“There are still a lot of scientific minds that
are skeptical about the value of CT scans for lung cancer screening -- I
welcome that skepticism... It is important to support the discussion with
evidence in order to move lung cancer screening forward.”
– Denise R. Aberle, MD
The American College of Radiology Imaging Network (ACRIN) approached Dr. Denise R. Aberle, a thoracic radiologist and expert in pulmonary diseases, to write a proposal for a large-scale study of lung cancer screening. Her proposal caught the eye of administrators in the National Cancer Institute’s Cancer Imaging Program and was ultimately combined with a similar proposal developed through the NCI’s Division of Cancer Prevention. Through a powerful collaboration, the National Lung Screening Trial (NLST) was born.
Though she wrote the initial proposal over a decade ago, the groundbreaking NLST results are just beginning to make their mark on the early detection and treatment of lung cancer. The NLST, a randomized national trial involving more than 53,000 current and former heavy smokers, made headlines in 2010 when its preliminary results showed a 20 percent reduction in lung cancer deaths when patients were screened using low-dose helical computed tomography (CT scans) compared to standard chest X-rays.
“There are still a lot of scientific minds that are skeptical about the value of CT scans for lung cancer screening -- I welcome that skepticism,” explains Dr. Aberle who is the nation’s principal investigator of the NLST and a Professor of Radiology at the University of California, Los Angeles. “The NLST helps us answer many questions about the benefits and risks of lung cancer screening, but there are many questions that remain. It is important to support the discussion with evidence in order to move lung cancer screening forward.”
And more evidence is on the way. The NLST researchers continue to mine the vast clinical trial data for more informative findings. By 2012, the NLST is expected to yield a pivotal report that takes a comprehensive look at the cost-effectiveness of using CT scans for lung cancer screening. This will help compare CT screening for lung cancer with other approved screening strategies, such as mammograms for breast cancer. In addition, additional groups are using the NLST data to develop intricate models of lung cancer to predict such things as the effects of changing risk criteria for those who should be screened and altering the frequency and total years of screening. “Ultimately, these reports will have a significant influence on whether insurance companies and health policy organizations, such as the Centers for Medicare and Medicaid Services, decide to pay for lung cancer CT screenings” explains Dr. Aberle.
There is a big difference between proving the benefits of a medical intervention in a randomized trial and implementing that procedure. It typically takes decades for a procedure to be fully incorporated into public health. “Getting from the evidence-base to implementation is a major transition,” she notes. “Thoughtful analysis of how to inform major stakeholders such as patients, primary care physicians, and sub-specialists takes a huge amount of organizational commitment and effort.”
Getting people organized and moving lung cancer research forward is nothing new to Dr. Aberle. In addition to managing the administration of the NLST on a national level, Dr. Aberle serves as one of the principal investigators of the NLST on the UCLA campus. She is also a practicing thoracic radiologist and a proud member of LUNGevity’s Scientific Advisory Board.
“Lung cancer research has been woefully underfunded and LUNGevity gets real dollars to support lung cancer research,” she says. “That has made them an invaluable and major influence in guiding research for lung cancer. In this role, they are perhaps the most successful of lung cancer advocacy groups.”