Posted by - J. Rand Baggesen, M.D.

In our continuing discussions on how technology can improve your health, this month’s column will investigate the recent advances in lung cancer detection. Lung cancer remains the number one cancer diagnosed in America with about 175,000 new cases last year. More people die of lung cancer than colon, breast and prostate cancer combined. Lung cancer survival depends primarily on the extent of disease at the time of diagnosis, thus the earlier we can find the problem, the better the chance for cure. The International Early Lung Cancer Action Program Investigators Study has been following over 31,000 individuals at high risk of lung cancer to find how and if technology can speed early diagnosis.

So who should be screened and how can technology help? Most studies have been focused on smokers. 87% of lung cancers are smoking related but there are other risk factors. Asbestos, radon and radiation exposure are all put you at risk. Most experts agree that a person with a ten year or more smoking history, persons older than 65 or those with other risk factors should undergo “screening”. Like many “new” things in medicine, there are not yet recommended standards for screening. You need a doctor’s prescription to undergo any medical testing so it’s always recommended you speak with your physician to determine what’s right for you.

Various screening strategies used in the past have focused on sputum examination, chest x-ray, bronchoscopy and other non-imaging techniques. None of these methods proved able to identify cancer at a stage when treatment improved outcome. Four medical studies have clearly shown no benefit from chest x-ray screening for lung cancer. By the time a tumor can be seen, it’s too late. Enter today’s highly accurate multi slice CT scan machines. These machines are able to take pictures of inside the body with great speed and detail. These new CT scanners can see masses as small as 2-3mm in size. When a tumor has grown to 1cm in size, it is already made up of somewhere near 1 billion individual cancer cells, likely by this point many of those cells have traveled elsewhere causing diffuse disease.

Multi slice, low-dose CT scanning is fast, accurate and non-invasive. The scan takes about 15-20 seconds to perform and gives relatively low dose of radiation. In a recent study, peoples whose lung cancer was found early and removed within one month, had a 10 year survival rate of 92%, an improvement from the typical 70%. In people who are diagnosed after the cancer has spread beyond their lungs, 10 year survival rates are a dismal 5%. This highlights the incredible power of new technology to change the outcome of disease. These scans are available here in the Richmond area.

What does the future hold? While the advancements in imaging technology are very impressive, the ability to see cancer remains at a level where millions of cancer cells must be present in order for it to show up. Our best imaging remains in tissue where cancer masses can be differentiated from other surrounding normal tissue. This works best in the lung and perhaps the colon. When it comes to soft tissue such as the liver, it is more difficult to visualize early cancers from normal tissue. Being able to identify cancer when it is still in a microscopic early-stage is where furious research is occurring today.

Cancer cells often produce unique proteins. The PSA blood test looks for a unique protein in the blood produced by abnormal prostate cancer cells. Other cancers make similar unique proteins that may allow us to produce a biologic marker which could attach to specific cancer cells allowing them to be identified. PET/CT scans work by identifying rapidly growing cell which pick up glucose with a radioactive tag. Cancer cells are rapidly growing and voraciously take up glucose for growth. Using these factors may allow both the detection and elimination of cancer in its early stages when the chance for cure is much higher.

Technology has revolutionalized many industries. Medicine has remained for the most part reactive in its approach to disease. Spending on treatment is often almost unlimited while prevention is not reimbursed. As the promise of technology grows and is able to provide life saving information sooner, we must all be ever open to the idea of health surveillance replacing the practice of disease treatment. Currently healthcare spending on earlier detection remains a very small fraction of our overall 1.8 trillion dollar healthcare industry.

We at the Executive Health Evaluation program believe the promise of early detection holds to key to wellness today. Detection of cancer, vascular disease and other health threats takes time and a holistic approach to your individual needs. Your health is your biggest and most important asset. For those who wish to step out of the medical line and access today’s and tomorrows latest technology, we offer a choice. The right medical studies combined with unprecedented access to your executive physician, medicine to promote wellness.

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