Cancer mortality is decreasing and we're just getting started

Cancer mortality is decreasing and we're just getting started
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This month the American Cancer Society (ACS) delivered good news to start the new year: steady progress has led to a drop of over 29 percent in cancer deaths since 1991. The dramatic decrease has led to an estimated 2.9 million lives saved in the last 25 years. 

Over the past decade, the improvement in overall cancer survival is mostly a result of better outcomes for patients with melanoma and lung cancer. The latter is especially significant because it is the leading cause of cancer deaths in both sexes. Lung cancer — which is my specialty — kills more people every year than colon, breast, prostate, and brain cancers combined.  

But as the ACS’s report indicates, we are starting to turn that grim statistic around. The reasons are many. Fewer patients have presented with the disease, largely as a result of less cigarette smoking. Also, we have new, more potent drugs to fight tumors in those with advanced lung cancer.

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Finally, although the adoption has been less than desired, Americans have increased their use of CT scan screening for early lung cancer detection, which has allowed us to catch small tumors before they spread and become less treatable. 

Before we uncork the champagne and declare victory over lung cancer, however, we need to face a sobering fact. The overall survival of lung cancer in the US remains low. Currently, only 22 percent of patients are alive five years after diagnosis.

That rate is despite advances in surgical techniques, new systemic immunotherapies, and targeted agents. 

If we want to turn lung cancer survival rates around, we need to find it much sooner and much more often. Consider that lung cancer detected in the early stages has a survival rate approaching 90 percent in many series. 

More good news: The government pays for screening CT scans in patients that meet criteria, based on a clinical trial demonstrating that screening saves lives. Yet, despite the fact the test is available and free, less than 5 percent of eligible American former or current smokers avail themselves of this potentially life-saving test.  

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One of the significant obstacles to improving this number is the restrictive criteria agreed upon by the Center for Medicare and Medicaid Services (CMS), the government’s approving body, to cover the cost of CT screening for lung cancer. 

On average, a patient needs to be between 55 and 78 years old, have smoked a pack a day for 30 years, and not have quit more than 15 years ago. These are indeed the highest risk folks. The older you are and the longer and heavier you smoke, your risk goes up for lung cancer. That said, the risk is substantial in patients well before they log in 30 years of solid smoking.

Government and private insurance, along with health care provider organizations, should redouble their efforts to expand lung cancer screening. 

To start, the criteria should be broadened to all current or former smokers with significant exposure. In time, we should consider expanding it to a wider age group. The additional expense to screen more people will almost certainly be offset by the decreased need for high-cost new cancer drug therapies and lost productive years. 

At the same time, hospital systems and managed care should insist on lung cancer screening in patients who meet current and future criteria. Campaigns to educate patients and caregivers about the lifesaving power of early detection need to be implemented in earnest. 

The importance of these screening CT scans cannot be overstated. A screening CT scan for lung cancer carries minimal risks, and 1 out of every 25 scans performed identifies lung cancer (most often early stage and curable).  

The cost per scan is a few hundred dollars; this is a bargain compared to the extremely high cost of newer cancer drugs that, while more effective, rarely cure patients. 

Even with less than 5 percent of eligible patients receiving screening CT scans, we have seen the needle move where cancer survival has significantly improved. Imagine if we could get the majority of eligible patients screened — the number of lives saved would be exponentially greater and then we’d have something to celebrate.

Michael Liptay M.D. is a lung surgeon with a fellowship at Rush University Medical Center in Chicago.