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NLST study offers hope for cancer
patients
by Cindy
Abole
Public
Relations
Finding a more sound screening method for lung cancer among at-risk men
and women may one day save the lives of current and former smokers
across South Carolina and the nation. The effort is a step closer to
reality and has the potential to reduce lung cancer deaths and
mortality in South Carolina while giving hope to others by improving
their quality of life.
In 2002, Hollings Cancer Center was among 29 national sites
participating in the National Cancer Institute’s National Lung
Screening Trial (NLST). The $200-million randomized, controlled study
was created to evaluate the efficacy of screening methods, chest X-ray
or spiral computerized tomography (CT) as the most ideal approach in
detecting lung cancer in men and women.
“It’s always a great thing when lung cancer is detected early in any
individual,” said James Ravenel, M.D., chief of Thoracic Imaging,
Department of Radiology and principal investigator for the MUSC/NLST
study site. “Today, more modern methods exist that can help specialists
evaluate lung cancer through screenings based on risk factors, data and
cancer survivor results. These and other questions are best answered
using a randomized, controlled trial such as the NLST.”
Lung cancer continues to be the leading cause of death among men and
women surpassing breast, prostate and colorectal cancers combined.
Today, 90 million people in the United States either are smokers or
former smokers. All of them are at risk of acquiring lung cancer and
other cancers due to long-term tobacco use. In South Carolina, almost
one-third of all cancer deaths in 2002 were caused by lung cancer
resulting in more than 2,700 deaths in 2005. Unlike successful
screening methods associated with other types of cancers, medical
specialists are continually challenged to find a key method for
detecting lung cancer at an early, curable stage, which makes a
difference in a patient’s chances for treatment and survival.
Before the NLST study, little scientific evidence was available
to prove whether screening and early detection of lung cancer using
either spiral CT or chest X-rays actually saved lives. But advances in
technology and medical expertise have improved detection methods
through the years. Conventional chest X-rays can detect tumors from 1
to 2 centimeters in size while a spiral CT scans the entire chest area
in seconds finding tumors under 1 centimeter in size. The smaller the
tumor is when found increases an individual’s chance of survival.
The NLST study, considered among the scientific community as the gold
standard for research, involved more than 50,000 participants
nationwide. At MUSC, about 580 people from areas throughout South
Carolina, North Carolina and Georgia were enrolled in the study, which
is being managed by Ravenel and his team.
Starting in 2004, trial participants have been randomly assigned to
receive either a chest X-ray or spiral CT annually for a three-year
period. After the initial assessments, study researchers will continue
to monitor their health annually and record results until 2009. Also
during that period, if a patient tested positive for lung cancer, they
received appropriate medical care and treatment. According to Ravenel,
the study’s purpose is to determine whether screening for lung
cancer will reduce lung cancer mortality. As of November, all
screenings relating to MUSC-NLST study patients were completed.
In October, results from a multinational study at New York-Presbyterian
Hospital/Weill Cornell Medical College suggested that screening
for lung cancer with CT increases chances for survival. Results were
presented in a New England Journal of Medicine report. Researchers
administered CT scans to more than 31,000 international participants
who were at-risk for lung cancer. Study results showed that CT scans
detected many small masses within the lungs of study patients. There
were 412 patients diagnosed and treated for stage 1 lung cancer and
10-year survival was estimated to be as high as 88 percent.
“Sure, the results are provocative and compelling,” Ravenel said. “But
do not provide proof that screening with CT makes a difference in lung
cancer mortality. The question of screening efficacy is best answered
in a randomized, controlled study.”
For example, it’s difficult to compare the success of mammography as an
effective screening method for breast cancer among women versus CT
scanning for lung cancer.
“It’s not a fair comparison,” Ravenel said. “Different organs offer
different risks to patients. Tumors can behave and react differently
according to treatments and patient response. All screening tests offer
pros and cons and offer both risks and benefits to patients.”
According to Ravenel, the principals of an effective screening test are
to find disease early, catch it early (before symptoms), and most
importantly, formulate a treatment plan or method that involves input
from both physician and patient that is not dangerous or harmful to the
patient. Finally, the test must show a benefit in
disease-specific mortality in large populations
For example, the idea of using advanced tools like fine needle
aspiration to biopsy lung nodules in lung cancer patients may not be as
practical for small pulmonary nodules as compared to some breast
lesions. Small screen-detected nodules ultimately turn out to be
benign, a watchful waiting approach is advocated to assess for growth.
Ravenel credits the help of many MUSC staff—physicians, surgeons,
nurses, and radiology technologists—who contributed to the success of
the NLST study, and especially the Clinical Trials Office team,
including Brad Benjamin, Tricia Adrales-Bentz, Alan Brisendine and
Paola Spicker. The study coordinators and staff were integral to
communicating and working with study participants in obtaining health
information and helping patients through the system.
“A trial like this does not run without a good study coordinator and
team. They do the lion’s share of work and we recognize it. There’s an
incredible amount of data that needs to be collected for a trial like
this to answer some of the questions. They don’t get enough
appreciation from the public as they deserve,” Ravenel said.
Ravenel and his NLST team will await final results from the multi-site
study, which are expected to be revealed in 2010. It is hoped that some
preliminary data may be available in late 2007.
“Lung cancer may not always get the fair attention it should as a
national public health issue. The development of better screening
methods for those men and women who present a higher chance of
developing the disease are all steps in the right direction,” Ravenel
said.
Friday, Dec. 15, 2006
Catalyst Online is published weekly,
updated
as needed and improved from time to time by the MUSC Office of Public
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