I want to be screened for lung cancer. Should I delay because of COVID-19?
A group from the American College of Chest Physicians (ACCP) has recommended not only that people with high risk of lung cancer delay getting a CT scan for screening, they also recommend delay in getting follow-up CT scans for known lung nodules and even recommend delay in having surgical treatment of proven stage 1 lung cancer.
I and many of my colleagues disagree strongly with this recommendation.
We believe that it is safe to get a CT scan at an approved center.
2. We believe that it is unsafe and dangerous not to do follow-up CT scans or other work-up in individuals with known lung nodules.
3. We believe that it is unsafe and dangerous to delay surgical or radiation therapy treatment of known Stage 1 lung cancers.
In my opinion, ACCP is wrong to label CT screening as “elective”. Lung cancer screening is not an “elective” procedure.
Examples of elective surgery are treatment of varicose veins, hemorrhoids and liposuction. They are called elective, because the problem in question does not pose a risk of death or major complication in the near future.
As we discussed in an earlier section, this is not the case if you are at high risk of lung cancer, because of past or present heavy smoking. If you fall into this category, your risk of lung cancer now, or in the near future is substantial.
It is important to understand that the ACCP has a long track record of opposing lung cancer screening. I am a former member of this organization who tried, unsuccessfully, to get them to remove inaccurate information from their Lung Cancer Screening guideline recommendations against screening.
ACCP’s current statement regarding delay of CT screening in the era of COVID is problematic. The article is based on a survey of 17 individuals. It is not clearly stated how participants were chosen, raising the question of whether they were selected with their views known in advance. If this is the case, it would be, in effect, like dealing from a stacked deck. My suspicion is heightened, because two of the three individuals who led the project are known to have long-track records of opposition to CT screening.
Gerard Silvestri MD, for example, recommended that a 65 year old woman, an otherwise healthy, long-distant runner with a high risk of lung cancer, “run away from” CT screening. Michael Gould MD is one of the authors of a 2011 publication that tells individuals at high risk that their personal risk of lung cancer is only 2.1% and that they have high risks of false positives and lung cancer overdiagnosis. All of this information is inaccurate; not by a little, by a lot.
Why is it unsafe to delay treatment of Stage 1 lung cancer?
We have a wealth of information, collected throughout the world over the past 50 years, showing that invasive lung cancer in stage 1 is a progressive disease; that the lung cancer grows relatively fast, doubling in volume over a period of 90-180 days on average. With increase in size, the risk of spread (metastasis) to lymph nodes and to distant organs increases progressively. Delay in treatment raises the very real risk that a stage 1 lung cancer – with a very high chance of cure- will progress to a higher stage – with a substantially lower chance of cure. In addition, as discussed earlier, treatment of advanced stage disease has more complications and greater expense.
In defense of the ACCP group, at the time their article was written, little was known about possible dangers of COVID 19 infection during CT screening or surgical operation for lung cancer. It is now known that, with modern methods of COVID personal protection, CT screening, CT follow up tests and surgical resection of lung cancer have very low risks of COVID infection.
For example, both at City of Hope, in Duarte CA and at Mount Sinai Hospital in NY, CT screening programs are active and patients with lung cancer are undergoing surgical treatment.