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Health Care & Insurance

6,133,200 Reasons I'm Scared

I inhaled a lot of smoke before quitting cigarettes 14 years ago. My risk for lung cancer has dropped, but breakthrough work on CT scans could detect it early if it ever does develop.


This month I'm stepping back from the money matters you usually read about on this page to talk about something else dear to all of us: our health. I calculate that I inhaled cigarette smoke 6,133,200 times before quitting 14 years ago. Amazing that I'm alive, isn't it? It came as no surprise to be told by Jim Mulshine, a physician and lung-cancer researcher, that my odds of contracting this disease plummeted when I quit smoking but will always be above average. "And by the time my cancer is seen on an x-ray," I replied, "my goose is cooked, right?" Maybe not, he replied.

Early warning

That's when I learned of computed tomography (CT) screening for lung cancer. These scans are three-dimensional, computerized pictures of your lungs that spot cancers years before they show up on conventional x-rays. When an x-ray sees lung cancer, it has usually spread and become incurable.

The breakthrough work on CT scans is being done by the International Early Lung Cancer Action Program, or I-ELCAP, a consortium of radiologists, thoracic surgeons and other health-care specialists on three continents, led by two Cornell University doctors, Claudia Henschke and David Yankelevitz. During the past 15 years, I-ELCAP has conducted CT scans on more than 31,000 at-risk people. Of those found to have early (stage 1) lung cancer, the ten-year survival rate is an astounding 88%. The investigators argue that CT scanning of people at risk of lung cancer could prevent 80% of the deaths from this disease, which claims the lives of 160,000 Americans annually.

I won't kid you -- this topic is complex and controversial in medical circles. A paper published this year in the Journal of the American Medical Association says that CT screening may be a crock. The lead author, Dr. Peter Bach, of Memorial Sloan-Kettering Cancer Center, admits that CT scans increase the rate of lung-cancer detection. But he says there's no proof that scans actually reduce the death rate from lung cancer. Maybe small nodules that are found will never develop into full-fledged cancers, he says, or maybe unnecessary surgeries are themselves killing people.

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How do you settle an argument like that? The National Cancer Institute is conducting a randomized trial -- half of the 50,000-person study group is screened by x-ray, half by CT scan. But results won't be known until at least 2009, and frankly, disagreements will undoubtedly continue. Very few medical studies provide unambiguous answers that are universally accepted. Let me give you one example: A surgeon's group said this spring that the benefits of mammograms are uncertain for women under age 50. But my wife's breast cancer was detected by a mammogram when she was 42. So while experts would say her mammogram was unnecessary, it saved Cathie's life. What do you suppose she will advise our daughters to do?

My point is this: Forget waiting for scientists to agree with one another because they probably won't. We're capable of making our own decisions, even when they involve highly technical details. I've decided. I'm happy to pay a small portion of the money I no longer spend on cigarettes to undergo CT screening annually at the clinic run by Henschke and Yankelevitz at NewYork-Presbyterian Hospital.

A better habit

If you smoke, the most important thing you can do to extend your life is to kick the habit. Addicted as I was, I did that. The next-most-important thing is to learn more about CT scans. Consider visiting http://www.ielcap.org/contact.htm to find a screening site near you.