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Celebrity cases spur demand for lung cancer test
By Marilynn Marchione
Aug. 21, 2005 - If a simple, painless test can find the worlds deadliest cancer when it is smaller than a pea and such a test does indeed exist shouldnt people who are most at risk have one?
Surprisingly, the federal government, American Cancer Society and a raft of cancer specialists say the answer is no.
They are waging an uphill battle as frightened current and former smokers rush to get a special kind of X-ray that other physicians are urging for lung cancer detection but that has not yet conclusively been shown to save lives.
A huge federal study is under way to see whether it can, and answers may come as soon as next year. In the meantime, its generating a classic cant wait for science stampede.
The clamor rose recently with the deaths of newsman Peter Jennings and Dallas star Barbara Bel Geddes, and the news that Superman widow Dana Reeve has lung cancer.
Patricia Dowds and her husband, David Byrom, psychologists from Long Island, are among the many former smokers who voted with their wallets and had the $300 test recently.
We do it for our own peace of mind, Dowds said.
No one disputes that the test, called a spiral or helical CT scan, detects lung abnormalities as small as 5 millimeters less than a fifth of an inch.
The argument is over whether thats a good thing.
For every cancer these scans detect, many more false positives occur harmless bumps and lumps leading to painful, expensive and unnecessary biopsies and surgeries. Complications can include lung collapse, bleeding and infection.
The concern that we have is false positive rates, which range from 25 percent to as high as 60 percent, said Tom Glynn, the cancer societys director of science and trends. What we dont want to do is create even more anxiety by backing a test that is so imprecise, he said.
Even when cancers are found, experts argue about whether thats a benefit or a risk. No one knows how many of these tumors are so slow-growing that they pose less of a health threat than the surgery, radiation and chemotherapy used to treat them.
However, screening proponents say theres no mystery about how deadly the disease is and that survival improves the sooner it is detected. About 172,570 Americans will be diagnosed with lung cancer this year and almost as many, 163,510, will die of it.
The morning after Jennings death, the chairman of internal medicine at St. Louis University, Dr. D. Douglas Miller, contacted the public relations staff, urging them to get out the word on lung CT scans benefits.
Dr. Len Horovitz, a lung specialist at Lenox Hill Hospital in New York City, also has been urging the test. Though theres no proof yet that it improves survival, I cant believe it wouldnt, he said. There are half a dozen people I could bring into my office today who are alive for that reason.
As for the risk of unnecessary follow-up procedures, You dont have to biopsy everything you see, Horovitz says. You could also elect to watch it, and do a biopsy only if the lump appears to be growing.
The scans biggest proponent is Dr. Claudia Henschke, director of the Lung Cancer Screening Program at New York-Presbyterian Hospital/Weill Cornell Medical Center, who published a landmark paper in 1999, reporting that the scans found far more lung tumors than conventional chest X-rays.
We feel we have evidence that CT screening saves lives, not just from that 1,000-person study but follow-up work on 30,000 patients around the world, she said.
But her study isnt considered the gold-standard kind of evidence that insurers, policy-makers and scientists require. That will come from the huge randomized screening study the National Cancer Institute commissioned after Henschkes paper appeared. The cancer society, the American College of Radiology and other professional groups are participating in the enormous effort.
As an indication of how eagerly anticipated this study is, doctors allowed themselves two years to recruit 50,000 people for it and got 53,000, four months ahead of schedule, said Dr. Denise Aberle, the University of California at Los Angeles scientist leading the study. It will compare regular chest X-rays to CT scans and see whether either improves survival.
If it shows benefit, I would feel great, Aberle said, but wont recommend it until then, and a lot of my peers and the scientific community are not.
One is Mary Yagjian, coordinator of lung screening at the University of Pittsburgh Cancer Institute, who advised against testing for her own 82-year-old mother, a former smoker at high risk of lung cancer.
Shes scared to death about getting it, and has a brother just diagnosed with cancer and a friend going through a recurrence now, according to Yagjian.
Its important that we complete the definitive studies and get scientific information, said Dr. Christine Berg, chief of the early detection research group at the cancer institute. In the meantime, doctors have to do the best they can to advise each patient, considering that persons smoking history and other risk factors.
Its the physician-patient relationship thats paramount, she said.
As contentious as CT scans are, some people are seeking even more controversial tests whole body scans. Two years ago, at the insistence of his wife who did not trust the clean bill of health hed gotten from a regular chest X-ray, Hy Muroff of Windsor, Ontario, went to see Dr. Marc Kahn at EBT-Heart & Body Imaging in the Detroit suburb of Southfield, Mich.
Muroff, 78 at the time, had smoked but not in 20 years. The scan showed a tumor behind his heart; the growth was removed in surgery. He called to schedule another full-body scan a few weeks ago, after hearing that Jennings was diagnosed with lung cancer, to make sure his disease hadnt recurred.
People should get such scans, Muroff said, only if you want to stay alive.
Asbestos fears dog cyclone relief effort
The head of the cyclone reconstruction team in far north Queensland, General Peter Cosgrove, says he is concerned about the risk of asbestos in affected areas.
The Workplace Health and Safety Department has issued warnings about handling asbestos, which is a material that is found in almost all Innisfail homes.
It is asking residents to wear gloves and face masks when cleaning up the material, which can cause lung cancer.
Gen Cosgrove says he is now looking into the situation.
"The state health service is well aware of that and where that sort of treatment of rubble has to take place, appropriate actions will take course," he said.
A service to give thanks that no one was killed or seriously injured during cyclone Larry will be held this morning in Innisfail.
Hundreds of people are expected to gather for a church service in Innisfail in far north Queensland today to give thanks no one was killed during Cyclone Larry almost a week ago.
Gen Cosgrove says the service will have two purposes.
"It's going to be the community giving thanks for being spared any loss of life," he said.
"And also no doubt to say thank you to all the people far and wide who helped."
In a major step forward, power has been restored to a small number of residents in Innisfail.
However, cyclone victims in the Atherton Tablelands have been told it could be weeks before power is restored.
The disaster period declared in the wake of the cyclone has been extended by one week.
Queensland Premier Peter Beattie says it means emergency services can continue to do everything possible to protect people living in the cyclone-affected area.
He says it also means authorities can move people away from highly dangerous homes and structures, fallen power lines or other high risk situations.
"I'm hopeful we don't need to use these powers," he said.
"What we try and do is actually persuade people, like we'd come and say to you, look you need to move out of your house because if we connect power, this could in fact kill you.
"We need to be able to move you out until we do this various work, then we can move you back.