Monday, April 20, 2009: Last week, the Canadian Medical Association Journal published an editorial discussing lung cancer screening. In the piece, they misrepresented LCA's position on lung cancer screening. In addition, they came to the conclusion that the best use of funding for lung cancer would be in tobacco control and cessation programs. LCA President & CEO, Laurie Fenton Ambrose, sent in a Letter to the Editor of the Canadian Medical Association Journal clarifying LCA's position on lung cancer screening and urging those within the community to address the disease in a comprehensive manner with tobacco cessation programs, early detection and treatment research.
Dear Editor,
The editorial in the April 14, 2009 Canadian Medical Association Journal entitled "A Pause for Thought on Lung Cancer Screening", by M.B. Stanbrook and K. Flegel accuses the Lung Cancer Alliance of having "promoted" CT screening for lung cancer. For the record, our position is that those at high risk for lung cancer (those with greater than 20 pack year smoking history, those with a family history of lung cancer, those with exgtensive exposure to asbestos, radon, Agent Orange and other carcinogens) should speak with their doctors about the risks and benefits of a CT scan.
Please note that we emphasize those at high risk, not population based screening. Even before mammograms and psa testing became widely accepted population based screening tests in the US. (The 5-year survival rates for those cancers are now 88% and 99% respectively and whether or not screening played a role in this increase in survival rates you can debate). The 5-year survival rate for lung cancer is still only 15%.
Lung cancer is far more lethal for the individual patient and in its overall public health impact. Nearly one in every three cancer deaths in the United States is due to lung cancer and only 16% of patients are being diagnosed at an early, most curable stage. Advances in CT scanning now present an alternative to late stage diagnosis for those at hight risk and recent papers coming out of ongoing European trials are further refining the process of CT screening.
Certainly we can look forward to a simple biomarker to further refine the optimal population subset for a CT scan, and we have adocated strongly for reseach funding in these areas. But in the meantime are you suggesting that those at high risk should do nothing? Your conclusion is: "In the meantime, given how much we know about the prevention of lung cancer, targeting smoking avoidance and cessation, rather than detection and management of lung cancer, would seem a better investment."
Sadly this statement ignores the fact that over 50% of lung cancer is being diagnosed in people who have already quit, many of them decades ago. Another 15 to 20% have never smoked. Without considering these individuals,any investment analysis in lung cancer in 2009 and the future is incomplete and suspect.
Sincerely,
Laurie Fenton Ambrose
President & CEO
Lung Cancer Alliance
Laurie Fenton Ambrose
President & CEO
Lung Cancer Alliance
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