As the number one cancer killer in the U.S., there’s a high likelihood that lung cancer will affect you or someone you know. Lung cancer kills more Americans than breast, colon and prostate cancers—combined.
And while we typically see a sea of pink in support of breast cancer each October, those in the lung cancer community work tirelessly to bring lung cancer into the spotlight for Lung Cancer Awareness Month in November.
In a short amount of time, the lung cancer community has seen exciting advancements in research including innovative new therapies that can offer meaningful clinical benefits and minimal toxicity, like targeted therapies and immune-oncology. Active clinical trial opportunities have also multiplied and now include numerous trials evaluating the efficacy of immunotherapy treatments. And, we are finally making headway with the stigma that lung cancer is a “smoker’s disease.” In fact, 20 percent of people who die from lung cancer have never touched a cigarette.
Still, we have a long way to go in these efforts, because although we’re prolonging life, we are not curing the vast majority of patients with metastatic lung cancer. Until we discover a cure, the best chances for survival come from screening and early detection. Dramatic benefits have been reported in early detection through low dose CT scanning (LDCT). Case in point: 5-year survival rates for stage 1 lung cancer are 55 percent whereas stage 4 lung cancer is 11 percent. Yet, lung cancer screening still hasn’t been widely accepted as a standard clinical guideline like breast or colon cancer screenings. Less than two percent of screening-eligible lung cancer patients get screened. That number is simply not good enough. Especially considering the proven safety and efficacy of LDCT. As a result, LDCT is currently the only recommended form of lung cancer screening.
Recently published data from the NELSON study on screening, which strongly confirms the results published in 2011 from the National Lung Screening Trial, make me hopeful that screening will become part of standard primary care practice. Findings from this study, reinforce the significant value of screening and show the magnitude of benefits are stronger than we first thought. These data are substantially better in saving lives than breast or colon cancer screenings, as lung cancer is so deadly, especially when found in later stages. In women, the NELSON study found a 39-61 percent reduction in lung cancer mortality. In breast cancer, recent studies have shown that mammograms may not reduce mortality rates at all.
Bolstered by the NELSON study results and the confirmed safety of LDCT, it should be common sense to make lung cancer screening universal for high risk patients. Unfortunately, sometimes even the strongest of data are not enough to change practitioners’ protocols. This is partially because lung cancer screenings are currently not factored into hospital quality measures. We must create a next generation of quality measures around lung cancer with the aim of incentivizing its screening like other cancer screenings.
An incentive we don’t have to wait for is lung cancer screenings’ cost-effectiveness. According to research from the Lung Cancer Alliance, the cost per life-year saved is better than that of breast, cervical and colorectal screenings, all of which Medicare covers and USPSFT recommends. Furthermore, catching and treating lung cancer early avoids the need for expensive later-stage treatments.
Lung cancer screening saves lives and money, and we have the data to prove it. As lung cancer practitioners, we must do our part to emphasize the proven value of screenings and continue to make our case until all practices and hospitals executives see its benefits too.
By David Carbone, M.D., Ph.D, professor at Ohio State’s Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute and past president of the International Association for the Study of Lung Cancer (IASLC)