Low-dose computed tomography (LDCT) scans have emerged as an effective screening tool for lung cancer, especially in high-risk patients. However, the method may have a significant rate of overdiagnosis, that is, detection of cancers that would not have caused any symptoms during the patient’s lifetime. These cancers may be slow growing or otherwise clinically insignificant. Overdiagnosis can lead to unnecessary treatment, generating significant cost and anxiety and risking medical complications. A large study comparing LDCT screening with another screening method, chest radiography, estimated that 18.5% of the lung cancer cases detected represented overdiagnoses. For cases of non-small cell lung cancer (NSCLC) and bronchioalveolar carcinoma (cancer of the air sacs), estimated overdiagnosis rates were 22.5% and 78.9%, respectively.
Personalized cancer medicine uses genetic testing of patients’ tumors to guide individually tailored treatment decisions. Such tests can determine which chemotherapies would likely be most effective and whether the patient may benefit from novel drugs targeting specific mutations. One example is the case of Elizabeth Lacasia, who has advanced bronchioalveolar carcinoma, a type of non-small cell lung cancer (NSCLC). Testing revealed that she does not have any of the mutations targeted by the new drugs. Based on her test results, she was treated with a combination of Tarceva (erlotinib) and Alimta (pemetrexed) following an alternating schedule that has been proven effective for people with her cancer type. Her cancer has been in remission for 2 years.