VOL. 129 | NO. 103 | Wednesday, May 28, 2014
By Don Wade
Early screenings reduce lung cancer’s mortality rate. Dr. Benny Weksler is sure of that much.
Dr. Benny Weksler is a key player in a lung cancer screening program that the University of Tennessee Health Science Center and West Clinic hope to launch by fall.
(Daily News/Andrew J. Breig)
“I don’t think there’s a debate in terms of the effectiveness; the debate is how are we going to pay for it?” said Weksler, chief of the Division of Thoracic Surgery at the University of Tennessee Health Science Center and also UTHSC’s first Eastridge-Cole Professor.
“As has been well-publicized in last few weeks, it costs money – just like every other screening program,” he said. “Can you imagine, for example, going back on breast cancer screening to say, because it costs money and because there are some unneeded biopsies (it shouldn’t be done)? That’s unthinkable. Nobody would even consider it.”
Weksler is a key player in a lung cancer screening program that UTHSC and the West Clinic hope to launch by this fall. The program is modeled after a major study that found annual CT scans could cut the chances of dying from lung cancer by up to 20 percent in those at high risk – people ages 55 through 79 who have smoked a pack of cigarettes a day for 30 years, or the equivalent, such as two packs a day for 15 years.
The debate comes from a study by the Fred Hutchison Cancer Research Center in Seattle that calculated these screenings could cost Medicare about $2 billion a year and add $3 to monthly premiums.
Lung cancer is the world’s leading cancer killer; typically, it’s detected too late for treatment to help the patient. Most deaths involve Medicare-age people, and most of those are attributed to cigarette smoking.
“Lung cancer mortality is higher than the combined mortality of breast, colon and prostate cancer,” Weksler said.
He says the initial goal in Memphis is to screen 500 people in the first year of what would be a three-year program open to cigarette smokers ages 55-75 who have smoked for at least 30 years. The screening guidelines come from the National Comprehensive Cancer Network. The program will be funded through the West Clinic, the Methodist Healthcare Foundation and commercial insurers that already approve the screenings.
Weksler says they will spread the word of the screenings through the Congregational Health Network. The plan is for there to be four allotted screening slots per day Monday through Friday, split between West Clinic’s East Memphis and Downtown locations.
A patient who has a negative screening the first year would come back for another screening in year two. If that one is negative, the patient would be screened again in year three. Weksler said the program would also include a smoking cessation component through UTHSC.
“In that national trial (more than 50,000 people), the reduction in lung cancer mortality was 20 percent, which may not sound like a lot to laypeople, but this is the most reduction in lung cancer mortality in any intervention we’ve ever had,” Weksler said.
“The key here is to detect early tiny lesions that are less than half an inch or even smaller than that, and that have not given any metastases to lymph glands around it,” he said. “And they’re isolated. That’s where we’re gonna have the reduction in mortality before stage three and stage four and our actions are limited.”
Weksler says that a previous major national study set the parameters for their screening program and indicates that out of every 100 screenings they can expect to find four incidences of lung cancer and 27 will have some “abnormality” that warrants further investigation.
He also hopes that over time the screening parameters can be expanded. Especially in a community such as Memphis, which has a high rate of poverty and health disparity, and a large African-American population.
“How about African-Americans? They have a lower threshold for developing lung cancer,” Weksler said. “What if you are 45, African-American, and smoked for 30 years because you started when you were 15? We’re carefully setting this up to be able to address those questions with time.”