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Professor says screening to detect early stage lung cancers in chronic smokers lacks awareness it merits

A 2013 screening recommended to detect early stage lung cancers in chronic smokers has not gained the awareness level it merits, given that lung cancer is America’s most deadly cancer. That was the assessment of Corey J. Langer, MD, professor of medicine, Abrahamson Cancer Center, University of Pennsylvania, at a panel discussion on non-small cell lung cancer convened by The American Journal of Managed Care, according to a news release.

While breast cancer has the pink ribbon and a monthlong campaign every October to get women screened and colonoscopies experienced an upsurge after former Today Show host Katie Couric had an onscreen exam after losing her husband to colon cancer in 1998, screenings for lung cancer did not see a similar surge last summer when it was recommended for the roster of tests for which insurance must pay under the Affordable Care Act, Langer said.

USPTF final recommendation

On Dec. 31, the U.S. Preventive Services Task Force released its final recommendation for annual lung cancer screenings with low-dose computed tomography in adults ages 55 to 80, who have smoked 30 “pack years”. A pack-year means the person has smoked at least a pack a day for a year; a person who smoked two packs a day for 15 years would have 30 pack years.

The draft recommendation, based on results from the National Lung Screening Trial, received a great deal of media attention when it came out last July, yet the public seems unaware of it, according to Langer. “The impact and the general notice of the NLST has not penetrated,” Langer said in
the release.

Langer’s comments were part of a wide-ranging discussion on treatment strategies for non-small cell lung cancer, including new and emerging agents, the need for precision in pathology to identify the characteristics and stage of the disease, and the use of molecular-level tests and agents.

Michael Chernew, PhD, a health economist at Harvard University and co-editor-in-chief of The American Journal of Managed Care, led the discussion that also included David J. Sugarbaker, MD, chief of thoracic surgery at Brigham and Women’s Hospital in Boston, and Steven Peskin, MD, senior medical director, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield New Jersey.
Langer did not offer a reason for the lack of awareness, according to the release.

Smoking stigma clouds screening promotion

On its website, the American Lung Association said the stigma associated with cigarette smoking has clouded efforts to promote lung cancer screening. That’s quite a shift from when the U.S. Surgeon General unveiled its landmark report in 1964 that showed cigarettes cause lung cancer in men and “probably” in women. At that time, 46 percent of Americans smoked; today fewer than half that number smoke.

Some questions about who should be screened and how often come down cost effectiveness. Overuse of scans has been a hot topic in cancer care, with the American Society of Clinical Oncology recommending against some scans in its Choose Wisely initiative.

Sugarbaker noted the costs of screening for lung cancer had to be weighed against the expense of end-of-life care for a patient with stage IV lung cancer, which Chernew said can easily exceed $100,000 a year. Too often, he said, lung cancer is diagnosed after surgery is no longer possible and a patient’s only options are expensive chemotherapy or targeted therapy treatments.

Both Langer and Sugarbaker said screening and payment protocols are still evolving at major academic centers, with some centers offering the baseline screening for free for chronic, long-term smokers. Some patients don’t quite fit the 30 pack-year criteria, or may not be old enough, but there is the question if waiting for a screening makes sense.

The USPSTF recommendations call for ending annual scans once the patient has quit for more than 15 years, or if the patint develops some other medical condition that would make him or her unable or unwilling to be treated for lung cancer. Unlike the initial trial, scanning goes on to age 80.

According to the American Lung Association website, 160,340 people in the U.S. were expected to die from lung cancer in 2012.

More info available

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For the full discussion in which Langer took part, visit:

By | 2014-01-27T00:00:00-05:00 January 27th, 2014|Categories: National|0 Comments

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