UNMC to launch unique lung cancer screening program

by Karen Burbach, UNMC public affairs | August 11, 2005

In the wake of ABC anchorman Peter Jennings' death from lung cancer, University of Nebraska Medical Center officials have announced a unique statewide effort to identify potential lung cancer early through CT scans provided by participating hospitals across the state.

Lung cancer facts

Lung cancer is the leading cancer killer in both men and women in the United States. In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women.  

Lung cancer causes more deaths than the next three most common cancers combined (colon, breast and prostate). An estimated 163,510 deaths from lung cancer will occur in the United States during 2005.

Smoking is the most important cause of lung cancer in the United States. It is estimated that 87 percent of lung cancer cases are caused by smoking. Other causes include radon, asbestos and air pollution.

Source: American Lung Association

Beginning this fall, study participants will see whether periodic CT (computed tomography) scans can detect lung cancer -- the deadliest cancer in America -- in its earliest and most treatable stages in current and former smokers, who are most at risk.

"This type of screening has never been done before on a statewide basis," said Ken Cowan, M.D., Ph.D., director of the UNMC Eppley Cancer Center. "Given the rural nature of Nebraska, the Internet becomes an essential tool for this study. We will use Web-based systems to help train physicians across the state in order to provide the same cutting-edge technology for lung cancer screenings for all Nebraskans. If our effort succeeds, we could help shape lung cancer screening programs in other states and give new hope to people at risk for lung cancer.

"Using an extensive questionnaire given to each study participant, we will be studying other factors such as family history and other environmental exposures that can influence the risk of getting lung cancer."

Nationally, nearly 60 percent of those with lung cancer die within one year of diagnosis and nearly 75 percent die within two years of diagnosis. About 87 percent of those diagnosed with lung cancer are current or former smokers. Last year, more than 170,000 new cases of lung cancer were diagnosed in the U.S., and nearly 160,000 people died from the disease. In Nebraska, 895 people died of lung cancer, while more than 1,000 were diagnosed with the disease.

Jennings, who announced in April that he had lung cancer, died Sunday at age 67. On Tuesday, Dana Reeve, 44, wife of the late actor Christopher Reeve, announced that she has lung cancer.

The leading cause of cancer death worldwide, lung cancer is curable in its earliest stages, however, the prospects for cure are quite low when it is detected in advanced stages. Unfortunately, the symptoms of lung cancer - coughed-up blood, chest pain or a hoarse throat - often appear when the cancer already has spread beyond the lungs and when chemotherapy isn't likely to stop the cancer.

It's unclear whether annual or periodic CT scans will reliably detect and improve outcomes, Dr. Cowan said. But, Claudia Henschke, M.D., Ph.D., and David Yankelevitz, M.D., researchers at Cornell University in New York recently reported early findings of an ongoing international study involving CT scans of more than 30,000 current or former smokers. At this point, they said, 80 percent of the lung cancers they've detected have been in the earliest stage.

While chest X-rays can detect lesions about the size of a dime or larger, CT scans can detect lesions almost 10 times smaller. "The hope is that CT scans will provide an early detection of lung cancer and improve survival in people diagnosed with a disease which we haven't been able to change the outcome of for years," said Craig Walker, M.D., chairman of the UNMC Department of Radiology. "The outcome currently is poor because often lung cancer is diagnosed in the late stages. The hope with early detection is early treatment and thus, ideally, better outcomes."

One year ago, UNMC began planning the statewide screening study, based on the Cornell University model. The study, called the Nebraska Early Detection and Informatic Technology study or NEED-IT, soon will begin enrolling those with a smoking history of at least 30 pack-years (1 pack a day for 30 years or 2 packs a day for 15 years). Eligible participants will receive free CT scans annually for five years.

In addition, the statewide consortium will provide training for physicians on the use of state-of-the-art imaging to detect lung cancer and on approaches to optimize smoking-cessation programs.

UNMC's hospital partner, The Nebraska Medical Center, will pay for the first 500 subjects. Dr. Cowan hopes to secure federal or grant funding to expand the program across the state, although a handful of Nebraska hospitals already are joining the effort. "At this point, each hospital and physician that agrees to participate will provide free scans and services for each patient," Dr. Cowan said. "It's the right thing to do and hospitals and physicians across Nebraska are willing to donate their efforts to decrease the burden of lung cancer in Nebraska."

Among the participating hospitals is the Regional West Medical Center in Scottsbluff, Neb., which has CT-scanned about 140 current and former smokers for lung cancers in the past two years, according to Thomas White, M.D., a general surgeon who heads their study.

"As a lung cancer surgeon, I was frustrated with the proportion of lung cancer patients that present with late stage disease," Dr. White said. "Early stage surgery is the primary modality for curing people with lung cancer, but patients in Stage 3 and 4 are not going to be cured."

Dr. Yankelevitz, professor of radiology at the Weill Medical College of Cornell University and attending radiologist at NewYork-Presbyterian Hospital, applauds the Nebraska study. "The best way to ascertain the real value of screening for lung cancer is by offering it to a large proportion of the population where you can see its overall effectiveness," he said. "That is something Nebraska will uniquely be able to do."

Unlike the Cornell study, Dr. Yankelevitz said Nebraska will be able to proportionately reach a larger segment of the population and involve all the major hospitals to get a real sense of whether CT screening influences the overall rate of lung cancer deaths in the state. "That's what's so exciting about this trial," he said.

Nebraska's study provides an opportunity to do more complete public health research, said James L. Mulshine, M.D., vice president for research and associate provost for research at Rush University Medical Center in Chicago. An internationally recognized expert in lung cancer research, Dr. Mulshine formerly served as head of the Intervention Section, Center for Cancer Research at the National Cancer Institute.

"The challenge with early disease detection is that those who need it most usually have the least access to services," Dr. Mulshine said. "It is vital to make early detection services available to all people, especially those at highest risk. In a thoughtful, careful and thorough way, the people in Nebraska are trying to overcome issues of health disparities and provide the same state-of-the-art screening to everyone at high risk for lung cancer in Nebraska.

"Lung cancer screening with CT is very promising technology and major national trials are underway to look at whether this tool is associated with a mortality reduction, which is the gold standard for success of the screening tool. In parallel, we are looking at issues of how to best deploy this tool, understanding it has a major impact on how the whole patient is managed."

June Ryan, program manager of the Nebraska Comprehensive Cancer Control Program called Nebraska C.A.R.E.S. (Cancer Awareness, Research, Education and Service), praised the UNMC Eppley Cancer Center on its lung cancer screening program. "Increasing cancer screening and early detection is one of the six goals in the Nebraska C.A.R.E.S. State Plan," Ryan said. "Lung cancer is the leading cause of cancer mortality in Nebraska, accounting for more than 25 percent of cancer deaths, and statewide efforts aimed at early detection are definitely needed to help patients with this disease."

Nebraska C.A.R.E.S. involves a collaboration of 225 individuals representing more than 125 organizations across Nebraska, including the UNMC Eppley Cancer Center.