Wednesday, July 31, 2013

Lung Cancer Screening?

More people in the US die from lung cancer than any other cancer. Yup, it’s true. Our number one cancer killer is not breast or prostate cancer (#2, for women and men, respectively), not colon cancer (#3 for both) or skin cancer (doesn’t even make the top ten). In fact, the lung cancer mortality rate (the number of deaths per 100,000 people) is more than double the rate of the number two cancer killers. Just to give you an idea, in the US in 2009, there were 205,974  people diagnosed with lung cancer: 110,000 men and over 95,000 women. In that same year, 158,000 people died of lung cancer.

This means that most of us know someone who has had lung cancer. Don’t you?

When I was thirteen, my godfather (a career bus driver for Golden Gate Transit and gifted salmon fisherman) died just three months after being diagnosed with lung cancer. He was a lifelong smoker. Almost ten years later, my mother’s mentor (a grandmother-figure for me) also died less than six months after being diagnosed. She was a prolific artist and a retired kindergarten teacher; she had been a smoker for over 40 years but had quit about 15 years before her diagnosis.

As a family doctor, I see lung cancer with some frequency. Just last week,  I was working at the hospital and a healthy 50-ish woman came in after several months of feeling short of breath. She, too, had been a long-time cigarette smoker but had quit eight years ago when her own mother died of lung cancer. Because she had no health insurance (cue for another post: uninsured in America),  her family doctor tried to avoid an expensive evaluation (a single chest radiograph can cost over $150), treated her for bronchitis, pneumonia, then COPD (chronic lung disease from smoking). Eventually, an x-ray showed an unmistakable lung cancer.

Last year, one of my favorite patients, a garrulous retired umpire and amateur historian who always had at least one joke for me during our clinic visits (usually clean jokes but occasionally a little off-color) passed away from metastatic lung cancer. Amazingly, he survived for more than 18 months after his diagnosis and was able to get a few things ‘in order’ before he died. Most important to him was  to donate his body to a medical school so that medical students could learn from him . And he did it! (cue another post: body donation)

And, in the plus column of cancer advances, also last year, one of my dearest patients was actually declared ‘cancer free’ from his inoperable lung cancer five years after he went through intensive chemotherapy and radiation.

Unfortunately, most everyone you or I have ever known with lung cancer has been really quite ill by the time they were diagnosed. (Studies show that 75% of people with lung cancer present ill with metastatic and/or incurable disease at time of diagnosis). And, unlike breast cancer (though, mammograms aren’t perfect-- another future post: mammograms) and cervical cancer (pap smears and HPV testing have revolutionized us: pap smears), historically we just haven’t had good ways to screen ‘healthy people’ for lung cancer.

Well, the new news in lung cancer is maybe times are changin’.  

We may actually start screening our highest risk patients for lung cancer. Soon.

Just to be clear remember that a SCREENING test is a test of totally well person to ‘screen’ for a disease, while a DIAGNOSTIC test is as test on a patient who comes in with symptoms (e.g. cough, weight loss, etc).

Just this week the United States Preventive Task Force (USPSTF-- you should know that  the USPSTF is one of my favorite go-to bible-sources. I consider them one of the most unbiased, non-partial, uninfluenced by finances official body who makes recommendations about various medical conditions) put out a DRAFT new recommendation, updated from their previous recs in 2004, in support of annual lung cancer screening, using annual low dose CT scans, for people ages 55-79 who have at least a 30 pack year smoking history (and have smoked in the past 15 years).

Why did they make this change?
There have been seven studies in the last 15 years looking at low dose CT scan screening for lung cancer. The largest, the National Lung Screening Trial (NLST) published in 2011, looked at 53,454 current or former smokers. This study showed that patients getting a low-dose helical CT scans  every year for three years had a 20% lower risk of dying from lung cancer  (and  a 6.7% lower risk of dying from all causes) than people who received chest X-rays every year. They reported that we need to screen 320 patients one time with a CT scan to prevent one lung cancer death. (This is called the NNT) Of note, three smaller European studies (all with under 5,000 patients) patients found no benefit to screening.

What does this mean for me?
Well first, off, I will stick with a hard party line. If you don’t smoke, don’t start. If you do, then quit. Now. Then you hardly have to worry about this stuff! However, if you are between the ages of 55 to 79 and are either a current smoker (for at least 30 pack years) or quit in the last 15 years, you might want to talk to your primary care doctor about getting a low dose CT scan. Remember, there is still radiation involved and no test is without risk The good news from a financial perspective is that the current ACA (Obamacare) agrees to cover All Grade A and B recommendations, so this study should be covered if you have health insurance (including Medicare, CMSP, MediCal, etc)

What are the risks?
Radiation exposure: radiation associated with one low dose CT ranged from 0.61 to 1.50 mSv
False positives: remember not every test result that comes back bad means there is something bad actually happening. This is one of the trickiest areas of medicine because people really want to trust tests, but tests are not perfect.
False reassurance: Screening tests don't necessarily pick up every cancer either, so just because your CT scan was normal doesn't mean you don't have cancer (yup, that's an uncomfortable one to swallow).
Overdiagnosis: Just like with other types of cancers (and even less worrisome illnesses like herpes or strep throat), the more we screen for the things, the more we find. We may find that some lung cancers picked up screening would have never progressed to make anyone sick, but it would be impossible to tease that out.

How does this change the game?
In two major ways: 1) If the USPSTF rating remains at B, then lung cancer screening will join other common cancer screenings (like breast and colon cancer screening) as covered entities under the Affordable Care Act (i.e. it will be covered by your health insurance) and 2) Smokers are going to get quite a few CT scans in their lifetime.

So, I have a better idea, how about you just put out that cigarette and call it quits, keep yourself out of this risk pool and call your mom?


  1. I got my first electronic cigarette kit off of VaporFi, and I enjoy it a lot.

  2. Using electronic smokes may well not solution your own tobacco dependency completely. However, it can be stated that the employ of digital camera cigarettesis much a lesser amount of harmful compared to smoking tobacco cigarettes.They genuinely is usually a healthier alternative. Buy one in electronic cigarette online store is a nice choice.

  3. How to Order Prescription Drugs Safely Online | Where to Order Prescription Drugs Safely Online.
    Where to Buy Research Chemicals Online | Buy Barbiturates Online | Buy Human Growth Hormone (HGH) Online

    We supply good quality Benzodiazepines, Pain Medications, Anxiety Medications, Relief Medications, Insomnia Medications, Weight Lost

    Medications, Stimulants, Opiate/Opioid, Research Chemicals, etc...
    We ship with the United States and we do ship worldwide as well with tracking number provided.
    We now offer 30% Discount, Contact us or Check out Our stocks and Prices using the details below:

    Text: +1 (706) 873-1642,
    Whatsapp: +1 (706) 873-1642,
    Wickr Id: jasonstewart


    - Buy With Bitcoin or Other Cryptocurrencies.
    - Good quality Chemicals.
    - Good and affordable prices.
    - 100% Money Back Guaranteed!
    - Fast and Reliable delivery With Tracking Available!
    - Various shipping option (Overnight and Airmail).
    - Buy Direct and Save Time and Money!
    - 100% Customer Satisfaction Guaranteed!

    ** Medications **
    We do sell meds such as:

    - Buy Oxycontin Online
    - Buy Roxycodone Online
    - Buy Rohypnol Online
    - Buy Opana Online
    - Buy Ativan Online
    - Buy MSContin (Morphine Sulfate) Online
    - Buy Klonopin Online
    - Buy Phentermine Online
    - Buy MDMA (Pills and Powder form) Online
    - Buy Percocet Online
    - Buy Lortab Online
    - Buy Norco Online
    - Buy Codeine Pills Online
    - Buy Suboxone Online
    - Buy Methadone Online
    - Buy Valium Online
    - Buy Hydrocodone Online
    - Buy Desoxyn Online
    - Buy Xanax Online
    - Buy Dilaudid Online
    - Buy Actavis Promethazine Codeine Purple Cough Syrup Online (16oz and 320z)
    - Buy Ambien Online
    - Buy Adderall Online
    - Buy Ritalin Online
    - Buy Vicodin Online
    - Buy Ketamine Online
    - Buy Soma Online
    - Buy Viagra Online
    - Buy Dexedrine Online
    - Buy Mandrax Online (Quaalude)
    - Buy Fentanyl Online
    - Buy Demerol Online
    - Buy Lyrica Online , etc.
    For more visit:

    ** Barbiturates **
    - Buy Nembutal (Pentobarbital Sodium) Online
    - Buy Seconal (Secobarbital Sodium) Online
    - Buy Luminal (Phenobarbital) Online
    - Buy Butisol (Butabarbital Sodium) Online
    - Buy Pentothal (Thiopental Sodium) Online
    - Buy Brevital (Methohexital) Online
    - Buy Donnatal (Belladonna and Phenobarbital) Online
    - Buy Mebaral (Mephobarbital) Online
    For more visit:

    ** Research Chemicals **
    - Buy Etizolam Online
    - Buy Ketamine Online
    - Buy 25I-NBOMe Online
    - Buy 3-MMC Online
    - Buy Mephedrone Online
    - Buy Ephedrine Hcl Online
    - Buy Esctacy Online (MDMA)
    - Buy A-pvp Online
    - Buy Crystal Meth Online
    - Buy JWH 250 & 180 Online
    - Buy Mdpv Online
    - Buy Mexedrone Online
    - Buy Bk-2C-B Online
    - Buy Ethylone Online , etc....
    For more visit:

    ** HGH and Steroids **
    We do sell HGH and steriods such as:

    - Buy Sustanon Online
    - Buy Winstrol Online
    - Buy Anavar Online
    - Buy Clomid Online
    - Buy Dianabol Online
    - Buy Testosterone Online
    - Buy Omnadren Online
    - Buy Dianabol Online
    - Buy Trenbolone Online
    - Buy Deca Durabolin Online
    - Buy Riptropin Online
    - Buy Jintropin Online
    - Buy Igtropin Online
    - Buy Hypertropin Online
    - Buy Hygetropin Online
    - Buy Ansomon Online
    - Buy Kigtropin Online and variety Steroids available.
    For more visit:

    ** Marijuana strains **
    - Buy AK-47 Online
    - Buy Og Kush Online
    - Buy Sour diesel Online
    - Buy White Widow Online
    - Buy Hindu Kush Online
    - Buy Blueberry/Blackberry Kush Online , etc
    For more visit:

    Other good stuffs like:
    - Buy Potassium Cyanide (KCN) Online
    - Buy Ketamine Online
    - Buy MDMA (Ecstasy) Online
    - Buy Carfentanil Online

    Are also available. Just have a look at our website for more products, feel free to have a look:


    Text: +1 (706) 873-1642,
    Whatsapp: +1 (706) 873-1642,
    Wickr Id: jasonstewart