MAHONING, SHENANGO VALLEYS Cancer-screening trial seeks current and former smokers

The study will determine if screening helps reduce deaths from lung cancer.
By WILLIAM K. ALCORN
VINDICATOR HEALTH WRITER
Attention: Healthy smokers and former heavy smokers between the ages of 55 and 75.
St. Elizabeth Health Center in Youngstown and UPMC-Horizon in Farrell, Pa., want you.
The hospitals are sites for the National Lung Screening Trial sponsored by the National Cancer Institute and implemented by members of the American College of Radiology Imaging Network (ACRIN).
St. Elizabeth and UPMC Horizon have already signed up more than 500 people each, but want 1,000 each for the study.
Which is better?
The overall purpose of the NLST is to determine if screening and early detection for lung cancer will reduce cancer deaths in current or former smokers.
The study also wants to find out if screening with a standard chest X-ray or spiral CT (low radiation-dose computed tomography) scan has better results in preventing lung cancer deaths, said Dr. Richard Barr, medical director for the Northeastern Ohio Radiology Research and Education Fund at St. Elizabeth. Dr. David J. Gemmel, Ph.D., is director of research at St. Elizabeth.
According to the National Cancer Institute (NCI), standard chest X-rays and spiral CT scans are used for early detection of lung cancer.
So far, however, neither method has definitively been shown to reduce the chances of dying from lung cancer, Dr. Barr said.
The eight-year NCI study, which will eventually involve 50,000 people, also examines the risks and benefits of spiral CT scans compared to chest X-rays. The NLST is randomized, meaning participants have an equal chance of being assigned to the spiral CT or chest X-ray groups.
Potential benefits
There are potential benefits to participating in the program besides getting free medical examinations, Dr. Barr said.
For instance, pancreatic cancer was found in one participant, and an aneurysm in another, both unsuspected, Dr. Barr said.
St. Elizabeth also pays its participants $40 for each of their first three visits. And, with test subjects coming from a distance, lodging arrangements can be made with HMHP's guest house.
Anxiety
However, there are also some potentially real risks to participants, one of which is anxiety caused when abnormalities are found.
Some 25 to 60 percent or more of screening spiral CT scans, which are more precise than X-rays, find abnormalities, most of which are not lung cancer, according to NCI.
However, the abnormalities, caused by scars from smoking, areas of inflammation, or other noncancerous conditions, can mimic lung cancer on scans and lead to unnecessary biopsy or surgery, and unnecessary treatments such as chemotherapy or radiation. They are risky and costly procedures which are not paid for by the NLST.
As a result of those concerns, another goal of the NLST is to determine the level of anxiety caused by the findings, Dr. Barr said.
Government's question
Also, the results of the NLST will be important in helping the government decide if it will pay for preventative medicine in the case of lung cancer, such as screening with X-rays and spiral CT scans.
Normally, early detection of cancer means a better cure rate, but no one has proven that to be true for lung cancer, Dr. Barr said.
The reason early detection is not as useful for lung cancer as for other cancers, Dr. Barr said, is because lung cancer spreads or metastasizes very quickly, when the tumor is small and before it is detected, Dr. Barr said.
There is a lot of blood flow in the lung area, and the concern is that the cancer tumor near the blood flow breaks off and spreads.
Certain of the NLST sites, such as St. Elizabeth, are also bio-marker sites, at which blood, urine and sputum samples are taken from participants.
The samples are sent to the national tissue bank for use by researchers. Then, if someone in the NLST later develops cancer, blood, urine and sputum samples can be taken again to determine the changes in body fluids and perhaps lead to a test for lung cancer, Dr. Barr said.
Seeking minorities
Dr. Barr urged minorities, who he said tend not to get involved in testing projects, to become participants.
If enough minorities get involved, their information could be broken out and used to make comparisons with the rest of the population to determine if there are differences, and if different treatments are indicated.
Participation in the study allows area people to become involved in national research that will help decide what we're going to do with lung cancer for the next couple of decades, Dr. Barr said.
alcorn@vindy.com