Cincinnati—Computed tomography (CT) scans are an effective lung cancer screening tool for a high-risk patient population, if done with a strict clinical protocol in place and with the input of a multidisciplinary care team, according to University of Cincinnati (UC) research.
Led by Sandra Starnes, MD, the Cincinnati-based clinical trial was conducted to determine if lung cancer screening could be done effectively among a high-risk population living in a geographic area with rates of histoplasmosis three times higher than the national average.
Histoplasmosis is a fungal infection that enters the body through the lungs and increases the likelihood of lung nodules. These irregular sections of lung tissue can look like lung cancer on CT and lead to unnecessary biopsies.
"Despite having a 60 percent nodule rate, we were able to avoid doing benign biopsies and not miss any lung cancer diagnoses if the protocol was strictly followed. No one was diagnosed at a stage where the lung tumor could not be surgically removed,” says Starnes, director of thoracic surgery at the UC College of Medicine and a surgeon with UC Health.
Starnes and her colleagues report their findings online ahead of print in the Journal of Thoracic and Cardiovascular Surgery.
"The Ohio River Valley’s high prevalence of histoplasmosis makes lung cancer screening very challenging because so many nodules show up on the imaging studies. By using three-dimensional CT imaging, we are able to look more closely at the anatomical structure of these nodules and identify concerning lesions,” explains Starnes.
For this study, UC recruited 132 heavy smokers over age 50 who had smoked at least 20 packs of cigarettes per year. Participants completed a questionnaire about their smoking habits and medical history then underwent annual low-dose computed tomography (CT) scans for five years to screen for signs of lung cancer.
Lung cancer is the leading cause of cancer-related death among both men and women, according to the National Cancer Institute, with more than 222,000 expected new diagnoses in 2010. Currently, there are no nationally recognized screening tools to detect lung cancer.
Research trials—both locally and nationally—have recently reported benefits of CT scans as a lung cancer screening tool in a high risk population of heavy, long-term smokers. Preliminary results from the National Cancer Institute’s National Lung Cancer Screening Trial—announced in November 2010—showed that heavy smokers who were screened with low-dose CT scans versus traditional X-rays experienced 20 percent fewer deaths. The randomized national trial is ongoing and involves more than 53,000 current and former heavy smokers ages 55 to 74.
Starnes cautions, however, that if screening does become standard practice, it needs to be done with a defined protocol that is rigorously followed and includes the input of a multidisciplinary team.
"If lung cancer screenings are not offered in a scientifically valid and regimented way, people will end up getting unnecessary testing and biopsies for benign disease. That is why the collective knowledge of an experienced, multidisciplinary team is so critical,” she adds.
Smoking tobacco, heavy alcohol consumption and exposure to secondhand tobacco smoke are thought to increase a person’s risk for lung cancer. Research has also shown that exposure to radon, air pollution, asbestos, chromium, nickel, tar and soot can also increase a person’s risk, according to the NCI.
UC Health’s multidisciplinary thoracic cancer team—made up of pulmonologists, radiologists, medical oncologists, radiation oncologists, pathologists, gastroenterologists, respiratory therapists, experienced oncology nurses and fellowship-trained surgeons—specializes in treating the entire range of cancers affecting the chest cavity. The treatment team is part of the UC Cancer Institute, which brings all cancer-related research, patient care and education efforts under a single umbrella.
Starnes and her colleague Julian Guitron, MD, see patients at the UC Health Physician Offices in Clifton and West Chester. For appointments, call (513) 475-8787 (Clifton) or (513) 475-7450 (West Chester). A full list of UC Health specialists is available at ucphysicians.com.