Quotes of the Month
I know; the summer is almost over. The past two months have been quite busy for me. Every time I sat down to write this quarter's Webletter, something else pressing, seemed to bump the effort. Then, to top it off, my wife had to have emergency surgery two weeks ago. That's enough excuses.
I would like to veer from the usual format of paraphrased medical articles and discus a contemporary subject, which has arisen again by the death of the noted TV journalist, Peter Jennings. Lung cancer causes more deaths, in the United States, than any other malignancy. Because of this, practical screening techniques have been sought in order to diagnose the disease in its earliest stage; thus offering a curative surgical removal which is the only means of a complete cure. The best approach is prevention by cessation of smoking, but these efforts have seemed to have maxed out in the past 10 years. About 90% of the most commonly occurring cases of lung cancer are caused by years of smoking and the longer time and the more cigarettes smoked per day, directly increases the incidence. The American Cancer Society estimates that about 172,000 cases of lung cancer cases will be diagnosed this year and about 160,000 Americans will die from the malignancy. Currently, less than 20% of lung cancers are diagnosed at a stage where they can be, hopefully, cured. Routine chest x-rays, sputum cytology, and bronchoscopic exams, as screening tests in high risk asymptomatic individuals, have not enhanced survival rates. There should be a way to screen for lung cancer, in high risk patients, and diagnose it at a curable stage. Current technology does exist, but its practicality is controversial.
Spiral computerized tomograms which are high speed x-rays that produce over 300 images of a patient's lungs in the time of a single breath and have the capability of showing a tumor smaller than a pencil eraser. This sounds terrific-why not use it. I found this quote from The United States Preventive Services Task Force in a New York Times article by Jane Brody. "Current data do not support screening for lung cancer with any method." Insurance carriers and Medicare will not support any screening technology that has not been shown to reduce the overall mortality rate for that particular malignancy. Furthermore the screening techniques must be shown to be safe and beneficial with any benefits outweighing risks. Critics oppose the spiral CT as a screen for lung cancer because of false negative and positives and also the expense. The false positive findings outnumber the negatives but they have distinct downsides. False positive results can trigger tremendous patient anxiety and lead to potentially dangerous biopsies. PET scans can be used to better delineate the potential malignant characteristics of the nodules but they are expensive and not infallible. Dr. Claudia L. Henschke, a Cornell radiologist, is a proponent of the spiral CT for screening. She is director of a current study on the screening uses of the spiral CT. She stated that a repeat study in 3 months, to see if the nodule under question has changed or not, reduces the number of false positives. A spiral CT scan costs $250 - 1000 and it has been estimated, according to Ms. Brody, that it would cost $39 billion to screen all current and former smokers in the United States. Another problem is the time consumed in reading the many images by a trained Radiologist. We need to see what the large government funded study, led by Dr. Henschke, shows. I'm hopeful that it will demonstrate practical benefits and agree with my favorable opinion. Also much work needs to be done on sputum analysis technology using targeted antibodies or gene identification.
While we await the results of advanced studies on screening technology, I would hope we can get rid of entrepreneurial boutique radiology groups that sell the benefits of CT screen to people willing to shell out "big bucks" and learn, the hard way, that there is no continuity of care.
Until we know, smokers beware. If Peter Jennings and Dana Reeve's problems have not gotten your attention, then maybe all of the problems associated with practical screening for lung cancer will.
QUOTES FOR THE QUARTER
LUNG CANCER IS THE NUMBER CANCER KILLER WORLDWIDE
Take care until next time,
Richard J. Turner, III, M.D., F.A.C.S.
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Spring 2005 - Preventive Medicine
Winter 2005 - Medical Pearls
Fall 2004 - Women's Health
Summer Trip to Russia
Miscellaneous Medical One Liners
Trip to Ireland
Texas Surgical Society Meeting Notes
The Malpractice Crisis
Treatment and Prevention of Malignant Disease
West Nile/Cancers/Discontent with American Healthcare/Prescriptions
History of Preventive Medicine
Smoking Risks/Depression/The Western Diet