News
Miriam Maslo/Science Photo Library
An international focus for lung imaging and cancer screening
Published Online November 8, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70223-6 For more on the International Day of Radiology see http://www.international dayofradiology.com/ Read Breathe Easy at http://www.international dayofradiology.com/wp_live_ idor_uai3A/wp-content/ uploads/2013/11/IDOR_2013_ ThoracicImaging-Book_Breatheeasy.pdf For the US Preventive Services Task Force draft recommendation see http://www.uspreventive servicestaskforce.org/bulletins/ lungcandrftbulletin.pdf For the joint statement on CT screening for lung cancer see http://radiologyinfo.org/en/ news/target.cfm?ID=565 For the Lung Cancer Alliance’s letter see http://www. lungcanceralliance.org/assets/ images/news/CMS-NCD%20 Request%2010_25_2013.pdf For more on the Lung Cancer Alliance’s National Framework for Excellence see http://www. lungcanceralliance.org/getinformation/am-i-at-risk/ national-framework-for-lungscreening-excellence.html For more about efforts to increase lung cancer awareness among US military veterans see http://www.lungcanceralliance. org/news/lung-cancer-alliancenews/2013/honoring-veteransand-saving-lives.html For more on the prospects for population screening and diagnosis of lung cancer see Series Lancet 2013; 382: 732–41
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The European Society of Radiology has released an update on pulmonary imaging, Breathe Easy, to coincide with this year’s International Day of Radiology on Nov 8. The Society was one of more than 100 medical societies in 57 countries that is celebrating advances in medical imaging, with an emphasis this year on lung imaging. November is also Lung Cancer Awareness month. The chest radiograph remains the standard for diagnosis or exclusion of pneumonia, pneumothorax, and tuberculosis. In London, UK, now recognised as an epicentre of tuberculosis infection in western Europe, a mobile radiography unit offers free real-time lung imaging examinations to high-risk homeless populations and individuals who use illicit drugs. The van, reminiscent of mobile units deployed throughout Europe and the USA in the 1950s, has identified one new case of tuberculosis each week, screening 10 000 people a year. But increasingly sophisticated highresolution CT techniques offer superior spatial precision and have supplanted chest radiography for the definitive assessment of pulmonary embolism, lung cancer, and diffuse interstitial lung disease—three diseases for which imaging techniques are detailed in Breathe Easy. High-resolution CT can confirm fibrosis when chest radiograph falls short, for example, and CT angiography has become the standard for assessment of lung arteries when pulmonary embolism is suspected. The International Day of Radiology “not only celebrates imaging’s tremendous contribution to medicine over the last century, but also honours…ongoing research”, says Radiological Society of North America (RSNA) president Sarah Donaldson. Breathe Easy spotlights CT lung cancer screening as a particularly “powerful” example of such research, yielding new lifesaving techniques.
“Tens of thousands of lives could be saved” by lung cancer screening and early detection, Laurie Fenton Ambrose (Lung Cancer Alliance [LCA], Washington, DC, USA) tells The Lancet Respiratory Medicine. “Screening those at high risk now will dramatically make a difference and will open the door to much faster advances in research on all stages of lung cancer.” “People are not aware of their condition until after most treatment options are no longer effective”, notes Richard Heimler (New York, NY, USA), who was diagnosed with non-small-cell adenocarcinoma in 2004. “60% of lung cancer patients die within 1 year due to the progression of cancer before it is detected.” Screening high-risk current and former smokers offers the best chance of detection of early-stage lung tumours, asserts oncologist Christopher Lathan (Dana-Farber Cancer Institute, Boston, MA, USA), citing results from the US National Lung Screening Trial. “The best way to cure lung cancer is still to take out tumours in early stages with surgery.” The US Preventive Services Task Force issued a draft recommendation in July that CT screening for lung cancer be undertaken in people aged 55–79 years who have a smoking history of 30 pack-years or more. The American College of Radiology (ACR) and RNSA have responded with a joint statement supporting that recommendation, and the ACR is developing screening guidelines and standards. Meanwhile, LCA has petitioned the US Centers for Medicare and Medicaid Services (CMS) to start a National Coverage Determination review that could lead to federal reimbursements for screening. “With the Task Force’s positive recommendation, CMS should definitely recommend screening and reimburse for screening”, Lathan suggested. Reimbursement is crucial for lowincome, high-risk patients, Lathan says.
“One of the problems is that right now there are screening programmes for lung cancer, but they cost US$300 to $400, out-of-pocket”, explains Lathan. That is prohibitive for “the very people who are at highest risk for lung cancer”, he notes: “working folks who don’t have a college degree, who have lower incomes and would benefit most from screening with smoking cessation counselling.” “That very vulnerable group— whether you’re talking about people of colour, or working-class whites, or immigrants—can least afford to pay $300 or $400”, Lathan says. “Right now, there’s a disparity; you can only access screening if you have disposable income. That’s not how the system should work.” LCA maintains a list of US centres—134 so far—that observe best screening practices, says spokeswoman Gabriele Geier. The charity also organises community vigils, and in November launched its second annual Veterans Screening Initiative at 15 centres across the USA. Even with such action, the leading cancer killer in the USA “still seems to be invisible” when it comes to public awareness and research budgets, Lathan notes. Part of the problem is social stigma associated with lung cancer, which contributes to isolation of patients and widespread underappreciation of lung cancer’s toll and diverse causes. Such stigma “is the number one reason lung cancer does not receive a fair and proportionate amount of research funding”, says Heimler. Nearly 20% of patients with lung cancer are non-smokers, Geier notes. “There’s still a lot of stigma involved with lung cancer”, agrees Lathan. “We’ve done a great job of stigmatising smoking. Unfortunately, we’ve also stigmatised lung cancer patients.”
Bryant Furlow
www.thelancet.com/respiratory Vol 1 December 2013
Miriam Maslo/Science Photo Library
An international focus for lung imaging and cancer screening
Published Online November 8, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70223-6 For more on the International Day of Radiology see http://www.international dayofradiology.com/ Read Breathe Easy at http://www.international dayofradiology.com/wp_live_ idor_uai3A/wp-content/ uploads/2013/11/IDOR_2013_ ThoracicImaging-Book_Breatheeasy.pdf For the US Preventive Services Task Force draft recommendation see http://www.uspreventive servicestaskforce.org/bulletins/ lungcandrftbulletin.pdf For the joint statement on CT screening for lung cancer see http://radiologyinfo.org/en/ news/target.cfm?ID=565 For the Lung Cancer Alliance’s letter see http://www. lungcanceralliance.org/assets/ images/news/CMS-NCD%20 Request%2010_25_2013.pdf For more on the Lung Cancer Alliance’s National Framework for Excellence see http://www. lungcanceralliance.org/getinformation/am-i-at-risk/ national-framework-for-lungscreening-excellence.html For more about efforts to increase lung cancer awareness among US military veterans see http://www.lungcanceralliance. org/news/lung-cancer-alliancenews/2013/honoring-veteransand-saving-lives.html For more on the prospects for population screening and diagnosis of lung cancer see Series Lancet 2013; 382: 732–41
764
The European Society of Radiology has released an update on pulmonary imaging, Breathe Easy, to coincide with this year’s International Day of Radiology on Nov 8. The Society was one of more than 100 medical societies in 57 countries that is celebrating advances in medical imaging, with an emphasis this year on lung imaging. November is also Lung Cancer Awareness month. The chest radiograph remains the standard for diagnosis or exclusion of pneumonia, pneumothorax, and tuberculosis. In London, UK, now recognised as an epicentre of tuberculosis infection in western Europe, a mobile radiography unit offers free real-time lung imaging examinations to high-risk homeless populations and individuals who use illicit drugs. The van, reminiscent of mobile units deployed throughout Europe and the USA in the 1950s, has identified one new case of tuberculosis each week, screening 10 000 people a year. But increasingly sophisticated highresolution CT techniques offer superior spatial precision and have supplanted chest radiography for the definitive assessment of pulmonary embolism, lung cancer, and diffuse interstitial lung disease—three diseases for which imaging techniques are detailed in Breathe Easy. High-resolution CT can confirm fibrosis when chest radiograph falls short, for example, and CT angiography has become the standard for assessment of lung arteries when pulmonary embolism is suspected. The International Day of Radiology “not only celebrates imaging’s tremendous contribution to medicine over the last century, but also honours…ongoing research”, says Radiological Society of North America (RSNA) president Sarah Donaldson. Breathe Easy spotlights CT lung cancer screening as a particularly “powerful” example of such research, yielding new lifesaving techniques.
“Tens of thousands of lives could be saved” by lung cancer screening and early detection, Laurie Fenton Ambrose (Lung Cancer Alliance [LCA], Washington, DC, USA) tells The Lancet Respiratory Medicine. “Screening those at high risk now will dramatically make a difference and will open the door to much faster advances in research on all stages of lung cancer.” “People are not aware of their condition until after most treatment options are no longer effective”, notes Richard Heimler (New York, NY, USA), who was diagnosed with non-small-cell adenocarcinoma in 2004. “60% of lung cancer patients die within 1 year due to the progression of cancer before it is detected.” Screening high-risk current and former smokers offers the best chance of detection of early-stage lung tumours, asserts oncologist Christopher Lathan (Dana-Farber Cancer Institute, Boston, MA, USA), citing results from the US National Lung Screening Trial. “The best way to cure lung cancer is still to take out tumours in early stages with surgery.” The US Preventive Services Task Force issued a draft recommendation in July that CT screening for lung cancer be undertaken in people aged 55–79 years who have a smoking history of 30 pack-years or more. The American College of Radiology (ACR) and RNSA have responded with a joint statement supporting that recommendation, and the ACR is developing screening guidelines and standards. Meanwhile, LCA has petitioned the US Centers for Medicare and Medicaid Services (CMS) to start a National Coverage Determination review that could lead to federal reimbursements for screening. “With the Task Force’s positive recommendation, CMS should definitely recommend screening and reimburse for screening”, Lathan suggested. Reimbursement is crucial for lowincome, high-risk patients, Lathan says.
“One of the problems is that right now there are screening programmes for lung cancer, but they cost US$300 to $400, out-of-pocket”, explains Lathan. That is prohibitive for “the very people who are at highest risk for lung cancer”, he notes: “working folks who don’t have a college degree, who have lower incomes and would benefit most from screening with smoking cessation counselling.” “That very vulnerable group— whether you’re talking about people of colour, or working-class whites, or immigrants—can least afford to pay $300 or $400”, Lathan says. “Right now, there’s a disparity; you can only access screening if you have disposable income. That’s not how the system should work.” LCA maintains a list of US centres—134 so far—that observe best screening practices, says spokeswoman Gabriele Geier. The charity also organises community vigils, and in November launched its second annual Veterans Screening Initiative at 15 centres across the USA. Even with such action, the leading cancer killer in the USA “still seems to be invisible” when it comes to public awareness and research budgets, Lathan notes. Part of the problem is social stigma associated with lung cancer, which contributes to isolation of patients and widespread underappreciation of lung cancer’s toll and diverse causes. Such stigma “is the number one reason lung cancer does not receive a fair and proportionate amount of research funding”, says Heimler. Nearly 20% of patients with lung cancer are non-smokers, Geier notes. “There’s still a lot of stigma involved with lung cancer”, agrees Lathan. “We’ve done a great job of stigmatising smoking. Unfortunately, we’ve also stigmatised lung cancer patients.”
Bryant Furlow
www.thelancet.com/respiratory Vol 1 December 2013
