Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


In the past, if your doctor diagnosed you with lung cancer, your days were numbered. In fact, you had an 88 percent chance of dying within five years. Poor odds by anybody's calculation.

To make matters worse, an ever?increasing number of Americans have been dying from lung cancer each year - at last count, over 160, 000. In the old days, women rarely suffered from this disease. Today, however, they are afflicted much more often -- probably because more and more women are smoking. In fact, among women, the death rates from lung cancer are now comparable to death rates from breast cancer. (As a Virginia Slims commercial put it, "You've come a long way, baby.")

Curing lung cancer has always been tied to early detection. The disease can be diagnosed by a chest x-ray and confirmed by microscopic examination (either by biopsy or by surgery). Sometimes a patient will be bothered by a persistent cough and go to the doctor; but by the time the symptoms appear, the disease has usually progressed too far to be treated successfully. Hence the high mortality rate.

Those patients who are cured usually have an early diagnosis followed by surgery. A number of these malignant tumors are detected almost by accident. For example, a heart patient, awaiting surgery, has a routine chest x-ray; and the radiologist, while evaluating the heart, also notes a round nodular density on the lung portion of the film . . . early diagnosis of a lung cancer.

But suppose you aren't lucky enough to be facing heart surgery? Is there any way to detect lung cancer at an early stage without undergoing frequent x-rays? A 1999 study -- conducted in New York City at the combined Cornell-Presbyterian hospital centers and published in Britain (The Lancet, vol. 354, pp. 99-105) -- provides genuine hope for early detection of the disease. In fact, this article may represent a significant breakthrough.

The study, called the "Early Long Cancer Action Project," focused on 1,000 patients over the age of 60 -- 46 percent female, 54 percent male. All were or had been smokers. All had chest x-rays and low-density radiation C.T. scans. Then researchers compared the effectiveness of the chest x-ray and the C.T. scan in diagnosing lung cancer.

The contrast was dramatic.

Lung cancer was diagnosed in 27 (2.7 percent) by the C.T. scan and only 7 (.07 percent) by the chest x-ray. In other words, the C.T. scan diagnosed early ("stage 1") cancer six times more effectively than did the chest x-ray. The five-year survival rate of patients diagnosed with "stage 1" lung cancer is 70 percent -- as opposed to a 12 percent survival rate among patients diagnosed at a later stage.

No patients in this study underwent surgery unless malignancy was verified by a biopsy. And it was clear that the cure rate depended on the stage and size of the cancerous tumor. So early detection was the chief factor in an increased survival rate.

An added benefit of this diagnostic tool: The cost of the low-dose C.T. used isn't much more expensive than the chest x-ray. So it is entirely possible that an annual C.T. scan could be performed on smokers, increasing their chances of surviving lung cancer by as much as five or six fold.

We now have another weapon in the battle against cancer -- a diagnostic tool comparable to the mammogram in providing early detection of cancer. This study should result in dramatic changes in the way doctors deal with patients who have been heavy smokers.

The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

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