GJ study well ahead of nation on CT scans for lung cancer
If it’s possible that there is a good place to have lung cancer, then that place is Grand Junction, and it has been for the past few years.
While the rest of the world learned earlier this month that early detection can result in greater survival rates for lung-cancer sufferers, physicians in Grand Junction already knew it.
A five-year study conducted by Dr. Joel Bechtel, a Grand Junction pulmonologist, in concert with Dr. William Kelley and other physicians, the Saccomanno Research Institute and Primary Care Partners, demonstrated the significance of early detection.
The study, which covered 100 patients from 2001–2006, ended up discovering 18 cancers all told, Bechtel said.
At the five-year mark, the study group showed a 50 percent survival rate, “which beats the heck out of 14 or 15 percent,” Bechtel said, referring to the national average for the five-year survival rate for patients diagnosed with lung cancer.
The National Lung Screening Trial, conducted by the National Cancer Institute, recently trumpeted a 20 percent reduction in the death rate for people who underwent annual screenings that included computed tomography, or CAT, scans. The CT scans were compared to patients who underwent only x-rays.
The CT scans also subject patients to less radiation than x-rays.
The national study covered more than 53,000 middle-aged and elderly people who once smoked heavily.
The cancer institute said the study had the potential “to save many lives among those at greatest risk for lung cancer.”
That’s by no means a small number. The institute estimated that 222,500 Americans will be diagnosed this year with lung cancer and that 157,000 patients suffering from the disease will die from it this year, Bechtel said.
Among all the cancers, “Lung cancer is the most lethal malignancy,” Bechtel said.
Of 100 people diagnosed today with lung cancer, 14 or 15 will still be alive in five years. The five-year survival rate for colon cancer? Sixty-four percent. It’s 88 percent for breast cancer and 97 percent for prostate cancer.
One possible reason for the lethality of lung cancer is the lack of tools aimed at early detection.
Grand Junction is home to one of the pioneering methods of early lung cancer detection, a technique known as sputum cytology. It amounts to having a patient cough up mucus from the lungs that can be studied under a microscope for the presence of cancerous cells.
Dr. Geno Saccomanno discovered that sputum could yield important early clues to lung cancer as he studied uranium miners, many of whom also were smokers.
At least as far as seeking out ways to detect lung cancer early on, “The world is finally catching up” with Saccomanno, Bechtel said.
“When Geno did it, it was all sputum cytology, There were no CT scans,” Bechtel said. “Now we’re finding out that the CT scan is a dynamite tool.”
Sputum cytology is “like a minibiopsy” of the lung, Bechtel said. “But there’s one big problem. It’s very difficult to interpret.”
Identifying cancerous cells under the microscope requires a practiced eye.
There’s another issue, as well. Sputum cyctology works well to detect tumors in the central parts of the lung, not so much in the peripheral parts, Bechtel said.
But cytology can pick up the earliest indicators of problems, ones too small to detect in any other way.
So, Bechtel said, the best approach seems to be combining the cutting-edge CT scans, which the Grand Junction and national studies showed to be the most powerful early-detection tool, and the decidedly less glamorous approach of examining mucus slides under a microscope.
The Grand Junction findings have been published in two professional journals and presented at a conference in Barcelona, Spain.
Patients are likely to see increased emphasis on the use of CT scans because “all the gurus are touting this as a huge improvement in cancer detection,” Bechtel said.
The discovery, though, underscores something else, Bechtel said: “We were dead wrong on not doing surveillance for lung cancer.”