CHICAGOAlthough the incidence of non-small-cell lung cancer
(NSCLC) is similar to that of other types of cancer, the death rate
tends to be higher because lung cancer often is not detected until it
is the size of an orange. There is no reason why the death rate
for lung cancer cannot be reduced to the levels seen with other
cancers if high-risk patients undergo regular screening and lesions
are found when they are the size of a grain of rice, Claudia I.
Henschke, MD, PhD, said at the 85th Annual Meeting of the
Radiological Society of North America (RSNA).
Dr. Henschke, professor of radiology and chief of the Division of
Chest Imaging, Weill Medical College of Cornell University, New York,
reported on the results of the second year of the Early Lung Cancer
Action Program (ELCAP).
In its first year, ELCAP enrolled 1,000 men and women aged 60 years
or older who had a strong history of cigarette smoking; enrollees
smoked at least a pack of cigarettes a day for 10 years or two packs
a day for 5 years.
An Unanticipated Benefit of Screening
A related study of subjects enrolled in ELCAP showed an unexpected
When reviewing the CT images for possible lung cancer, the study
Of these 1,000 high-risk individuals, 808 have had a baseline and a
repeat low-dose CT screening examination. Dr. Henschke presented
findings from multiple CT studies of these 808 individuals, which
provided a total of 1,398 person-years of annual CT screening.
Repeat annual CT screening identified one to six noncalcified nodules
(new or previously undetected at baseline screening) in 78
individuals, for a detection rate of 5.6%. Of 11 patients with
nodules selected for biopsy, based on study criteria, nine were found
to have malignant lesions.
Low-dose CT screening produced a dramatic improvement in
the detection of early-stage NSCLC, Dr. Henschke said. Baseline CT
screening, which was reported at the 1998 RSNA meeting, detected 27
of 28 lung cancers, 23 (85%) of which were stage IA. Repeat CT
examination found all nine malignancies diagnosed at biopsy, eight
NSCLCs and one small-cell lung cancer. Seven of the eight NSCLCs
(88%) were stage IA.
According to Dr. Henschke, previous randomized trials have shown that
if NSCLC is found at an early stage and managed with surgical
resection, the survival rate approaches that of other cancers that
are found through screening and treated promptly. Dr. Henschke
stated, therefore, that regular CT screening of individuals who are
at high risk for NSCLC may identify patients with stage IA disease
suitable for surgical resection and improve the survival rate for
NSCLC to 80% or higher.
Dr. Henschkes coauthors were Drs. David Naidich, David
Yankelevitz, Dorothy McCauley, Georgeann McGuinness, James Smith,
Daniel Libby, Mark Pasmantier, and Olli Miettenen.