By CYNTHIA McCLOUD
For The State Journal
Prevention health experts declared this week longtime heavy smokers should get annual low-dose CT scans to look for lung cancer — something West Virginia University Healthcare has offered for more than a year for $99.
Insurance companies will be required by the Patient Protection and Affordable Care Act to pay for the screenings, which cost $300-$400, when the recommendations are finalized following a public comment period.
The U.S. Preventive Services Task Force recommends screening healthy persons with a 30 pack-year or more history of smoking who are ages 55 to 79 years and have smoked within the past 15 years. A pack-year means the person smoked a pack a day for a year. WVUH currently screens up to age 74.
A CT scan is better than chest X-rays at finding tumors early, when they are most treatable, in this group of 7 million Americans, the panel said.
Lung cancer is the third most common cancer and the No. 1 cause of cancer death in the United States, the USPSTF wrote. Smoking causes 85 percent of all lung cancer cases. Fewer people smoke today, but 37 percent of the nation's adults are current or former smokers. The incidence of lung cancer increases with age. Nearly 90 percent of people with lung cancer die of the disease.
The USPSTF recommendation and WVUH's project are based on research published two years ago.
"A big study by the National Institutes of Health that cost $500 million involved 50,000 patients around the U.S.," said Dr. John Parker, chief of pulmonary and critical care medicine at WVU Healthcare. "They found that if they screened for lung cancer with one of these low-dose CT scans every year for three years that they had a 20 percent improvement in survival from lung cancer.
"At WVU I believe we've found four early lung cancers, and enough time hasn't passed to know if these people have benefited from early detection," Parker said.
In addition to giving patients results of their screenings, WVUH gets them smoking cessation counseling.
"We never wanted someone to have a screening test that might be negative to justify continuing smoking," Parker said. "That's the fundamental aspect of the program. If the patient opts for pharmacological help in stopping smoking, the state Quitline provides free smoking cessation aids, not just education and counseling."
Twenty-five or 27 percent of West Virginians smoke, Parker said. Though a lot of people may be eligible, participation is low. But Parker expects participation will increase, just as it did for breast, cervical and colon cancer screenings.
The Task Force said the benefits of screening for early detection outweigh risks that include excess radiation exposure and unnecessary procedures.
"There is some concern about radiation and its effects on the body," Parker said.
"The spiral low-dose CT scan is an effort to reduce the radiation below what we use in other tests."
Doctors expect to see an abnormality on the scans.
"In up to 20 percent of people they find something," he said. "A very small percentage end up having the abnormality be lung cancer."
When something is found at WVUH, the patient is further studied either by getting a CT scan three months, six months or a year later and looking for change or by taking a tissue sample.
"Sometimes it's a small lung infection that goes away the next time we look," Parker said.
This advance in screening makes Parker hopeful.
"For the first 30 years or so that I practiced medicine, and I've been practicing for 37 years, it was frustrating to have no useful screening test for cancer of the lung," he said.
"There was really no good breakthrough. About 15 percent of people with lung cancer survived and everybody else died. Without early detection and without good therapy, we hadn't made much progress."