Stepping into the debate over who should be screened for lung cancer, a leading medical specialty group issued new guidelines on Tuesday recommending that doctors offer annual low-dose CT (computed tomography) scanning to people whose age and smoking history puts them at significant risk of lung cancer.

That means current smokers aged 55 to 74 with more than 30 pack-years of smoking, or former smokers with that profile who have quit within the last 15 years, said the American College of Chest Physicians.

That was the population in whom the largest-ever lung-cancer-screening study, the National Lung Screening Test, found CT screening cuts deaths from lung cancer.

A pack-year is a measure defined as smoking 20 cigarettes a day for a year or any equivalent, such as two packs a day for six months.

That describes an estimated 7 million people, says chest physician David Midthun of the Mayo Clinic.

The NLST, which studied 53,000 current or former heavy smokers, concluded in 2011 that CT scanning reduced mortality from lung cancer in this high-risk group by 20 percent compared to no screening or to X-rays. CT finds small cancers, which can be cured with surgery, that X-rays cannot.

But other medical groups that have weighed in on annual CT screening for lung cancers cast a wider net. Last year, for instance, the National Comprehensive Cancer Network (NCCN) recommended that people 50 (not 55) or older who have at least 20 (not 30) pack years of smoking plus one additional risk factor, such as having chronic obstructive pulmonary disorder or a close relative with lung cancer, also be screened.

Experts are divided on how primary care physicians will implement the recommendations. One concern is that CT screening for lung cancer will proliferate like PSA tests for prostate cancer, which are often given for free in such non-medical settings as sports events.
Marketing for such mass screenings encourage men to get a test that, experts from the American Cancer Society to the American Urological Association now agree, should not be routinely offered to most men, since it leads to biopsies and surgeries that can cause impotence and incontinence but prevents few deaths from prostate cancer.

"Where we have to be wary," said Dr Frank Detterbeck, chief of thoracic surgery at Yale University School of Medicine, who helped develop the screening guidelines for the College of Chest Physicians, "is with entrepreneurs who decide to offer CT screening for free," as some medical centers are already doing.

That may seem like a generous public service, but Detterbeck says there is an "inherent conflict" in taking a loss up front and planning "to make up for it with profits from tests and procedures on things that you find. The problem is that you find a lot of things with screening," but about 97 percent "are nothing. So (free screening) creates pressure to intervene more frequently, whereas doing the right thing dictates that you only intervene when it is really suspicious for cancer."

Lung cancer kills more people in the United States than any other cancer, claiming just under 160,0000 lives each year, more than breast, colon, prostate and pancreatic cancer combined. Only 16 percent of patients live five years after their diagnosis, an indication of how ineffective treatments are.

By the time most patients are diagnosed, the cancer has spread to such organs as the bones and brain. In contrast, early-stage lung cancers "have not metastasized, so surgery is more likely to bring a complete elimination of disease," said Mayo's Midthun.

CT screening is not without risks, however, which is why some experts are concerned about mission creep. Physicians expect worried smokers who fall just outside the new guideline - a 54-year-old with 30 pack-years, for instance - to press their physicians for CT screening, which costs several hundred dollars.

"Requests for CT screening from smokers slightly outside the (chest physicians') new guidelines is an issue we'll face," said Dr Peter Mazzone, a lung specialist at the Cleveland Clinic. "All you can do as a physician is try your very best to stick to the parameters."

Doing otherwise, by offering CT screening to people at lower risk for lung cancer, will find many more suspicious nodules but prevent many fewer lung cancer deaths, tipping the balance toward greater risk than benefit.

"You find a lot of things and most of them are nothing," said Detterbeck.

Nevertheless these can cause worry, additional testing and an invasive biopsy, which is often done via a long needle inserted through the chest wall. Another risk is that CT itself can itself cause lung or breast cancer.

On the benefit side, the NLST found that the number of high-risk smokers who had to be screened with CT to save one person from dying of lung cancer was 320. This compares to 780 women who need to get a screening mammogram for one to be saved from dying of breast cancer.

LanaLanglois / Featurepics.com

Tofu is one soyfood that may help at least some women survive lung cancer better, a study finds

Soy foods, long shown to help lower the risk of cancer, may also help people survive at least some forms of cancer better, researchers reported on Monday.

They found that Chinese women who ate the most soy were also less likely to die of lung cancer, the No. 1 cancer killer across the world.

The findings, published in the Journal of Clinical Oncology, lends support to the idea that adding soy foods to the diet can help people in multiple ways, says Dr. Jyoti Patel, a lung cancer specialist at Northwestern University in Chicago, who was not involved in the study.

 “It may be that we do need to change our diets a little bit and eat more of these soy-based diets. The benefits may go beyond cardiac health,” Patel said in a telephone interview.

For the study, Gong Yang and colleagues at Vanderbilt University Medical Center, Shanghai Cancer Institute, and the National Cancer Institute looked at data from a large study of Chinese women called the Shanghai Women’s Health Study. They pulled out the records of 444 of the women, who had lung cancer.

The women had all filled out questionnaires that included details of what they normally ate. They did this twice – when they enrolled in the study, and two years later.

Of the 444 patients with lung cancer, 318 died during the three years of follow-up, the researchers wrote. “Initial analyses including all patients showed that higher intake of soy food was associated with better overall survival after adjusting for demographic and lifestyle characteristics and other nonclinical factor,” they wrote.

Women who reported eating the least soy were 1.8 times as likely to die, on average. Those who ate the most were about 11 percent less likely to die.

“This finding, along with our previous observation of an approximately 40 percent reduction in risk of incident lung cancer associated with high intake of soy food,  provides further support for the role of soy food intake in lung cancer development and prognosis,” the researchers wrote.

Most of the women in the study had never been smokers, and there’s a lot of evidence to suggest that lung cancer is a different disease in smokers versus non-smokers. “In Asian countries, 80 percent of women with lung cancer are never- smokers,” Patel said.

“We don’t know if there is an inherited susceptibility to it,” she added. There might be an infectious disease that causes some cases of lung cancer —like the virus that causes cervical cancer, or the bacteria that causes stomach cancer.

“Although the risks are probably different for American women for developing lung cancer, I do think it is a call to action for more research about how we develop lung cancer,” Patel said.  “There are probably 30,000 people in the U.S. who never smoked and who have lung cancer.”

Lung cancer kills 160,000 Americans a year. It’s diagnosed in 110,000 women and 118,000 men a year in the United States alone.  It accounts for 27 percent of all cancer deaths, according to the American Cancer Society.

Studies suggest that people who eat the most soy have a lower risk of heart disease and osteoporosis. Women may have fewer menopausal symptoms, and perhaps a lower risk of some cancers.

The Food and Drug Administration says soy products may carry a heart-healthy label saying that soy may reduce cholesterol when eaten as part of a diet that is low in saturated fat and cholesterol.

It wouldn’t be difficult to eat enough soy to be protected, Patel noted. “The high soy level patients were eating what the FDA has said is heart-healthy, or 25 grams of soy a day,’ she said.

Studies have shown that supplements containing soy protein don’t have much health benefit. But foods such as soy milk, tofu and edamame do. “We think that consuming food in their whole forms is more important  than the supplements,” Patel said.

Some researchers have wondered whether Western people who eat more soy food are benefiting from the soy itself, or because they perhaps use it as a substitute for meat and dairy foods. Patel says this study in China, where soy is a normal part of the diet and where dairy foods are less commonly eaten, suggests it’s the soy itself that adds the benefit.

Soy and many other plant foods contain hormone-like substances called phytoestrogens. These may be affecting a cell compound called estrogen receptor beta, she said.  That compound interacts with another one called epidermal growth factor receptor or EGRF, which is known to play a role in many cases on lung cancer.

“Lung cancer is the most common cause of cancer death. There are many never-smokers with lung cancer,” she said. “People should consider eating a diet that is healthy. By all accounts one that includes soy decreases cardiac risks and could also affect lung cancer,” Patel concluded.

How can people add soy to their diets? A cup of vanilla soymilk poured over cereal provides 6 grams of soy protein, while an eight-ounce glass provides 8 grams. A soy burger delivers 10 grams of soy protein, while 3 ounces of tofu has 8.5 grams.

Related:

Soy supplements don't help menopause

Soy may keep breast cancer from coming back

Lung cancer on NBCNews

By Rachael Rettner
MyHealthNewsDaily

Female smokers are more likely to die from lung cancer now than a few decades ago, a new study says.

In the 1960s, female smokers were 2.7 times more likely to die from lung cancer compared with women who didn't smoke. By the 1980s, women who smoked were 12.6 times more likely to die from lung cancer, and in the 2000s, they were 25.7 times more likely to die from lung cancer, the study found.

The dramatic increase reflects changes in smoking patterns among women that began in the 1960s. (Because lung cancer takes years to develop, changes in smoking patterns would not start to influence deaths until many years later.)

In the '60s, more women started smoking during their teenage years (a trend that men had already embraced during the 1930s). The number of cigarettes smoked per day was highest in men in the 1970s, and highest in women in the 1980s.

The findings confirm the prediction that "women who smoke like men die like men," the researchers write in the Jan. 23 issue of the New England Journal of Medicine.

The risk of death from lung cancer among male smokers has been level since the 1980s, and is about the same as the risk of death from lung cancer among female smokers today.

The risk of death from chronic obstructive lung disease continues to increase in both sexes.

This increase may be due in part to the introduction of  blended tobacco lowering the pH of cigarette smoke, making the smoke easier to inhale deeper into the lungs, said study researcher Dr. Michael Thun, former vice president emeritus of the American Cancer Society.

The good news is that quitting smoking at any age lowers the risk of death from smoking-related diseases, though quitting before the age of 40 is particularly effective at cutting risk, the researchers said. [See Quitting Smoking Lengthens Women's Lives.]

The study included information from more than 2.2 million adults ages 55 and older.

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Why Women Find it Harder to Quit Smoking

It took asthma, COPD, emphysema and finally, lung cancer to get Toni Manes, a retired cosmetologist, to try to quit smoking.

Unfortunately, the 58-year-old was so hooked, she couldn't kick the habit even after part of her left lung was removed.

"I remember my surgeon told me 'If you ever smoke again, your husband should break your fingers,'" says the Philadelphia resident, who was diagnosed and had surgery in 2010. "And I was like, 'Okay, I'm not going to smoke again.'  But then I came home from surgery, recuperated for a few weeks and started up again. I couldn't help myself."

According to a new study in the American Cancer Society journal CANCER, Manes is just one of many patients who've found themselves smoking after diagnosis.

Researchers looked at 2,456 lung cancer patients and 3,063 colorectal patients and discovered that at time of diagnosis, 38 percent of the lung cancer patients and 15 percent of the colorectal patients were smokers.

Courtesy of Toni Manes

Lung cancer patient Toni Manes continued to smoke after her diagnosis.

Five months later, despite a cancer diagnosis, 14 percent of the lung cancer patients were still lighting up (ditto for 9 percent of the colorectal patients).

'Why stop now?'
"People think it's a no-brainer and are surprised that cancer patients continue to smoke after they're diagnosed," says Elyse R. Park, a clinical health psychologist and associate professor of psychiatry at Massachusetts General Hospital/Harvard Medical School and lead researcher for the study. "But people still struggle to quit even after they're diagnosed. There are a lot of barriers to quitting, including a lot of stigma."

Park says many of the people who can't quit are "hard-core" smokers, i.e., they smoke a high number of cigarettes a day. Many, also, are surrounded by other smokers.

"These people are nicotine addicted, so it's tough for them," says Park. "They also have a lot of self-blame for causing the disease. There are feelings of fatalism. They think, 'Why stop now?' And a lot of people are very judgmental about lung cancer patients causing their own disease."

According to the Lung Cancer Foundation of America, 60 percent of new lung cancer diagnoses happen to non-smokers, 15 percent of whom have never smoked a day in their life (the rest are former smokers who quit 10, 20 or even 30 years prior to diagnosis). The American Lung Association estimates that active smoking is responsible for close to 90 percent of lung cancer cases; radon causes 10 percent, and occupational exposures to carcinogens account for approximately 9 to 15 percent.

Manes says following surgery, she went on to do three rounds of chemotherapy, followed by radiation. And even though she continued to smoke throughout, she worked with her oncologist at Thomas Jefferson University Hospital on ways to quit.

"We tried everything," she says. "Hypnosis, Chantix, patches, cessation groups, acupuncture, the gum, the lozenges -- and none of that stuff did anything for me. I was depressed and didn't want to face that I had cancer. I saw a death sentence for myself. What difference did it make if I smoked or not?"

Park says she hopes her study will pave the way for more smoking cessation programs and treatment options for patients who are smoking at the time of their diagnosis.

"One of the reasons it's hard to quit is that people think they have enough to worry about," she says. "But it's the best time to quit because it has the potential to improve their cancer treatment, from breathing easier and feeling less fatigue to reducing the chance of infection after surgery."

Parks says studies also show that quitting smoking can increase the efficacy of chemo and radiation and may even double the chances of survival for lung cancer patients.

"We're hoping to integrate evidence-based tobacco treatment into cancer care," she says. "So you don't just ask a patient, 'Do you smoke, yes or no?' But you try to get them to quit as part of their treatment. It's a tough time, but we're hoping to find ways to sit with patients and get them pharmacological and behavior counseling treatment."

The good news? There's some evidence Park's approach might just work.

"On October 31, 2011, I got a sinus cold again and with every puff, I was choking," says Manes. "So I put on a patch and humbled myself before God and begged him to help me. I needed some kind of inner strength. On the 31st of this month, it'll be three months that I've been smoke-free."