To Have and Have Not
Adopters. The controlled study that needs to be done, says Claudia Henschke, radiologist at Cornell's Weill Medical College and head of I-ELCAP, is one that compares a lumpectomy for these smaller cancers with the standard lobectomy. As doctors find more small tumors, it might be possible to remove less lung tissue without affecting survival rates. The more lung you leave behind, the better the quality of life.
We need guidelines, says Henschke, for doctors and patients already seeking this approach, as well as identification of centers with the technology and expertise. The interest is likely to grow as the Lung Cancer Alliance, a patient advocacy group, also supports early screening. Kenneth Cowan, director of the University of Nebraska's Eppley Cancer Center, recently launched what may be the first statewide screening program for heavy smokers using the I-ELCAP model. This will allow a comparison with unscreened patients in Nebraska's tumor registry-all states keep tabs on cancers in their populations-providing a kind of control group.
Long ago as an intern at Johns Hopkins Hospital, I admitted a patient for a blood pressure problem and noticed he had a cough at night. I rechecked his chest X-ray; it was perfect. Then I sent his sputum to the lab; it turned up cancer. My residents and I thought we'd saved his life, but it was more advanced than we realized, and he died within the year. Decades later we may finally have an early-detection option that would have helped him and the many millions who have been lost to lung cancer since then. Let's get on with it.