Baylor Dallas and Baylor Plano Monday began offering low-dose computerized tomography (CT) scans for high-risk patients who are referred by their physician and meet certain criteria.
Baylor Irving has been doing so since last fall, and expanded the service this week despite the fact that patient volume has been low in Irving.
There were two major developments regarding low-dose CT scans in May.
- The American College of Chest Physicians released guidelines that recommend that annual CT scans should be offered to current or former smokers aged 55-74 who have smoked 20 cigarettes a day for 30 years or more. An estimated 7 million Americans fall into this category.
- A New England Journal of Medicine (NEJM) study provided more details from the initial 2011 National Lung Screening Trial that indicated that low-dose CT scans were superior to chest x-rays in reducing lung-cancer deaths.
Screening is important for heavy smokers because lung-cancer symptoms often do not develop until the cancer is at an advanced stage. This makes treatment challenging. Lung cancer kills more people in the U.S. than any other cancer. It claims nearly 160,000 lives annually, which is more than breast, colon, prostate and pancreatic cancer combined. Only 16 percent of patients live five years after their diagnosis, an indication of how ineffective treatments can be.
The screening guidelines point to research that suggests that these recommendations could cut rates of lung cancer deaths in smokers or ex-smokers by around 20 percent.
However, no screening technique is without risk.
One risk, often overlooked, is the danger of false positives. For lung cancer, this usually would be when a non-cancerous lesion is detected.
However, other medical groups that have weighed in on annual CT screening for lung cancer cast a wider net. Last year, for instance, the National Comprehensive Cancer Network (NCCN) recommended screening for people 50 or older who have at least 20 pack years of smoking plus one additional risk factor, such as having chronic obstructive pulmonary disorder or a family history of lung cancer.
The NEJM authors say that more than 90 percent of nodules found by CT in the studies they looked at turned out to be benign.
This figure drops dramatically for high-risk groups, such as smokers, but one study quoted in the guidelines estimated that the false positive rate in high-risk groups could still be around 1 out of 4.
The NEJM researchers found that 27.3 percent of the low-dose CT group and 9.2 percent of the radiography group had a positive result, and 90.4 and 92.7 percent of those, respectively, underwent at least one follow-up diagnostic procedure. Lung cancer was diagnosed in 1.1 and 0.7 percent, respectively, with more stage I cancers in the low-dose CT group.
Kartik Konduri, MD, co-medical director of the Lung Cancer Center of Excellence at Baylor Charles A. Sammons Cancer Center, said of the May NEJM study: “These findings are an important step in helping to reduce the mortality rates due to lung cancer. It is the first time there has been any benefit of a screening program to show reduction in lung cancer-related mortality. It may have an important health care impact on the very large number of patients who would qualify for this type of evaluation.”
This trial also found that low-dose CT posed “few harms” when carried out in the context of a structured program of care. The risk of death or major complications from further investigations into harmless conditions was between 4.1 and 4.5 per 10,000.
Sylvia Coats, director of administration at Baylor Charles A. Sammons Cancer Center, said the expansion of low-dose CT scanning to the Dallas and Plano campuses was a matter of patient convenience. She said many primary-care physicians are not aware of the technology, and smokers are reluctant to be screened because they fear bad news.
“The earlier you have the opportunity to diagnose, the better chances are for care and survival,” she said.
Baylor University Medical Center at Dallas has been participating in a research study called the International Early Lung Cancer Action Program, which is comprised of 48 healthcare institutions in nine countries. The program is studying the benefits association with early detection of lung cancer by CT screening and seeking to develop best practices. According to the consortium, annual screening with CT scans can find lung cancers in their earliest stage, when up to 92 percent can be cured. For this research, Baylor has been performing low-dose CTs on high-risk individuals for years.
The fee for the low-dose CT is $150, which does not include the radiologist interpretation (usually around $50, but billed separately). Methodist Dallas Medical Center recently implemented a low-dose screening program that offers a CT scan and interpretation for $249.
Steve Jacob is editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected]