NEW YORKResection with intent to cure was possible for all but
one of the lung cancers identified in a German screening program
using low-dose spiral CT scans. Of the 13 cancers identified, eight
were stage I, Stefan Diederich, MD, a staff radiologist at the
University of Münster, said at the Second International
Conference on Screening for Lung Cancer. The inoperable lesion was
stage IIIB. However, it was resected after preoperative chemotherapy.
One lesion was small-cell cancer, six were adenocarcinomas, and six
were squamous cell carcinomas.
The screening program in which the cancers were identified enrolled
919 persons (647 men and 272 women) who were recruited through media
We suggested a minimum tobacco consumption of 20 years and a
minimum age of 40 years, Dr. Diederich said. As a result, only
24% of the participants were older than 60 years of age, the minimum
for acceptance into such programs as the Early Lung Cancer Action
The mean tobacco consumption for the group was 46 pack-years. Since
pack-years are defined by the number of packs of cigarettes smoked
daily, this would include a person who smoked one pack a day for 40
years, one who smoked two packs daily for 20 years, and one who
smoked four packs daily for 10 years.
Under the studys diagnostic algorithm, scans not showing any
soft tissue densities are considered normal. Persons with such scans
are invited to return for a repeat scan in 12 months. If there
is a soft tissue density nodule, Dr. Diederich said, we
invite the patients for follow-up thin section scan. Repeat
scans of the whole lung are advised at 12 and 24 months.
Biopsies are recommended for any soft density lesion larger than 10
mm unless the CT morphology strongly suggests a benign
lesion, he said. Such lesions are followed, and biopsies
recommended for any that show growth. In all, 16 lesions were
biopsied in the study. We performed biopsies on only three
benign lesions, Dr. Diederich reported.
The prevalence of lung cancer in the study population was 1.2%,
considerably lower than the 2.7% in the ELCAP study. However, among
participants over 60 years of age, a subset comparable to the ELCAP
population, the prevalence in the German study was 3.6%.
Patients in the German study will be followed for another 2 years.
We intend to collect more information on the nodules smaller
than 10 mm, Dr. Diederich said. Also to be studied are optimal
inclusion criteria for tobacco consumption and patient age, and more
information on appropriate screening intervals.