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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
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