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CT Scans Show Great Promise for Lung Cancer Screening
By Nancy Kennedy

Dr. Charles Koliner

Every year, 160,000 Americans die of lung cancer. It is the leading cause of cancer and is increasing among women; as a cause of death, it is number one for women. Lung cancer's deadly impact is due to multiple factors, including the fact that it is typically asymptomatic until it has reached an advanced stage, when it is essentially beyond treatment. In addition, although it is one of the most common and deadliest cancers, there has not been a screening test available for early detection of lung cancer, like the mammogram for breast cancer or the colonoscopy for colon cancer. But that is finally about to change: a major national study, the National Lung Screening Trial, has been completed and the results indicate that low dose CT scans are useful for detection of lung cancer in its early stages. This is great news for anyone with risk factors for lung cancer, says one of Pittsburgh's leading lung cancer experts, Charles Koliner, MD, of Washington Health System.

Dr. Koliner is a board-certified pulmonologist, critical care specialist, and sleep medicine specialist who served until recently as the medical director of Washington Health System's Critical Care Unit and also has a busy private practice treating people with lung cancer, emphysema, asthma, chronic obstructive pulmonary disease and other lung problems. "The availability of low dose screening is a major advance for early detection of lung cancer. The National Lung Screening Trial (NLST) was conducted from 2002 through 2009 with 50,000 participants, who met specific criteria," he explains. "They were 55 -74 years old; they were smokers for at least 30 'pack years' – meaning that they had smoked 20 cigarettes a day for 30 years or 40 a day for 15 years; or they were ex-smokers who quit within the last 15 years. The study found that there were 20% fewer deaths from lung cancer among those who were screened with low dose CT scans. "

Unlike some other cancers, lung cancer is very difficult to detect in its early stages. "The lungs are so big and in the early stages, the cancer nodules are very small – two centimeters or less. Usually, by the time it is discovered, it is most likely not operable, and even if it is operable, it is most likely not curable. Early detection will make a big difference in both operability and survivability; CT scans will identify early stage nodules which can then be removed. We can get excellent survival rates with surgical resection in the early stages."

Concern about exposure to radiation with a CT scan may intimidate some patients, but Koliner says that the amount of radiation used for a screening CT scan is considerably less that the amount used for a standard diagnostic CT scan. "We do have to be cautious about having CT scans, but a screening scan is not the same as a diagnostic scan, and so it requires one-fifth of the amount of radiation. An x-ray is not adequate for screening because it will not provide the detail and clarity that enables the radiologist to see pulmonary modules in the early stages."

Dr. Koliner says that for those who are in a high risk group, who meet the criteria used in the study, having a screening CT scan is a good idea. And for those who may not meet the exact criteria but have other risk factors, such as industrial exposure, a personal history of another form of cancer or a family history of lung cancer, screening may be appropriate. "This is something to discuss with your doctor. It's not the same as having a medical problem and going for treatment; most of the time, what we find will be benign pulmonary nodules which require no treatment."

Screening CT scans can be scheduled through Dr. Koliner's office. The program includes a health screening and interview with a nurse practitioner and then the scan is scheduled through Washington Hospital. A radiologist reads the CT scan and makes recommendations for follow-up or further investigation. Patients who are still active smokers are referred to a smoking cessation program offered by the Pennsylvania Department of Health. At this time the cost of the screening is $99.00. Health insurance does not yet pay for CT scan screenings, but Koliner believes that they will eventually; he anticipates that lung screening CT scans will become routine and commonplace in the near future and will potentially prevent thousands of lung cancer deaths every year. The American Cancer Society says that the impact will be profound, once national screening guidelines are put in place.

A native of Philadelphia, Koliner completed medical school at Columbia University, New York and completed residencies at both Harlem Hospital in New York and Royal Victoria Hospital in Montreal. He lives in Mt. Lebanon with his wife has three children.

Do you qualify for the screening?
Are you between ages of 55-79, with a 30-pack per day smoking history OR Age 50 or older with a 20-pack per day smoking history and have additional risk factors. Call (724) 222-2577 to schedule your screening.

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