"ELCAP"
EARLY LUNG CANCER ACTION PROGRAM

Cancer of the lungs is the leading cause of death from cancer in both men and women in the United States. Lung cancer kills more individuals than cancers of breast, colon, cervix, and prostate combined. In the year 2002, it is estimated that there will be 1.3 million deaths worldwide. Lung cancer has one of the poorest prognoses of all cancers, with a 5-year survival rate of less than 13%. Important risk factors for lung cancer include tobacco use and certain environmental carcinogen exposures. Tobacco is associated with 87% of all causes of cancer of the lung, trachea, and bronchus.

Lung cancer is usually asymptomatic until it has reached an advanced stage, when the treatment outcome is poor. Five-year survival for all stages is 11-14%. But Early-Stage I lung cancer has a cure rate of nearly 70%, and in certain subgroups, it is even higher. Unfortunately, results of screening programs designed to detect lung cancer at an early and potentially curable stage using either chest x-ray or sputum cytology were disappointing. However, there is now renewed hope in the possibility of early detection when lung cancer is in its early, most curable stage, with the promising scientific advances of CT (computed tomography). CT identifies lung cancers much earlier in their development than previously possible with conventional techniques.

The Early Lung Cancer Action Project (ELCAP) is a study performed by research that demonstrated low-dose, high-resolution CT screening conducted on persons with a high risk of lung cancer has the potential to markedly increase the detection of small, early lung cancers. An initial baseline CT can detect lung cancer at an earlier stage than ordinary x-ray, by detecting non-calcified pulmonary nodules as small as 2 mm in size.

In a study of 1,000 individuals with 10-pack year histories of cigarette smoking (smoking at least one pack per day for 10 years), research has shown that malignancies detected by CT screening were missed on high quality chest x-rays 85% of the time. This study confirmed the expectation that relative to chest radiography, CT-based screening markedly enhances the detection of small lung cancers at early and more curable stages.

WHO IS AT RISK FOR LUNG CANCER?
About 80% of lung cancer is caused by smoking. The lung cells of smokers go through changes that can lead to lung cancer. The longer a person has been smoking, and the more packs per day they smoke, the greater the risk.

People who work with asbestos also have a high risk of getting lung cancer. And if they smoke, the risk is greatly increased. In addition to smoking and asbestos, there are other known risk factors for lung cancer, including certain cancer-causing agents in the environment, aging, and lung scarring from some types of pneumonia.

Alternatively, some people who have never smoked, worked with asbestos, or been exposed to any known cancer-causing agents, can still be stricken with lung cancer. There are unknown factors and there is no certain way to prevent lung cancer.

RECOMMENDATIONS:
First, stop smoking. And if you are 60 years of age or older, a former smoker, or have smoked at least one-pack per day for 10 years, you should consider obtaining an annual low-dose, high-resolution CT scan of your lungs. The best hope of curing lung cancer is finding it as early as possible.

The physicians at Sacramento Heart and Vascular Medical Associates offer the “ELCAP” Early Lung Cancer Action Program. Sacramento HeartScan is currently offering a lung scan special of $250 or two for $400. The cost may be reimbursed by medical insurance.

Raye L. Bellinger, MD, FACC, MBA is affiliated with the Sacramento Heart Center. For more information about the Sacramento Heart Center, visit their website at www.sacheart.com or call (916) 830-2080 and request information be mailed to you. Please address your cardiology-related questions to “Ask the Cardiologist”, 500 University Avenue, Sacramento, CA 95825. Selected questions will be answered in future columns.