Has 5 year mark to consider "cure" for NSCLC been rethought for NSCLC? - 1260868

That is a single report, and numbers vary after 5 years, but we always knew that a small minority of patients will have cancer recur beyond a 5 year point. You could say 7 or 10 years, and there will still be a tiny proportion of patients who will recur after an extremely long time. There is also an approximately 1%/yr chance of a new cancer, and sometimes these can be misinterpreted as a recurrence of the old cancer.

In short, there is no magic date at which we can say that there is no chance a cancer will recur. Five years is a good general rule, but it's always going to be an oversimplification to declare a date and call someone unquestionably cured.

-Dr. West

I think you're not off base. These are the key issues in my mind:

1) There isn't a magical threshold at 5 years. Never was.
2) Chest x-rays are nearly useless for surveillance, mostly just a pretense to give a sense of doing something, but with exactly zero evidence to show that people live longer for having an x-ray done for surveillance after lung cancer surgery
3) Low-dose screening non-contrast chest CTs are now proven to improve survival in higher risk people, specifically those 55-75 with at least a 30- pack-year smoking history
4) Knowing that people with a history of lung cancer have a significantly higher risk of developing a new lung cancer than someone who never had a lung cancer, just having a history of a treated lung cancer should put someone in a high enough risk category to justify low-dose, non-contrast screening chest CT scans approximately annually, maybe every couple of years (no data on duration of screening in the research we've seen thus far, which only gave 3 consecutive annual scans).

It should also be said that if the cancer comes back as metastatic, there is no evidence, nor reason to believe, that finding metastatic recurrence a little earlier vs. a little later will lead to a better outcome. If it recurs as metastatic disease, it isn't curable, for all intents and purposes, so there is no reason to focus too much on finding out about a recurrent, incurable cancer long before the first symptoms would tell someone. I see the big value of screening and surveillance as the ability to detect local recurrence, which might be curable, or a new, distinct cancer.

-Dr. West

Dr. West was quoted in another thread, "What perplexes me is that even putting aside US standards, which can arguably be more than needed, the global standard for the industrialized world is clearly repeat CT scans comparing the size of measurable disease. Outside of the US, scans might be done every three cycles, typically every 9 weeks instead of every 6 weeks, and that's a reasonable compromise, but it's not just me who feels that serial chest x-rays are vastly inferior. They are not the way that global trials monitor the status of a cancer. While trying to not be too US-centric, I still can't escape the concept that anything less than repeat CT scans every few months is just substandard care. Not substandard vs. US, but substandard vs. global benchmarks."

In the same thread Dr. Weiss states, "This is a fairly simple issue for me--CTs are simply superior to chest xrays for monitoring disease progression/regression/stability. If someone wants to try to cut cost, a very legitimate argument could be made, at least in the US, that we use PETs far more often than really helps us to take better care of people. PETs cost more, take longer, and the CT component is lower resolution than a standard CT. On the other hand, CTs are such a standard tool for optimal care that not using them would be to me akin to not using a hammer in building a house."

http://cancergrace.org/forums/index.php?topic=10650.15

CT vs x rays have been a commonly recurring question in one way or another and they all have a similar tone.