Tuesday, July 10, 2001

Cancer survivors praise test

By Tim Bonfield
The Cincinnati Enquirer

        Rosa Dodson and Wilma Baird are former longtime smokers who say they are alive because a rarely used $150 test detected their lung cancer early enough to treat it.

        Now they and others in the medical community wonder whether more smokers and ex-smokers could be saved by the early screening. Of the several hundred thou sand smokers and former smokers in Greater Cincinnati, fewer than 1,000 have had this test.

        “A lot of people haven't heard of it,” Mrs. Dodson said.

        “A lot of people are afraid of what they might find. But ... what you don't find out about is what's going to kill you.”

        Ms. Dodson was saved by spiral, or helical, CT scanning, a 20-second X-ray procedure that can detect early- stage tumors in lungs five times more frequently than traditional chest X-rays.

        Lung cancer is America's deadliest cancer — killing nearly four times as many people a year as breast cancer, nine times more people than AIDS and 11 times more people than ovarian cancer. Lung cancer, at all stages, averages only a 14 percent five-year survival

        rate, far lower than breast cancer's 85 percent and prostate cancer's 93 percent.

        Usually by the time lung cancer is detected via X-ray, it has spread to lymph nodes and other parts of the body, said Dr. John Bottsford, a radiologist at Dearborn County Hospital.

        If cancer is detected early, surgery can boost five-year survival rates to nearly 50 percent. For very tiny lung tumors — smaller than 3 millimeters — survival rates can be as high as 80 percent, Dr. Bottsford said.

        Since 1999, only four health facilities in the Tristate have offered CT scanning for lung cancer, one as part of a study. Mrs. Dodson and Mrs. Baird received their CT scans at Dearborn County Hospital in Lawrenceburg.

        Mrs. Baird, a 64-year-old homemaker from Alexandria, smoked for 30 years but quit about 15 years ago. She didn't feel sick but had become concerned about her risk of lung cancer.

        “I'd been after my doctor off and on for years to get me in for a chest X-ray or something. My mother had died of lung cancer, and I smoked for 30 years. I just wanted to make sure,” Mrs. Baird said.

        She heard about Dearborn County Hospital's CT scanning service from a TV news program and in September 1999 drove 45 minutes to get the test.

        The scanner found a 20-millimeter tumor behind a rib; it had not been detected by the chest X-ray she'd had just days before.

        The following month, surgeons at St. Luke East Hospital in Fort Thomas removed part of a lung. She has been cancer-free since.

        “I am one lucky person,” she said.

        Mrs. Dodson, a 61-year-old Lawrenceburg resident, works for Dearborn County Hospital as a housekeeping supervisor. She smoked for 30 years until she was diagnosed with cancer in 1999.

        Mrs. Dodson had noticed she was coughing more than usual and asked a doctor to check her out. A chest X-ray revealed a suspicious area on her lung, but two follow-up CT scans and other tests revealed a growing tumor.

        She had surgery in July 2000 and, a year later, tests reveal her lungs are free of cancer.

        It will take four more years before these women are considered cured of cancer.

        “You never think it's going to be you. Now I preach about it to everybody,” she said.

        CT scanning is about five times better than chest X-rays at detecting lung cancer tumors smaller than 10 millimeters, according to a 1999 study by the Early Lung Cancer Action Project, which studied 1,000 patients in New York state.

        The group recommends that anyone who has accumulated 10 “pack years” of tobacco smoke get annual CT scanning.

        A pack year means someone smoked the equivalent of a pack a day for a year; someone who smokes a half a pack a day for 20 years also accumulates 10 pack years.

        So far, most insurers do not cover the test, although some have, Dr. Bottsford said.

        Dearborn County Hospital performs the test for $150. ProScan International in Kennedy Heights charges $350 and HealthSouth Diagnostic Center in Montgomery charges $200 for similar tests. All three require a doctor's order.

        But the test has not been endorsed by the American Lung Association and other anti-smoking groups. They have raised concerns that the tests could give smokers a false sense of security.

        The National Cancer Institute notes that 20 to 40 percent of CT scans in smokers have yielded “false positives,” or suspicious areas that turn out to be noncancerous, which can require a more expensive PET scan or a biopsy.

        Even so, the cancer institute is sponsoring studies to track CT scanning for lung cancer involving tens of thousands of patients over the next several years. The University of Cincinnati is participating, planning to test up to 500 longtime smokers, age 60 or older, with a 20-pack-year history.

        It took more than a decade for the medical establishment to agree that mammography was effective at screening for breast cancer, noted Dr. Stephen Pomeranz of ProScan International. He predicted it won't take as long for CT scanning to be accepted for lung cancer screening, because the public better understands high-tech medicine today.

        For information about CT scanning, call Dearborn County Hospital at (800) 676-5572; HealthSouth at 936-8082; or ProScan at (877) PROSCAN; or UC at 584-3183.



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