I can’t wait for the critics to weigh in on this same topic once a blood test is developed to detect lung cancer. I hope that they will re-quote the study indicating that there is no evidence that early detection prolonged survival as indicated in the study with the 3,000 patient study. If lung cancer is detected via the blood one day, guess what the next step is going to be for that patient - the same risky procedures of biopsy and/or surgery.

I think that the focus needs to be to find a way to SAFER biopsy and L/C surgery in patients so that we don’t have a 4-5% mortality rate from these procedures.

Critics of CT Scanning have twisted the early detection of lung cancer into a negative thing because of the fact that we need to find safer ways to perform procedures/surgery on these patients (maybe less invasive?) The early detection of lung cancer should have nothing to do with the fact that the mortality rate is what it is.

Let me further twist this concept by saying that maybe we should only give cancer treatment once a patient is symptomatic - hey early detection does not necessarily equate to longer survival right? I think that this would be the case regardless of the detection method (CT Scan, blood test, bronchoscopy, X-Ray, etc.)

Jim

P.S. - Great Site Dr. West!

dadawg001

I am really torn on this topic. I know that earlier detection can lead to greater survival (I know I wish I was stage I and not stage IV). However, treatment is still a guessing game at best with lousy survival rates. Finding cancer at stage I with a 2mm lesion as opposed to stage I with a 2 cm lesion does not improve survival rates, because the treatment is the same! I guess Jim and I are saying the same thing. Prevention has got to be priority and Improved treatment is the only way to improve survival rates.

Terryl

A blood test would be really valuable, in my opinion, because it could potentially be used in two important ways:

1) to potentially screen people as being higher risk for actually having lung cancer, like we use prostate serum antigen (PSA) blood tests to screen men for a prostate biopsy

2) more likely, if it’s an imperfect but helpful test, it could really help to raise or lower our suspicion that a small nodule in the lung is lung cancer and not some benign nodule. For instance, a 5 mm nodule could be anything. If the blood test is abnormal, and consistent with lung cancer, it would make you much more confident that undergoing the risk of biopsy and/or surgery is worth it. On the other hand, if the test were negative, you’d likely feel much more confident about following it without a biopsy and not rushing to surgery. So it could help modify the ambiguity and stress of CT scans that pick up a lot of benign nodules along with cancers.

Terryl, although I’m someone who would point out that we haven’t seen a survival benefit from screening, I’d definitely favor finding and removing a lung tumor at 5 mm rather than 2 or 5 cm, with the only issue being whether it was followed and had grown 1 mm over 2-3 years. If it looked like the rate of growth was very, very slow, treatment would be somewhat debatable. However, if you could see progression over less than a year, I think most of us would anticipate that this is a cancer that is likely to be relevant to survival and is worth intervening against.

-Dr. West

Dr. West

Hi Dr. West,

I am still trying to understand the idea that finding lung cancer early will not increase survival. I know I am biased toward screening, but I really would like to understand. I know that cancer comes in many flavors but why would lung cancer be the only one in which survival is not improved with early detection? I read almost daily that stage I, II and III are curable with some having a survival rate of 50%. That sure seems like a reason for early detection. Also, where are all these folks that have non-lethal slow growing lung cancer? I sure have never met any. Thanks as always for your thoughts.

Myrtle

myrtle

Myrtle,

Without knowing the truth from above, my impression is that, like many complex questions, the truth lies somewhere in the middle. We haven’t tended to talk much about indolent lung cancers, but for those of us who treat it for a living, I can assure you that they’re out there. They’re not most lung cancers right now, but the more you seek, the more you find. Many of these people may have never been bothered by their small, slow-growing cancer. Others are out there now but are thought to have a patch of pneumonia, may go a few years between x-rays or scans, and eventually be diagnosed with a slow cancer, often BAC.

There is definitely controversy about other screening, with PSA (blood test) screening for prostate cancer also detecting lots of cases of extremely indolent cancers that are treated with surgery, cause urinary incontinence and impotence/erectile dysfunction in some cases, but would have never gone on to produce a life-threatening cancer. I think the vast majority of men age 75 or older have prostate cancer if you really look for it, but that doesn’t mean it will be life threatening. Prostate cancer is said to be the cancer you often die “with, but not of”, so the same idea of questionable survival benefit but generating huge numbers of new survivors has been around for decades, not just for lung cancer. Breast cancer screening has also had detractors, and while it’s not as controversial now as lung cancer or prostate cancer, there is also suspicion that we’re finding huge proportions of women with breast cancer who may not have proven to be threatened by their cancer.

Overall, breast cancer screening does save lives, and prostate cancer screening seems to as well, but many patients are probably treated and called survivors who really weren’t the ones driving the survival benefit. Many of these people didn’t go from a destiny of dying with cancer to a new destiny of being saved by screening, but enough are saved that it’s worth it. I suspect that screening for lung cancer is a similar situation — we’d see a major rise in new cases, most of whom being patients with much less threatening lung cancer than we’ve previously known. But I think enough would do better that it could well improve survival.

I can assure you, though, that prostate and breast cancer screening wasn’t always an ironclad truism.

-Dr. West

Dr. West