Family doctor

Many malignant diseases are now the subject of organised screening programmes designed to detect the disease at an earlier stage. Breast cancer and cervical screening programmes are examples of how radiological and laboratory testing have been used to improve the survival of people who are at risk of developing these diseases.

Lung cancer is a common malignancy which has a well defined at risk population comprising those people who have smoked a packet of cigarettes per day for at least 15 years. The survival of people with diagnosed lung cancer is poor. This is often due to late detection and early spread of the cancer resulting in cancers being found for the first time at an advanced and incurable stage. In many cancers, early detection can mean removal of the cancer at a stage before it has spread to other sites.

There have previously been attempts to improve the survival of smokers by early detection of lung cancer using regular chest x-rays to detect small cancers which may be seen on the films prior to any symptoms developing. These attempts have not been successful in reducing lung cancer death rates. A recent publication in a prestigious medical journal, The Lancet, has looked at screening for lung cancer in a new way and early results look more promising.

This study has enrolled 1000 volunteers aged 60 years and over, all of whom have smoked at least 1 packet of cigarettes per day for 10 years. They used CT scanning to detect lung abnormalities rather than chest x-rays and found that CT was twice as sensitive at detecting small lung cancers than chest x-ray.

The scans also detected other non-cancerous abnormalities in the lungs and differentiating the cancers from the non-cancers often required extra tests including sampling or biopsy of the suspicious area. CT scans have a relatively high radiation dose but by using a new low-dose technique, the radiation dose was close to that of a chest x-ray.

The study represents work in progress and it is too early to say whether there will be a survival advantage to those at-risk people who choose to have screening for lung cancer using this technique. This information should become available as this study and other similar studies progress.

If you believe that you are at risk of developing lung cancer due to your smoking habits, you may wish to have a low dose helical CT examination of your chest on an annual basis as a screening test. This imaging technique will give you the best chance of detecting any early lung cancer you may develop. You should discuss this with your own doctor.

Having made the decision to have a scan of the chest, be sure you are having the test at a radiology practice with expertise in both the interpretation of chest CT images, and also in the invasive diagnosis of chest abnormalities, should this be necessary.

Getting help:

It is important to see your doctor for help with stopping smoking, to reduce your future risk of lung cancer, heart disease, and other diseases.

Also report any persisting cough, sore throat, hoarseness or chest pains.