Is there a way to detect lung cancer before it becomes advanced?

The tragedy of lung cancer is that it is often detected at an advanced stage. The main reason for this is that early lung cancer rarely produces symptoms. For years and years, researchers have tried to identify screening methods which can detect early lung cancer and save lives. The research has focused on screening those who are at high risk for lung cancer, specifically smokers who are older than age 50. The techniques which have been examined include chest x-rays, sputum cytology (looking under the microscope for cancer cells), and CT scanning. Until recently no study identified any technique, combination of techniques, or methodology which conclusively showed a reduction in lung cancer mortality (death rate). In November 2010, however, data was released from the National Lung Screening Trial which showed a 20% reduction in lung cancer mortality when yearly CT scanning was used for screening as compared to yearly chest x-rays. The study enrolled 53,000 heavy smokers ages 55-74, and it was stopped early due to the statistical benefit which was observed. So why aren’t we advising all smokers to have CT scans?  A CT may cost up to $300, and hundreds of patients must be screened to detect one lung cancer. The CT scans will often show abnormalities which are not cancer but lead to other costly tests and even surgical biopsies. Simply put, screening could be harmful to those who don't have lung cancer. Organizations such as the American Cancer Society and the U.S. Preventative Services Task Force are looking into these issues and will likely make recommendations in the future. In the meantime, we should continue to emphasize prevention (don't smoke). 

For many years, lung cancer has been detected at the late stages and there is no screening tests to identify this devastating disease early on.  However, in the recent months, there have been new developments that have impacted this issue and will likely change it for years to come.  A recent study has been published which has shown that screening low-dose CAT scans have been able to identify low-stage lung cancers and, therefore, prevent people from dying from advanced stages of disease.  This has only been shown in the last several months and currently multiple centers are implementing low-intensity CTs to screen for lung cancer.  Northshore University Health Systems is one of those centers .  The screening methods will change lung cancer detection and prognosis for patients with lung cancer in the near future.

There are no standard guidelines for routine screening for lung cancer at this point. However, patients are at a higher risk for lung cancer that are or have been smokers, have had prior lung, head or neck cancers, have been exposed to asbestos, or have COPD.  These patients can speak with their physicians and discuss whether a CT scan of the chest is appropriate in their case.  

A CT scan of the chest provides great anatomic detail of the lungs and mediastinum and allows visualization of very small nodules that are not discernible on chest x-rays. A PET scan can provide further functional detail to correlate with any suspicious CT findings.  Diagnosing and treating lung cancers at an early stage can hopefully prevent recurrence and metastasis. 

Early detection of lung cancer is an important priority for healthcare providers. Early stage lung cancer is curable (typically by surgery) about 70% of the time or higher, versus less than 10% for advanced cancer. There is no good blood test for lung cancer and many non-advanced lung cancers are just accidently found from routine x-rays or CT scans. There are studies to determine whether patients with a high risk of getting lung cancer (heavy smokers for example) can get CT scans to find cancer early. So far the results are still pending, although many doctors think these scans may be the best way of finding lung cancer before it spreads.