Screening in people with no symptoms

Lung cancer is such a serious disease because most cases are found only in the late stages of the disease, when treatments aren't often very effective. So researchers are eager to find some kind of test that could be given to people with no symptoms but who fit a certain risk profile. An example of people at higher-than-average risk for lung cancer would be older individuals who smoked for many years. Some of the tests used to diagnose the disease have also been proposed as potential screening tests, but they haven't proved to effectively find cancers at an early enough stage that they can be successfully treated.

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Now researchers are studying the benefits of screening the highest-risk patients with a special imaging scan called a spiral CT. This test, which takes about 20 seconds and exposes patients to a little more radiation than a standard X-ray, generates a three-dimensional image. The smallest lesion that can be spotted in a standard X-ray is about the size of a marble, which would contain a billion cancer cells. It takes about five years for a cancer to grow that large.

The downside to a spiral CT scan is that it can't distinguish between a small cancer that's on the move and a harmless nodule or a tumor that is so slow growing it poses little risk to health. In fact, 95 percent of the "spots" or suspicious-looking areas that show up on the CT scan are benign; only about 3 percent turn out to be cancerous tumors. For most people, then, the scan results in unnecessary, expensive, and sometimes risky diagnostic procedures as well as a lot of worry.

A large study to examine the potential benefits of a spiral CT screening program is underway, but full results aren't due for several years. Some people may want to have the test anyway, though it hasn't been proved to increase survival and could lead to unnecessary biopsies or other procedures.