Savvy solution?

VINO WONG / COX NEWS SERVICE Dr. John Moore shows a retrieval tool used in thoracoscopic surgery to patient Jane Hawksworth, 70, of Dunwoody, Ga. All she had was a bad feeling. A nagging, terrifying one that sent chills up her spine and just wouldn't go away.

A cigarette smoker for 36 years, Laura O'Connor, 58, of suburban Atlanta, had tried to quit "a bunch of times." Willpower didn't work. Neither did nicotine gum. Nor itchy nicotine patches that stuck to her skin, delivering a steady jolt of the toxic drug that was supposed to ease her cravings. Even a prescription antidepressant sold as a quitting aid didn't work.

Frustrated, at the verge of giving up, O'Connor heard that WellStar Health System in nearby Marietta had been chosen to participate in a highly selective international study aimed at finding lung cancer early enough to cure it, or at least greatly prolong life.

Currently, 85 percent of people diagnosed with lung cancer in the United States will die from it within five years, "and that's unacceptable," said Dr. Bill Mayfield, principal investigator for the study at WellStar. Lung cancer claims more lives every year than breast, colon and prostate cancer combined.

Moore used these model reproductions of human lungs to help explain the surgery he performed on Jane Hocksworth. "This doesn't have to be," Mayfield said. "We can drastically reduce the death toll with early [CT] screening of people at high risk, longtime smokers and smokers who've quit. We can do for lung cancer deaths what mammography did for breast cancer, drastically reduce it."

New York's Cornell University researchers say annual screening with spiral CT scans can find lung cancers in their earliest stages, when up to 92 percent can be cured. They're leading the International Early Lung Cancer Action Program (I-ELCAP), which involves some 50 institutions in nine countries.

St. Joseph's Hospital in Atlanta will start using a new, state-of-the-art CT scanner in the next few weeks.

"That is totally against conventional wisdom that by the time lung cancer is found, it's too late," said Dr. John Moore, a thoracic surgeon at St. Joseph's. "We just joined the I-ELCAP study, but we have been using CT scanning for several years. It works."

So far, that study, which began in 1993 and is regularly adding collaborating sites, suggests that annual CT scanning is effective.

I-ELCAP researchers said in a report published in 2006 in the New England Journal of Medicine that lung cancer could be detected in its earliest stages in 85 percent of high risk patients who undergo low-dose CT scanning. It said lung cancer's high death rate is a result of it not being detected early enough.

In the past 15 years or so, "remarkable advances" have been made in CT scanners, said Dr. Paul Scheinberg, chief of staff at St. Joseph's. "Screening for lung cancer is where mammography was 30 or 35 years ago. Some said then that physicians would induce cancer in the breast with the radiation from the mammography X-rays. Now major medical groups are saying the same thing about lung cancer. But since mammography became widespread, deaths from breast cancer have plummeted. We think we'll see the same thing if more people are scanned for lung cancer. CT scans can see things X-rays miss."

Moore said "tumors seen on X-rays, most of which are found by accident or fluke, are in advanced stages, and hard if not impossible to cure or even prolong life for very long."

Jane Hawksworth, 70, of Dunwoody, Ga., is pretty typical of people without symptoms whose lung cancer was found by "sheer luck."

She had no hacking coughs, weight loss, hoarseness, fatigue or chest pain.

Instead, she was "bugged by my two daughters to go get a flu shot. All these years, I said I couldn't because I'm allergic to eggs, but to appease them, I went to an allergist. He sent me to an internist for an X-ray and a regular blood work-up. A couple of days later, she called and said, 'There's a spot on your lung.' "

So she went to St. Joseph's for tests, and soon afterward, Moore removed her tumor.

Sitting in her doctor's waiting room last week, Moore pulled out plastic models of human lungs to show Hawksworth how he'd done it.

"It's a miracle," Hawksworth said. "I'm a believer."

As was the case for mammographies several decades ago, many major doctors groups oppose routine CT scans for lung cancer, even for people at high risk — smokers or those who smoked for years and quit.

Dr. Kay Vydareny, professor of radiology at Emory University School of Medicine, said routine CT scans aren't conclusive.

"We know we can see a lot of nodules with CT, but we can't tell the difference between what's cancer and what's not," she said.

Emory is participating in a study by the National Cancer Institute designed to tell whether CT scans are better than X-rays at detecting tumors. Some of the 50,000 participants get X-rays, the others CT scans.

At Emory and many other hospitals, only patients referred by doctors get CT lung scans, which cost $200 to $400, but aren't covered by insurance unless done for diagnostic purposes. The CT scans pick up many "false positives."

Dr. Daniel Miller, surgical director of Emory's thoracic oncology program, said scientists there will soon start a randomized study in which some high-risk participants will be scanned, and others observed annually.

The NCI's study results aren't expected until 2010 or 2011.

Moore said a CT scan "is the gold standard for diagnosing lung cancer" because "there are blind places in X-rays that hide tumors."

LUNG CANCER SYMPTOMS

• Constant chest pain
• Shortness of breath
• Wheezing
• Recurring lung infections, such as pneumonia
or bronchitis
• Bloody or rust-colored sputum
• Hoarseness
• Weight loss for no known reason
• Fatigue
• Loss of appetite
• Fever for unknown reasons

HOW IT IS DIAGNOSED

• Chest X-ray, to look for any mass or spot on lungs. • Computed tomography scan (also called CT or CAT scan), uses combination of X-rays and computer technology to produce crosssectional images of the body. • Sputum cytology: A study of phlegm to look for microscopic cancer cells. • Needle biopsy: Needle guided into the mass while lungs are being viewed on a CT scan, and a sample is removed and evaluated. • Bronchoscopy: Examination of the main airways of the lungs, using a flexible tube called a bronchoscope. • Mediastinoscopy: A small cut is made in the neck so that a tissue sample can be taken from lymph nodes along the windpipe and the major bronchial tube areas, for microscopic evaluation. • X-rays and scans of the brain, liver, bone and adrenal glands to determine if the cancer has spread to other parts of the body.

RISK FACTORS

• Smoking cigarettes or cigars, now or in the past. The more a person smokes, the greater the risk. Risk diminishes for those who stop, but is never completely gone. • Being exposed to secondhand smoke. • Being treated with radiation therapy to the breast or chest. • Being exposed to asbestos, radon chromium, arsenic, soot or tar. • Living where there is air pollution. • Excessive alcohol use. • Family history of lung cancer. • Your sex. Current or former women smokers have a greater risk of lung cancer than do men who have smoked an equal amount.

Sources: National Cancer Institute; WellStar Health System, Marietta, Ga; St. Joseph's Hospital, Atlanta