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New York, Nov. 15, 1999 -- NYU Medical Center launched a large-scale study that will determine the effectiveness of combining CT scans and gene markers as screening tools for detecting early-stage lung cancer in women who are longtime smokers.
"Screening programs for lung cancer haven't focused specifically on women," says Abraham Chachoua, M.D., Assistant Professor of Clinical Medicine and principal investigator on the new study. "Lung cancer kills so many women. It is vitally important that we find a reliable screening tool to use in women at high risk for this cancer," says Dr. Chachoua, who is a member of the Rita J. and Stanley H. Kaplan Comprehensive Cancer Center at NYU Medical Center.
Lung cancer is the leading cause of cancer death in women in the United States. Last year year some 80,000 new cases of lung cancer occurred in women and 70,000 women died of the disease. The cancer is so deadly because it is usually diagnosed after it has spread elsewhere in the body. However, when the cancer is still confined to the lung, the chances for successful treatment are increased considerably by removing the lesion surgically. Currently no screening tool is recommended for detecting the cancer.
In recent years, a technique called spiral computed tomography (CT) has emerged as a promising screening tool to detect early lung cancer. The new study, which is supported by the Bristol-Myers Squibb Foundation's Better Health for Women Program, will determine whether CT scans can effectively detect lung cancer at a stage when surgery is feasible.
Spiral CT scans, which are painless, employ a special machine that rapidly rotates around the body taking X-rays from many angles. "There is no doubt that CT scans are a much more sensitive tool than traditional chest X-rays for looking at the lungs," says David Naidich, M.D., Professor of Radiology and an investigator on the new NYU study.
"CT scans can pick up a lesion that is only three millimeters, which is smaller than
the size of a sesame seed," says Dr. Naidich. "Chest X-rays only begin to pick up lesions that are almost one centimeter long, which is almost half an inch."
A previous multicenter study determined that CT scans were far more likely to pick up early-stage tumors compared to traditional chest X-rays. However, the CT scans also picked up many "suspicious" nodules or growths that couldn't be immediately identified as malignant, that is, likely to grow and spread.
The new NYU study will combine CT scans with other techniques that may further refine the diagnosis of lung cancer. The combination, it is hoped, will allow "suspicious" growths to be more readily identified as malignant or benign. The study will enroll up to 500 women who are longtime smokers. Women who have smoked at least 30 "pack-years," that is, smoking a pack of cigarettes a day for 30 years, or two packs of cigarettes a day for 15 years, are eligible for the study. These women will receive a spiral CT scan.
If the CT scan reveals suspicious nodules, then a woman will undergo bronchoscopy and bronchoalveolar lavage (BAL) to obtain tissue from the lungs. The samples will be analyzed for mutations in two genes, K-ras and p53, which are implicated in lung cancer.
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