Israel approves ‘only thing that can save lives of lung cancer patients’

Ministry of Health to pilot lung cancer screening program proven internationally to catch up to 80% of tumors in their earliest stage.

Doctor inspects an x-ray, illustrative (photo credit: PIKREPO)
Doctor inspects an x-ray, illustrative
(photo credit: PIKREPO)
The Health Ministry has approved a three-year pilot program for early detection of lung cancer that could substantially increase the number of patients cured of the otherwise deadly disease, according to Prof. Dorith Shaham, head of Hadassah-University Medical Center’s Thoracic Imaging Center.
Millions of shekels will be invested in a program that should confirm the value of low-dose computed tomography (CT) screening in Israelis at high risk of developing lung cancer, she said.
Prof. Dorit Shaham (Photo Credit: Avi Hayun)
Prof. Dorit Shaham (Photo Credit: Avi Hayun)
About 2,500 people are diagnosed with lung cancer in Israel each year, and about 1,800 people die from the disease. Lung cancer is the No. 1 cause of cancer death, because in more than two-thirds of cases (70%), it is detected only at a late, metastatic stage.
Before reaching the most advanced stage of cancer, stage 4, lung cancer is considered a quiet tumor that does not express symptoms, which allows it to grow and spread without interruption, Shaham said.
“If 1,800 people die each year of lung cancer, even if we save 200 or 300 people per year, it’s a lot,” she said.
Shaham expects that CT screening could save even more people than that.
Studies by the International Early Lung Cancer Action Program (I-ELCAP) found that such cancers diagnosed under screening were typically small, and that the estimated cure rate of patients whose lung cancer was diagnosed this way was as much as 80%, she said.
Additionally, the large, randomized, population-based NELSON trial showed that CT scanning decreased mortality by 26% in high-risk men and up to 61% in high-risk women over a 10-year period.
“Today, in Israel, two means are available for early detection of lung cancer,” Shaham told The Jerusalem Post. “The first is by accident, because a CT scan was performed for another reason, for example, due to a car accident or coughing. The second option is by a CT scan meant for early detection of lung cancer.”
But, she said, until now, such screening was infrequent because of lack of awareness, as well as the high cost of paying for the test privately.
Shaham compared the low-intensity CT scan to a mammogram for breast cancer. The examination does not require special preparation by the patient or subsequent supervision. After the imaging of the chest is done, the examination is interpreted by a radiologist.
In the interpretation process, the radiologist is looking for different types of nodules (solid, part-solid and non-solid) and their size due to their differing pathologic findings and survival rates.
Using what is known as Lung-RADS, a quality-assurance tool designed to standardize lung-cancer screening, CT reporting and management recommendations, doctors can determine next steps in monitoring, testing, surgery or other treatments.
“We want to diagnose lung cancer as early as possible while doing as few unnecessary interventions as possible,” Shaham said.
In only 1% to 1.5% of cases, the patient is diagnosed with having malignant cancer cells. In other words, the vast majority of nodules are benign. But for those who do have cancer, the sooner the cancerous tumor is diagnosed, the greater chance of curing it.
A CT scan for early detection of lung cancer is recommended for people aged 55 to 75 who smoked one pack a day for 30 years or two packs a day for 15 years. This recommendation even applies to those who smoked this amount in the past and stopped within the last 15 years.
Shaham said the program will not include the entire target population described above, just a segment of it, which will help health professionals to determine that the screening has an equally positive effect in Israel as it does in larger countries such as the United States or Western Europe. Although lung cancer is among Israel’s largest killers, its prevalence remains about a third of that in the US or Western Europe, she said.
The degree of risk that a person takes by undergoing a low-intensity CT scan is the same as the risk of a person smoking one cigarette a day, Shaham said.
“So, radiation exposure, for a person who smokes a pack a day, is probably the last thing to worry about,” she said.
Shaham has been part of an international team studying early detection of lung cancer since 1996. She said early detection CT scans began being covered by private insurance in the US in 2014 and by Medicare and Medicaid in 2015.
“Technology is advancing very quickly,” Shaham said. “We want to capture as many people at risk as possible and do as much good as possible. This is the only thing that can really save the lives of lung-cancer patients.”