The Most Significant Medical Development of 2014

Monday, November 24, 2014

Bradford Glavan, MD

Dr. Brad Glavan explains why his pick for the most significant medical development of 2014 actually occurred in 2013.

In 2014, lung cancer remains the leading cause of cancer deaths in the US.  However, public awareness of lung cancer remains low.  Even among the health care community, there has been a relative lack of attention paid to the prevention and treatment of lung cancer.  Perhaps one reason for that is that most lung cancers are diagnosed at a late stage and there has been little improvement in lung cancer mortality over the last several decades, which remains unacceptably high.  However, all that may be about to change.

The most significant medical development in 2014 may actually have occurred on December 31st of 2013, the date that the United States Preventative Services Task Force recommended lung cancer screening for individuals at highest risk for lung cancer.  The guideline recommends screening with low dose chest CT scans (which result in <1.5 mSv of radiation exposure or the equivalent of 15 chest x-rays) on a yearly basis for those at highest risk for lung cancer. The recommendation stems largely from the results of the National Lung Cancer Screening Trial which demonstrated a 20% relative risk reduction in lung cancer mortality associated with yearly low dose chest CT scans. The USPSTF recommends screening for current smokers or those who have quit smoking within the last 15 years, aged 55-79 and who have smoked the equivalent of a pack of cigarettes per day for at least 30 years (or 2 packs per day for 15 years, etc.).

Why is this a potentially game changing development in the treatment of lung cancer?  There are two major reasons.  First, lung cancer screening identifies lung cancer at an earlier stage of the disease when treatments such as surgery and radiation can be curative.  Second, and perhaps equally importantly, the widespread adoption of lung cancer screening has the potential to change the public perception of lung cancer.  For example, few people are aware that lung cancer claims approximately 150,000 lives per year in the US, more than colon, breast and prostate cancer combined.  For those who are aware of the impact of lung cancer, too often there is a sense of nihilism in which the diagnosis is often equated with death.  Screening changes that paradigm and results in a proactive approach to lung cancer that parallels our approach to screening for breast cancer and colon cancer. The widespread adoption of lung cancer screening has the potential to get patients talking with their doctors about not only detecting lung cancer at a curable stage but also reducing their risk of developing lung cancer in the first place.  It may just be that conversation that saves the most lives because there is still only one proven intervention to prevent lung cancer: quitting smoking.