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MIAMI - When Jessie Trice was diagnosed with lung cancer in 1999, she had six months to live.
Before she died at age 69, Trice, who was a public-health nurse and longtime smoker, gave her co-workers at Health Choice Network a mandate - get involved to find lung cancers earlier, when they're still treatable.
It was a "sacred charge," said Betsey Cooke, the president and CEO of Health Choice Network, an organization of community health centers in Florida, New Mexico and Utah. "She knew the present way of diagnosing lung cancer wasn't enough."
Four years later, Health Choice is working with the University of Miami School of Medicine on a worldwide study of an early test for lung cancer, the country's leading cancer killer, with 160,000 deaths each year.
The study, called the International Early Lung Cancer Action Program (I-ELCAP), aims to enroll 50,000 smokers worldwide, examine their lungs with a low-dose spiral CT (computed tomography) scan, and follow them long-term.
The researchers, who also include doctors at the Mount Sinai Medical Center and Miami Heart Institute, met in Miami recently to discuss their work with the CT scan. Studies have shown this scan to detect tumors that traditional X-rays miss.
It's not a time-consuming test - patients lie down, slide through a doughnut-shaped machine and stay still for the scan's 20-second duration. The scan takes X-rays from different angles throughout the body, which are then reconstructed by a computer to give a detailed image of what's inside.
"There's no reason why this technique shouldn't be used as a gold standard for monitoring people who are at high risk for lung cancer, but you need data," said Dr. Shari-Lynn Odzer, a diagnostic radiologist who is the principal investigator of the Mount Sinai I-ELCAP site.
And researchers hope this study will prove scanning saves lives.
The current prognosis for lung cancer sufferers is dismal, with only 12 percent living for five years after diagnosis.
The CT scan can pick up tumors when they're as small as two to four millimeters, no bigger than a grain of rice. This is promising, researchers said, because 90 percent of lung cancer patients live at least five years after surgery that removes a tumor smaller than 20 millimeters.
Although the scan is widely accessible at hospitals and free-standing centers, it's not covered by insurance and costs, on average, $300.
And it's so sensitive that it can pick up scars and other nodules, subjecting patients to unnecessary biopsy.
"We don't want to operate on a whole bunch of patients who don't need it," said Dr. Richard Thurer, a University of Miami cardiothoracic surgeon who is the principal investigator of the UM I-ELCAP site. "So that's the challenge."
The study began in New York in 1993, with 1,000 patients, headed by Dr. Claudia Henschke, a professor of radiology at Cornell Medical Center. The first round of results were published in 1999, announcing that the CT scan detected stage 1 cancers - early tumors that hadn't spread - six times as often as chest X-ray.
The worldwide response spurred a growing number of other medical institutions to get involved. For the past two and a half years, the Rev. Ted Greer Jr., the pastor of Miami's Ebenezer Community Church, has worked with dozens of other churches throughout South Florida to recruit smokers for the study's University of Miami site.
To qualify, individuals must have smoked at least a pack a day for 10 years (or two packs per day for five). They must be 50 or older, Thurer said, or - with a family history of lung cancer - 45, and agree to a baseline scan and one-year follow-up.
They've identified 4,000 smokers, many of them uninsured, and referred nearly 200 of them to receive free scanning at Jackson Memorial Medical Center.
Mount Sinai has also scanned 200 patients, at $75 per scan, and found four malignant cancers. Doctors removed the tumors, and Odzer said three or the four patients are considered cured.
"This is unheard of in lung cancer," she said. "It's very exciting."
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(c) 2003, The Miami Herald. Distributed by Knight Ridder/Tribune News Service.
