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Lung cancer screening guidelines miss early disease, LI doctors say

Long Island doctors say the official guidelines on screening people for lung cancer miss a significant proportion of early tumors and increase the potential for death from the disease.

In recent years, low-dose CT screening has become the norm across the country in efforts to catch one of the deadliest cancers at an early, treatable stage. In 2013, the U.S. Preventive Services Task Force, an independent panel of 16 experts appointed by the U.S. Department of Health and Human Services, issued its final recommendations about the scans. The panel concluded that smokers and former smokers would benefit from screening. The group recommended that people at risk ages 55 to 80 undergo periodic low-dose scans.

But Dr. Shahriyour Andaz, director of thoracic oncology at South Nassau Communities Hospital in Oceanside, says the task force recommendations leave too many people unscreened and therefore vulnerable to lung cancer.

“The U.S. Preventive Services Task Force misses 30 percent of lung cancers using those guidelines,” Andaz said Tuesday.

Andaz and colleagues conducted their research using the vast database called the Early Action Lung Cancer Project, a major population study that helped determine the benefit of low-dose scans. That analysis, which included many Long Island patients, has helped guide decisions by Andaz and his colleagues as to who benefits from screening. The scans use low dose X-rays.

The team concluded that people younger than 55 and older than 80 should be offered screening if they are current smokers or if they quit the habit years ago.

“Some people start smoking as young as 14,” Andaz said, noting that screening smokers and former smokers in their 40s and early 50s could boost the effort to catch lung cancer early. He noted that former smokers who quit as many as 30 years ago may have a lower chance of developing the disease but the risk doesn’t drop to zero.

The local research dovetails with findings from the National Cancer Institute, which reported similar findings last week in the Journal of the American Medical Association. NCI researchers also said the task force guidelines may be too narrowly cast.

But in an editorial appearing in the journal, Dr. Michael K. Gould of Kaiser Permanente Southern California emphasized the decision to undergo screening is personal and each individual should weigh-in on routine CT scanning. Some patients, Gould argued, may feel the risks of screening outweigh its benefits. “The challenge for clinicians is to make sure that individual patients receive the information they need to make the best decision possible,” he said.

Jennifer King, science and research director for the Lung Cancer Alliance in Washington, D.C., told Newsday that studies from Long Island and the National Cancer Institute, though compelling, did not mean the U.S. Preventive Services Task Force got its protocol wrong.

“The task force made its decision based on the only randomized trial that was out there and it provided the highest level of [clinical] evidence,” said King, previously a researcher at Memorial Sloan Kettering Cancer Center in Manhattan and University of California Los Angeles’ Jonsson Cancer Center.

Although the research in which Andaz was involved — the Early Action Lung Cancer Project — had hundreds of patients, it was not included in the data reviewed by members of the task force. The debate over smoking and CT-screening comes as scientists at UCLA and in China have found that a simple saliva test may ultimately prove to be a noninvasive method to screen people for lung cancer. The researchers found evidence of a telltale biomarker — a mutation unique to lung cancer — in the saliva of people with early evidence of the disease.

Andaz called it one of many noninvasive testing methods on the drawing board. He said a spit test was intriguing but it would work best when backed up with scanning.