting and doing well. Chemo every 3 weeks. I hope that CT scans become a norm like mammograms to screen for my own selfish sake.
That is truely a great achievment. PPl around us need these tech badly esp ppl in field of mines, nuclear plants ...
Awsome news... Please share with everyone you know.. This could change the life of needy in a single step..
Or you could just practice the Gerson Therapy...oh wait, that's right...we live in America. Nevermind.
My uncle small cell lung Cancer with found when he had ct scan. if not found when was,it would spread. thank god for ct.
I believe this is the same study my Mom was part of. Although the author doesn't specfically name the study, it sounds strikingly familiar. She took part in this study because she had been a smoker (although had quit about 14 years before). She got the CT scans. Doctors noticed a nodule on her first CT scan. Doctors "watched" a nodule for 5 years with repeat CT scans. The nodule grew slightly once and then more the next time and the doctors became concerned. By the time they biopsied it, she had stage 3b lung cancer. If they had biopsied it initially, it would have been stage I. She had rigourous treatment for over two years but eventually died. CT scanning is an invaluable resource and obviously identifies abnormalities that an x-ray cannot. However. there is always room for error, even when different medical opinions are obtained. Although this article mentions the fact that there could be problems with overdiagnosis or false positives, it doesn't mention the fact that doctors reading the scans can misidentify actual tumors for something benign. And, therefore, there is no screening that is absolutely reliable. I am certain that my Mom's results would have been different if her turmor was biopsied years before it was – when it was first identified – and her prognosis could have been much different. But, whatever the case, my Mom was always proud of the fact that she had been part of this study, even after she received her diagnosis. I think CT scan screening is important. And I am happy that lives have been saved. Unfortunately, medicine is an art, not a science. And nothing is ever perfect.
My father was a heavy smoker (2-3 pack-a-day Camels) who smoked from about 19 until he was 51 years old in 1983. He was diagnosed with small cell lung cancer about 20 years after he quit smoking in the fall of 2003 and died the summer of 2004. I have to believe the recommendations of this study (ie., begin screening at age 55, or even at age 70 in 2002) might have detected his lung cancer before it was to late.
Fact: 60 percent of those contracting lung cancer are either life long nonsmokers or have not smoked in 10 years. 160,000 americans will die from lung cancer this year. The 5 year survival rate is "5" percent because of late diagnosis. Do not believe all the emphasis on smokers. It is the #1 cancer killer of "nonsmokers"! Visit: lungcancerfoundation.org.
I agree, when you say lung cancer you are immediately asked "oh was she a smoker?" Does it really matter? My mom smoked long ago, my friend did not. They both died from a horrible disease. Does smoking long ago mean my mom deserved to die and my non-smoking friend did not? Lung cancer has too much stigma attached to it! Lots of non-smokers die from lung cancer
The tobacco settlement money should be used to screen smokers -in PA they are trying to divert funds from health care but if you can screen for lung cancer like you would administer a mammogram to detect breast cancer, then tobacco companies should pay for the tests.
The numbers are clear from recent BEIRS VII data. By studying Hiroshima and Nagasaki survivors and subsequent cancer risks and extrapolating, each standard chest CT (around 10 mSv) causes 1 cancer in every 1000 chest CT's performed (see FDA website data). Since over survival rates are around 50%, this causes 1 cancer death in every 2000 screening CT's (with a latency of decades and at standard doses, I am unsure as to the dose of reduced dose CT in this study). As the article above states (I have not examined directly the NEJM article), 300 CT's are needed to reduce 1 cancer death. This is a risk benefit ratio of nearly 7. That is, for every 2000 screening CTs performed, around 7 people will be saved from lung cancer death immediately, while 1 will be caused decades later. Not as good as mammography (best comparison with a risk:benfit ration of around 60) but not bad.
My wife was diagnosed with lung cancer 9 yrs ago with an x-ray. They did a PET scan to confirm. She had her left lung removed and had 6 weeks of radiation. She is cancer free today and doing great. My concern is that MEDPAC and Congress are trying to deny Medicare patients home health care which is preferred by patients over more costly nursing home and hospital care. Scott Lara Please follow me on Twitter @scottlara1961
Fact: 160,000 americans will die from lung cancer this year. 60 percent of those are lifelong nonsmokers or have never smoked. Stop focusing on the smoker. Focus on the screening for the average person. The 5 year survival rate is 15 percent because of late diagnosis. AND THAT IS NONSMOKERS!! Visit: lungcancerfoundation.org
I think the tobacco companies should spend all that advertising money pushing cigarettes on universal CT scan coverage for their customers instead. If you've been a long-time smoker, you got hooked when the knowledge wasn't out there yet about smoking's destructive effects on the body. If you started smoking after the information was put out there, then you're just plain dumb. I hope your children don't have to watch you die of lung cancer because it's a horrible way to die. Quit! If you're struggling, keep trying. I quit a long time ago. It was the best thing I ever did!
Facts: Five (5) year survival rate for cancers: Breast 89% – Prostate 99% – Because of the screening tests (mamogram – psa test, etc). Lung Cancer survival rate – 15% – of those diagnosed with Stage1 Lung Cancer due to lucky "accidental" diagnosis. The 5 year survival rate for those diagnosed with Stage 3 or 4 Lung Cancer – "5 percent". Why – NO SCREENING TEST – other than a Thoracic CT Scan. Lung Cancer is the #1 cancer killer of NON-SMOKERS. "smoking can cause lung cancer, but lung cancer is NOT caused by smoking". Read it as it is written! Fact – for every $9.00 going to Breast Cancer Research, $1.00 goes to Lung Cancer Research. It is now time to start focusing on the #1 cancer killer of NON-SMOKERS. You may not believe this, but wait until it hits home to one of your loved ones. The chances are it will!. It obviously did to me. Visit and give to: lungcancerfoundation.org
I am a five year lung cancer survivor. I had a CT Scan 3 year prior for possible gall bladder problem, tumor on lung found accidently.
Surgery no Chemo or radiation treatment. Yes Ct Scans are expensive but in the long run it saved my life for 5 years. Hoping to get at least another 10 years.. Entire lifetime of non smoking. Mystery of the horrible diagnosis cause still haunts me
If this were common practice on yearly physicals maybe they could have caught my mother's cancer before it went to stage 4. She was in hospital for breathing trouble when it was finally caught. Too late. She died 2 months later, and 11 months after my father. She had breathing issues off and on but they always figured it was bronchitis or something less serious so they never looked closer...if they had done a CT...maybe...my 2 year old and 3 month old kids would grow up knowing their grandmother first hand and not through my stories....
I was diagnosed with stage 1a lung cancer in January of this year. Had lobectomy of right upper lobe, no chemo or radiation required so far and both the surgeon and oncologist are very optimistic about my being cancer free! This happened only because my tumor was spotted by an x-ray initially and confirmed with a ct scan and a biopsy. If not for the ct scan and the dilligence of the emergency room x-ray technician, it would not have been found at all. I had no symptoms to speak of. Ct scans are vital in the detection and diagnoses of early stage lung cancer.
New study shows a 15% rate of pneumothorax in folks getting lung nodules biopsied … 6% requiring a chest tube.
Multiply times the 95% false positive rate of 25,000 scans (or 50,000,000 if it’s rolled out?) Number needed to screen of 320 in a high-high-risk population, which number will go way higher when lower-risk people are screened as would seem likely.
So, I’m not recommending my ex-heavy smoking family member get a chest CT. At least not till things are more clear. Would you?
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