Celebrity death increases awareness of lung cancer

The most persuasive public relations campaigns to increase the average person's interest in his or her health sometimes come not from Madison Avenue but from Hollywood or Capitol Hill.

When President Bill Clinton underwent triple bypass surgery, interest in heart disease spiked. The same phenomenon occurred for aortic diseases when actor John Ritter died suddenly from a dissection, and for colon cancer screening when "Today" host Katie Couric had a televised virtual colonoscopy following her husband's death from colon cancer.

Now, lung cancer is in the spotlight. The death of news anchor Peter Jennings in August and the revelation the same month that Dana Reeve, actor Christopher Reeve's widow-and a nonsmoker-has lung cancer have sparked renewed interest in screening for the disease.

"I've received several e-mails inquiring about lung cancer screening trials," said Dr. Kavita Garg, a professor of radiology at the University of Colorado Health Sciences Center. "One in particular was from a 46-year-old woman, a nonsmoker, who was concerned about lung cancer because of her exposure to second-hand smoke."

Garg was the principal investigator at UCHS for the National Lung Screening Trial, an eight-year, $200 million randomized controlled trial under the auspices of the National Cancer Institute.

Now in its third year, the NLST hopes to discover whether lung cancer screening with low-dose multislice CT can reduce mortality compared with chest x-ray. The trial concluded its enrollment of 52,000 participants in February 2004.

"We have received e-mails from people who were disappointed when we told them the trial had closed," she said.

Garg now uses volumetric software to follow nodules between 5 mm and 8 mm in size, which are difficult to biopsy. This is not part of the national trial, however. The volumetric measurements document the smallest incremental growth over time and are easily reproduced. The software provides quantitative data, including the height and width of the tumor and the volume in centimeters. These data should help researchers determine which types of lesions are most virulent.

Jennings' death together with Reeve's announcement have raised awareness that lung cancer is a disease that kills, and that nonsmokers can contract it, according to Dr. Michelle Ginsberg, director of general radiology at Memorial Sloan-Kettering Cancer Center.

Ginsberg has often spoken out about the disproportionate attention paid to other cancers compared with lung cancer. While lung cancer kills more women than breast cancer and more men than prostate cancer, the latter two diseases receive far more attention. This is due in part to the stigma that smokers cause their own disease, she said.

Dr. Denise R. Aberle, chief of thoracic imaging at the University of California, Los Angeles and principal investigator of the NLST, has also noted a spike in screening interest. Many people not involved in the trial have asked when the results will be available and what the researchers have learned about chest x-ray and CT screening for the disease.

"People call, tell me what they have heard, and want clarification of some sort," Aberle said.

Half the participants in the trial had a chest x-ray and half underwent low-dose CT. Each of the two cohorts received an annual screening test, including a third and final one this year. Investigators will comb the data to determine the effectiveness of screening with each modality and the difference in mortality rates between the two groups, which have the same risks for lung cancer.

"Any changes we observe between the two arms can be due to the differences in the screening test," Aberle said.

Researchers in New York overseeing the International Early Lung Cancer Action Project also report renewed attention to screening.

"We have certainly had an increased interest, and people have scheduled CT scans," said Dr. Claudia I. Henschke, principal investigator for

I-ELCAP.

Unlike the NCI trial, the I-ELCAP observational study screens everyone with low-dose CT and then randomizes them to either treatment or no treatment. Their data indicate that up to 98% of lung cancers caught and treated at stage IA can be cured. Proponents of randomized trials contend that many of the stage IA cancers found in the I-ELCAP study could be indolent and not biologically dangerous.

Aberle sees a fundamental difference between the two camps. The intent of I-ELCAP is to promote lung cancer screening for the individual patient, whereas the NLST results will be used to shape public policy.

"When a patient asks me if he or she should have a screening exam, I don't say no. I explain the risk and what we know and don't know. But when I'm asked if we should screen as a matter of public policy, I emphatically say no," she said.