1992: Lung Cancer Action Project studies Chest CT Scan for Early Detection of Lung Cancer
When we started the Early Lung Cancer Action Project (ELCAP) in 1992, chest CT (computed tomography) scanners were strong and powerful enough that they could acquire all the images of your lungs in a single breath hold. At that point, we decided that we could look at chest x-ray and a chest CT scan to determine how much earlier the chest CT scan allowed us to detect lung cancer in comparison to standard x-rays (lung cancer screening). Chest CT scanners first became available in the eighties.
X-Rays vs CT (Computed Tomography) Scans
We ran a side-by-side comparison on one thousand people who were all smokers over the age of 60, and we found that the chest CT scan, not the chest x-ray, allowed for the early diagnosis of lung cancer considerably sooner than the chest x-ray did. All of the patients in our study were smokers. In 1999, we published our findings on the topic in the journal Lancet. The article was so significant that it was featured on the front page of the New York Times. Since then, a great number of individuals all over the world have shown interest in the topic. The question is are CT (computed tomography) scans or imaging tests the best option for showing blood vessels?
It prompted a great deal of debate on the topic of chest CT scans versus x-rays inside the NIH, and they got the ball rolling on that back in 2004. In 2009, they released their findings and validated our findings. Because the tumors are smaller and less likely to have spread beyond the lungs at the time of the lung cancer screening, chest CT (computed tomography) scans are able to detect the disease at an earlier stage when it is much more treatable and much more treatable given any treatment that was available or any kind of drug. This was confirmed by the researchers.
2015 the CMS Established Coverage for CT Scans with Low-Dose CT Scans (LDCT)
What happened for our study that showed there is a technique for early detection was that it was sent to the US Preventive Services Task Force, and ultimately the US Preventive Services Task Force gave it a B rating, which means that it needs to be made available to the US population who is at risk of lung cancer. This led to a lot of discussions, but finally in 2015 the centers for Medicare and Medicaid services, also known as CMS for short, decided to endorse CT scans for lung cancer screening. Consequently, CT (computed tomography) scans were made available to smokers and former smokers who were 55 years old or older, had smoked at least 30 pack years’ worth of cigarettes, had not quit smoking during the previous 15 years, and were still smoking cigarettes. CT (computed tomography) are very good at showing bone, soft tissue, and blood vessels. Some CT scans require contrast material (IV contrast), a specific dye used to highlight the parts of the body being studied. Contrast (IV contrast) material inhibits X-rays and looks white on pictures, helping to highlight blood arteries, intestines, and other structures giving detailed pictures.
2021 Lung Cancer CT Scanning Recommendation Lowered to 50 Years of Age
It was agreed that the age should be lowered because there was another randomized experiment that was reported from Europe, and participants in that randomized trial smoked less than those utilized in the previous trial. Due to the fact that they smoked less and started smoking at a younger age, the United States Preventive Services Task Force has decided to drop the age threshold for lung cancer screening from 55 to 50 and 20 pack years of smoking.
Therefore, for this younger group, there is now a significant effort being made to reach out to smokers in order to alert them about the existence of this potentially life-saving CT scan. Permit me to explain the lung cancer screening. When you go in for the test, you will lie down on the table, and the photos will be collected after you have held your breath for a shorter amount of time than usual.
How long does a CT scan take for chest?
So just give that some thought. You are asked to hold your breath during the procedure, during which a minimal dose of radiation is delivered and a CT scan is performed all the way through your chest. Following this, a radiologist examines the CT scans to determine whether or not there are any suspicious pulmonary nodules that resemble early stages of lung cancer. We have proven that more than 80 percent of lung cancers can be cured if they are found early by means of a scan of the chest; nevertheless, there is a great deal of quality control that needs to be done in the screening process for lung cancer. In point of fact, between 90 and 95% of people can be cured of lung cancer if it is discovered at an early stage and there is no evidence that the cancer has spread to other parts of the body. Therefore, these CT scans, which have the potential to save lives, ought to have much more widespread publicity, and people who smoke or have smoked in the past and who match the criteria should really be flocking to get the CT scans to get detailed pictures.
Why would doctor order CT scan or imaging test of chest?
So, it’s a very basic question. We ask you, when did you start smoking? How long have you been a smoker, and approximately how many cigarettes have you smoked in that time? This enables you to determine the number of pack years of smoking that you have been subjected to during a typical period of time during which you smoked.
The Centers for Medicare and Medicaid Services recommend that people should receive free low-dose CT scans, and I emphasized low-dose CT scans, to check for any early signs of lung cancer if they have smoked for at least 20 pack years and are at least 50 years old at the moment. This recommendation has been endorsed by the Centers for Medicare and Medicaid Services.
Important for Patients Come Back Year After Year
The other essential factor is that you must continue to visit the doctor on a yearly basis in order to have your lungs scanned. Therefore, once a year you check in to see if there are any new pulmonary nodules or anything else new; this is the most important aspect of the process since it could save your life. When you come back year after year, there is nothing there that indicates lung cancer; but, if there is something new, you really need to further study it, and in most cases, this will involve getting another CT scan to determine whether or not there has been progression.
The only source of information that we have right now is from people who smoked cigarettes. No studies focused upon cigar smoking or vaping. Since vaping is still relatively new, more research needs to be done before we can determine how big of a health risk it poses to those who do it; for now, we only have data on the effects of smoking cigarettes.
Lung Cancer CT Screening Data: The Last 20 years
More people in our group who have been screened for lung cancer have survived, which is something that we’ve reported, and I have a 20 year follow-up that I’m going to present in Chicago in December, which shows that if we find it early, over 80% of all comers in a CT (computed tomography) scans screening program can be cured of it. This is something that I’m going to present. They are given the opportunity to live a long life, which is equivalent to being cured of lung cancer.
Over ninety percent of cases are treatable if it is detected in its early stages, which is often the case. Therefore, computed tomography scans are a truly life-saving piece of computer technology that ought to be welcomed and implemented all around the country. Now, in addition to this, and in addition to the lung cancer that we uncover, we also assess coronary artery disease because we see the heart and we see the coronary arteries very well in CT scans. This allows us to determine whether or not the patient has coronary artery disease.
Are There Other Diseases Looked for in a Scan of The Chest?
In addition to being able to diagnose emphysema, our team will examine all of the organs located in your chest to see whether or not they are normal and whether or not anything new has appeared. Therefore, I believe that CT scans should be included in the category of health checks. It is an annual health check, just like you used to have with the chest x-ray. Now, however, it is a low-dose scan of the chest, which gives you a higher radiation dose than a chest x-ray, but is still lower radiation dose than that of an annual mammogram. This is because a chest x-ray exposes you to a lower amount of radiation than a low-dose scan of the chest does. Women have been subjected to radiation (dose) during mammograms for a significant number of years without experiencing any adverse effects. Therefore, the low-dose chest CT scan exposes you to approximately the same amount of radiation as a mammography does.
We would like to broaden those to include never smokers who have been exposed to secondhand smoke, have a high risk, and we actually have IRB approval so that we can provide screening for never smokers, but it is under a study and IRB with explanation and consent of the individual. Well, certainly now, CT scans are endorsed for people who have 20 packer years of smoking history. However, we would like to broaden those to include never smokers who have been exposed to secondhand smoke.
Challenges with CT Screenings
There is still a poor uptake of CT screening among those persons who are eligible for it, which includes smokers who are 50 or older and have 20 or more packs of cigarettes in their smoking history. Despite the fact that it is a very powerful tool, it hasn’t really taken off as a screening tool at all. As a result, there has been a significant amount of emphasis placed on the matter, and in fact, the meeting that we were at in Washington, DC, from the lung cancer round table sponsored by the American Cancer Society was held to really encourage further outreach to the communities, particularly to the diverse communities. There is a disproportionately low number of African Americans in the screening population. Therefore, they have a significant chance of developing lung cancer, one that is larger than that of similarly smoking and similarly aged white participants. In point of fact, women have a greater risk of developing lung cancer than men who smoke at the same rate and are the same age. Additionally, the African American community also has a greater risk, and because of this, there needs to be a much greater emphasis placed on outreach to provide this information to them and encourage them to undergo these potentially life-saving CT scans.
Therefore, there have been a lot of efforts, and it is acknowledged that there has been less outreach to populations that have been underserved. In certain locations, the use of mobile vans has been advocated. The mobile van travels to the neighborhood to do the CT scan, and after it returns, the patient undergoes the follow-up chest scan at the stationary scanner.
Therefore, this has shown to be fairly successful in a few areas of the country, but it is not applicable everywhere in the US. These kinds of scans have been made available in Georgia as well as in Buffalo and in a number of other locations. In point of fact, it has been made available to workers in the atomic energy industry in the states of Tennessee, Kentucky, and Ohio by means of a mobile van. Because this computer technology has the potential to save so many people’s lives, we need to increase the number of times that we reach out to the communities using these various techniques.
Well, I would suggest that you go to your physician that you are getting your care from and say, “look, I started smoking at this age and I’ve smoked at least 20 pack years, or I’ve smoked for at least 20 years and I’m now 60 or 50 or 55 and I really want to have a chest CT scan for lung cancer early detection.” This is because you have smoked for a significant amount of time, which increases your risk of developing lung cancer. What advice would you give someone? And hopefully, that physician would say, “Look, I can sign you up for a chest CT scan, and you would not be charged for that CT scan or any follow-up results that are found.” Those are the two things that we anticipate will happen. It is covered by your insurance policy. Now this is one of the other challenges that you run into, and that is the follow-up, let’s say that you find lung cancer, and let’s say that you find early lung cancer. So, who is responsible for that? To reiterate, that is a legitimate concern in the neighborhood that is underserved. People who live in underserved neighborhoods need not just the screening, which can be provided at no cost, but also the follow-up care that is required to be offered to them. All of these are issues that need to be resolved in order to do this.
Professor of Radiology as well as a Radiologist, Claudia I. Henschke holds a Ph.D. and an MD. She has more than 25 years of clinical and research experience with low-dose CT screening, and she has led the implementation of numerous lung screening programs at the municipal, state, national, and international levels. Dr. Henschke is a pioneer and leading expert in diagnostic radiology, and she has this experience.
Imaging Techniques
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Chest radiograph – X-rays of the chest can reveal conditions such as cancer, infection, or air that has accumulated in the region around a lung, which can lead to the lung collapsing. They are also able to show chronic lung disorders like emphysema and cystic fibrosis, in addition to the problems that are associated with these conditions.
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Computed tomography – The term “CT scan” is frequently used interchangeably with “computed tomography.” A computed tomography (CT) scan is a diagnostic imaging method that produces images of the inside of the body by employing a combination of X-rays and computer technology to make the images. It is able to display in exquisite detail any component of the body, including the skeleton, muscles, fatty tissue, organs, and blood arteries.
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MRPositron emission tomography and integrated PET/CT – An example of an imaging technique used in nuclear medicine is positron emission tomography, which is sometimes referred to as PET imaging or a PET scan. Radiotracers are extremely small amounts of radioactive material that are utilized in nuclear medicine. Nuclear medicine is utilized by medical professionals in the diagnostic, evaluation, and treatment of a wide variety of disorders.
Claudia Henschke, MD, Ph.D. – Doctor and Affiliations
Dr. Henschke has been working toward the advancement of CT screening study of early lung disease, with a specific emphasis on lung cancer, ever since the Early Lung Cancer Action Project (ELCAP) was established in 1992. This research has a particular focus on lung cancer. She is now the leader of a collaborative and international group of distinguished physicians and scientists whose 75 institutions have, to date, screened over 79,000 people in 10 countries around the world for I-ELCAP. ELCAP soon grew into an international program (I-ELCAP), and now she is responsible for leading that group. In addition, the accomplishments of the I-ELCAP program resulted in the launch of a second international research project in 2016, dubbed The Initiative for Early Lung Cancer Research on Treatment (IELCART), which was designed to evaluate the effectiveness of a number of treatments for early lung cancer. Dr. Henschke is the author of over 400 publications that have been reviewed by his peers, as well as two books and a number of scientific lectures. In addition, he has instructed over 80 medical researchers.
Education
EDUCATION: PhD: University of Georgia; MD: Howard University; BA & MS: Southern Methodist University. Prior to joining the Icahn School of Medicine at Mount Sinai in 2010, Henschke was a faculty member at the Harvard Medical School and the Weill Cornell Medical College.
LANGUAGES: English, German, French Language English Position
CLINICAL PROFESSOR | Diagnostic, Molecular and Interventional Radiology Hospital Affiliations Mount Sinai Beth Israel Mount Sinai Brooklyn Mount Sinai Queens The Mount Sinai Hospital
Radiology | Mount Sinai – New York https://profiles.mountsinai.org/claudia-i-henschke 3/6 The Mount Sinai Hospital Mount Sinai Morningside and Mount Sinai West