Recognizing the growing public and physician awareness of the potential for spiral CT to aide in the early detection of lung cancer, AMI has now introduced low radiation dose (low dose) spiral CT Lung Cancer Screening.

In the USA in 1998, there were an estimated 160,000 deaths from lung cancer and an estimated 172,000 new cases detected. The cure rate for lung cancer is currently 12 percent, and the 5-year survival is only slightly higher. However, if lung cancer is detected when it is small (stage I), 5-year survival can be as high as 70 percent.

A study called the Early Lung Cancer Action Project (ELCAP) evaluated baseline and annual repeat screening by low dose spiral CT in people at high risk for lung cancer. The study, published in the July 10, 1999 issue of Lancet, found that, as expected, low dose spiral CT can greatly improve detection of small lung nodules, and thus detect lung cancer earlier at a potentially more curable stage. A follow up ELCAP study published in the July 2001 issue of Cancer found that annual follow-up screening lung CT, much like annual mammography, has added benefit. In addition to continuing to detect cancer, it decreases the “false positive rate” from 23 percent to 2.5 percent; that is, the likelihood of detecting a nodule caused by something other than lung cancer decreases substantially when the test is repeated annually.

AMI offers screening lung CT to those 40 years old and above and with more than 10 pack-years of smoking and/or asbestos exposure, with no previous diagnosis of cancer and no symptoms. (One pack-year is equivalent to smoking one pack per day for one year. Ten pack-years is therefore equivalent to smoking one pack per day for ten years, two packs per day for 5 years, 10 packs per day for one year, etc.) Individuals who meet this criteria are eligible for screening and should contact their physician’s office for a referral. Individuals who have symptoms should contact their physician for appropriate evaluation.

The exam uses a low-radiation-dose protocol that requires less than 20 seconds of scanning time and does not require an injection of contrast. It’s substantially less expensive than a standard spiral CT of the chest and has a radiation dose similar to a chest x-ray. A report is generated both for the patient and for the referring physician. The films and report are kept on file at AMI, just like any other study.

What happens if the test detects a small nodule? One benefit of screening is that it promotes smoking cessation! From the ELCAP trial, the risk of detecting a small nodule on baseline CT is about 23 percent. For those people, a diagnostic CT, which is typically covered by insurance, is the next step. With the diagnostic CT, the radiologist is able to further analyze the nodule for benign or malignant characteristics. From there, the possible options include follow-up CT at regular intervals (if the nodule is very small and benign appearing), biopsy, or PET scan (if the nodule is larger). AMI also offers PET scanning which reduces the need to biopsy nodules incidentally detected at screening lung CT.

Since screening is not yet covered by insurance, the situation is similar to mammography in the 1970s, meaning the patient must pay. AMI charges $295, which must be paid at the time of the exam.

For more information, contact AMI at (360) 337-6500, (800) 972-9264 or visit www.amiradiology.com.