Spot It and Stop It Before It Starts
For all the new, targeted drugs, for all the yellow LiveStrong bracelets, for all the healthy survivors, a cancer diagnosis is still a scary thing. For good reason: The disease killed nearly 290,000 men in 2002--almost a quarter of all deaths among men that year--mostly from lung, prostate, and colon cancer. Treatments are improving, but progress is incremental. And the idea of a single, silver-bullet "cure" has faded. Now doctors talk about managing cancer as a chronic disease.
Yet there is a potent, often underused weapon against cancer--stopping it before it even starts. "A pretty substantial proportion of cancers can be prevented," says Anne McTiernan, director of the prevention center at the Fred Hutchinson Cancer Research Center in Seattle. The poster child for prevention, of course, is lung cancer, the biggest cancer killer of American men, responsible for more than 90,000 deaths a year. You've heard it all before. Don't smoke. It's the single best thing a man can do to prevent getting cancer.
But given the aggressiveness of the disease, there is also plenty of interest in early detection, to find lung cancer before it is big or widespread enough to cause problems. Claudia Henschke, a radiologist at New York Weill Cornell Medical Center who is currently studying the benefits of screening the highest-risk patients (current or former heavy smokers who are age 50 or older), believes that a special imaging scan called a spiral ct can save lives by finding tiny tumors long before they do harm. The smaller the tumor, the less advanced the cancer, so removing those tiny growths drastically boosts the odds of survival, Henschke says.
The logic is there, and doctors say the idea has promise. Roman Perez-Soler, chief of oncology at the Montefiore Medical Center in New York, says that if he were a heavy smoker, he'd probably get the test himself. It was worth it for Ralph Reinhardt of Paramus, N.J., who smoked from high school until his early 40s. More than two decades later, in 2001, he heard about Henschke's study and had his first CT scan, which showed abnormal cells that were later biopsied and shown to be the earliest stage of cancer--and were promptly removed. "I had no symptoms whatsoever," he says. Now 67, Reinhardt has a scan every year and says he feels extremely fortunate to have had an early warning.
Needless worry. Yet, many experts say it's too soon to institute widespread screening (or to require that insurers pay for it). That's because the test may uncover cancers that would never have progressed into serious disease, causing unnecessary worry and requiring invasive treatment, with all the attendant risks. There's also the enormous cost of screening all those current and former smokers. Groups like the American Cancer Society haven't endorsed the test, saying there needs to be more conclusive scientific evidence that the test actually saves lives and does not just uncover early-stage tumors. The National Cancer Institute is sponsoring a large controlled study on just this point, but full results aren't due for several years.
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