Now, the National Cancer Institute has the largest screening trial ongoing. It's a trial using CAT scan in one group at risk and chest X-ray in another group at risk. They are recruiting about 50,000 people, and results from this study should be available in around 2009. Maybe at that time we'll find out that we should be suggesting a screening test such as a CAT scan to our patients. But as of right now, there's no accepted screening test.
What is the life expectancy for people who are diagnosed with lung cancer in later stages?
The survival rate is very, very dependent on the stage of the cancer. Because most people present later in the course of their disease . . . the survival rate is only about 15 percent at five years. So five years after the diagnosis, only about one in eight patients diagnosed with lung cancer will be living. And the later the stage [at which the cancer is detected], the worse [the prognosis] is.
For disease that has already spread outside the chest, to the brain and bones and so on, we might have an average survival of 12 to 18 months, and maybe 1 or 2 percent of those individuals will be alive five years from their diagnosis.
What are some of the things that make treating lung cancer particularly challenging?
Most cancers of a solid organ, like a lung, a kidney, a colon or breast, are best treated if the tumor itself can be entirely removed from the body. Chemotherapy and radiation therapy are useful in some situations, but localized disease that can be entirely removed from the body is the best situation to try to cure someone of a cancer.
Lung cancer is particularly difficult to treat for two reasons: One is because most people present at a stage where the cancer has gone beyond a very local area -- where it's already spread to the lymph nodes or outside of the chest cavity; it's spread in a way that you cannot remove all the cancer cells with surgery alone.
The second reason is that even when you can remove the cancer from the lung, a lot of individuals who develop lung cancer have other lung diseases. They may have emphysema, because they've smoked throughout their life. And to remove a good portion of the lung to take out this cancer leaves somebody with less lung to breathe with. So you have to have a patient who's fit enough to tolerate removal of a good portion of a lung.
Are there developments on the horizon in terms of ways to prevent lung cancer?
There are things on the horizon for all of these areas -- prevent, diagnose, screen and treat -- none of which I'm so optimistic will be available in the next year or two, but certainly a lot of work's being done. Prevention, I think, is clear to everyone. Prevention is simply: Don't smoke. There's no other way to say that, or to advance it beyond helping people quit smoking. . . .
