Low-dose CT scans find lung cancer before X-rays, save lives

Low-dose computed tomography, commonly known as CT scans, are reducing lung-cancer deaths by finding the cancer early before it spreads to other parts of the body, UK HealthCare reports. Used as a screening tool, the American College of Radiology says CT is "the only test ever shown to reduce mortality in high-risk smokers."

This is good news for Kentucky, which leads the nation in both lung cancer and deaths from it.  It also leads, by some estimates, in smoking, the leading cause of cancer.  An estimated 25 to 28 percent of Kentuckians are smokers, compared to 18 to 19 percent nationally.

Low-dose CT screening for lung cancer is recommended for high-risk patients, defined in a Mayo Clinic article as someone 55 to 79 who's smoked the equivalent of a pack of cigarettes every day for 30 years, or those 50 and older who have smoked a pack a day or more of cigarettes for 20 years or longer and have one additional risk factor for lung cancer.

Chest X-rays, the other screening technique, typically are not done until a person has symptoms because studies have shown that they are not effective in detecting lung cancer early. However, researchers have found that heavy smokers screened with low-dose CT scans can pick up much smaller tumors than chest X-rays and have a "20 percent lower risk of dying from lung cancer than those screened with chest X-rays," UK HealthCare reports.

A recent study found that nearly one in five lung tumors detected on CT scans are probably so slow-growing that they would never cause problems, reports Lindsey Tanner of The Associated Press. These tumors are not false positives, but cancerous tumors without symptoms, which are unlikely to become deadly, according to the research. However, National Lung Cancer Screening Trial results conclude that the benefits from low-dose CT scans significantly outweigh the "comparatively modest rate of over-diagnosis," according to the American College of Radiology. "Overdiagnosis is an expected part of any screening program and does not alter the benefits you get from the screening,"

Dr. Paul Ellenbogen, chair of the American College of Radiology Board of Chancellors, said in the release, "Physicians should certainly discuss the risk and benefits of CT lung-cancer screening with patients – including that of overdiagnosis. However, for high-risk patients, the group in which CT lung cancer screening is proposed, the lifesaving benefit outweighs the risks."

Experimental concentrated breast cancer radiation therapy offers new options for women who live far away from treatment facilities

A study at the University of Louisville James Graham Brown Cancer Center designed to make  radiation treatment more accessible to women who face obstacles such as distance, transportation problems and time constraints is proving promising. The idea is to cut daily trips to the cancer center to once a week, says Dr. Anthony Dragon, a radiation oncologist at U of L. It also has the added benefit of cutting treatment costs by better than half.

Laura Ungar of The Courier-Journal in Louisville reports that Dragun led a previous study that found that "about a third of Kentucky women with early-stage breast cancer didn’t get recommended radiation treatments after lumpectomy surgery. Among those least likely to get radiation were rural Kentuckians, the elderly, African Americans and women in the Appalachian region of the state. Women who did not get recommended radiation were 60 percent more likely to die during the time they were studied."

Dragun told Ungar that the folks at U of L were not satisfied with just gathering those numbers, they wanted solutions to the problem. Dragun said the new experimental regimen is yielding good results, with women who get weekly radiation reporting similar levels of side effects as those getting radiation every day. Ungar notes that some outside experts say the approach does seems promising, but one critic was concerned about breast appearance results after the once-a-week treatments.

According the National Cancer Institute, more than 3,070 new cases of breast cancer were diagnosed in Kentucky in 2009 and was responsible for 614 deaths.  (Read more) 

Several Kentucky hospitals overdo CT scans, despite cost, risk

Despite the risk of exposing patients to more radiation and the fact that radiologists say it is very rarely necessary, Medicare outpatients are regularly receiving two CT scans on the same day at 12 Kentucky hospitals, according to analanysis of Medicare data by The New York Times, which produced a handy interactive map, a segment of which is copied here. To use the actual map, click on the map below.

Though only 5.4 percent of hospitals nationwide scan a patient's chest twice on the same day, nine Kentucky hospitals are double-scanning at least 15 percent of the time and three are doing it more than 30 percent of the time, accoding to data for 2008. Figures for 2009, which are expected to be similar, are due out next month from the federal Center for Medicare and Medicaid Services.

Clark Regional Medical Center in Winchester has the highest rate, double scanning 43 percent of the time. Monroe County Medical Center in Tompkinsville double scans 34 percent of the time, followed by Pineville Community Hospital at 32 percent.

Other Kentucky hospitals that are double scanning at least 15 percent of the time include: Clinton County Hospital, Albany, 30 percent; Paul B. Hall Regional Medical Center, Paintsville, 25 percent; Harlan Appalachian Regional Healthcare Hospital, 24 percent; Norton Hospitals, Louisville, 23 percent; Westlake Regional Hospital, Columbia, 23 percent; Spring View Hospital, Lebanon, 20 percent; Methodist Hospital Union County, Morganfield, 19 percent; T.J. Samson Community Hospital, Glasgow, 18 percent; and The Medical Center at Bowling Green, 18 percent.

There are two types of CT scans, one that uses iodine contrast to monitor blood flow and one that does not. In rare circumstances, performing both scans — each with a separate charge — could help spot a tumor, said Dr. Michael J. Pentecost, a radiologist and Medicare consultant. While doctors may opt to double scan to get the most information on their patient possible, experts say being so thorough is rarely necessary, particularly given the added cost to the system and the exposure to radiation for the patient.

As Kentucky's numbers indicate, double scanning happens more often at small, community hospitals, where treatment can involve transferring patients to larger facilities. Nationwide, 200 hospitals administered double scans more than 30 percent of the time.

The Medicare agency released the data last year to hospitals "to show how they performed relative to each other and to encourage more efficient, safer practices," Walt Bogdanich and Jo Craven McGinty of the Times report. "The Medicare agency believes hospitals can and should do more to change physician behavior ... The federal agency plans to use other, similar measurements to rein in what it considers to be unjustified — and potentially dangerous — medical procedures." (Read more)