Diagnostics & Imaging Week
The fight against lung cancer has never been an easy one, but in its first Report Card on Lung Cancer, the Lung Cancer Alliance (Washington) has given primarily failing grades in its assessment of progress being made.
The Report Card on Lung Cancer will "evaluate progress utilizing key benchmarks annually in the battle to eradicate this disease," which alliance program director Kay Cofrancesco told Diagnostics & Imaging Week is its primary goal.
"Our goal is to make the paradigm shift from the late-stage diagnosis to the early-stage diagnosis," she said. "And there is no pre-approved screening method for lung cancer. Chest X-rays are just not that successful at detecting lung cancer at an early stage, whereas the spiral CT [computed tomography] is."
Lung cancer is the No. 1 cancer killer, the organization said, resulting in 30% of all cancer deaths and killing more people annually than breast, prostate, liver and kidney cancers combined. The death rate is so high that an estimated 172,570 people were diagnosed in 2005 and about 163,510 died.
"Lung cancer is the most lethal of all major cancers," Laurie Fenton, president of the Lung Cancer Alliance, said in a prepared statement. "This Report Card on Lung Cancer will put public health leaders and the American public on notice that it is time to change this."
The alliance said that only 15% of those diagnosed live longer than five years, and there has been "virtually no improvement since President [Richard] Nixon and Congress declared 'War on Cancer' in 1971. By comparison, breast cancer's five-year survival rate is now 88% and prostate cancer's is now 99%."
Most alarming as it relates to outcomes, the alliance said that 70% of diagnoses are late-stage, noting that "late-stage diagnosis is lethal diagnosis."
One of the people working to change that statistic is Claudia Henschke, PhD, MD, professor of radiology and chief of chest imaging at Weill Medical College of Cornell University (New York) and principal investigator of the International Early Lung Cancer Action Program (I-ELCAP), coordinated by the college.
"Lung cancer is difficult to detect early because we have a lot of excess capacity [in the lung], so unless you're actually bleeding and you're coughing and spitting up blood, or there's pain by hitting a nerve, it means it's already out of the lung," Henschke told D&IW, noting that most of the symptoms, such as hoarseness, appear "very late in the course of a lifetime of cancer."
Cancer can be found somewhat earlier with chest X-rays than symptomatically; however, even then they are typically found at 2 centimeters. "Death occurs" when the tumor reaches 10 centimeters in diameter.
"With a CT scan, you can find it when it's below 10 millimeters, so you're finding it much earlier," she said. "In a sense, tumors as they spread, they start to grow, so the earlier you find them the less likely it is to have metastasis."
Henschke and other researchers published a paper in The Lancet in 1999, as well as subsequent papers, as a result of I-ELCAP. In those studies, they have found that annual CT scans could save as many as 50% to 70% of those diagnosed.
"All of the data suggests that we could save over 50% of the lives," she said.
Already, the project is recommending annual CT scans for smokers and former smokers 50 and older who have smoked in their life 10 "pack years". That would include those smoking one pack a day for 10 years and two packs a day for five years.
Other companies, she said, are looking at blood tests and sputum tests, as well as other types of tests, for finding lung cancer earlier.
"We are very excited about finding it even earlier, and we certainly promote that there should be investigation of those other techniques that would readily be integrated into a CT scan program," Henschke said.
Among those companies is Xillix (Richmond, British Columbia), which says its fluorescence endoscopy systems allow physicians to see early-stage cancer and even "subtle, pre-cancerous lesions."
A "very exciting company," according to Henschke, is VisionGate (Gig Harbor, Washington), which is working to develop a "3-D cell nucleus diffraction analysis instrument for pharmaceutical drug discovery and cell biology research."
"This instrument will provide accurate, detailed information about a cell's macromolecular structure, as might result from changes in gene or protein expression due to mutation, disease processes or drug activity," the company said.