NEW YORK—From 85% to 91% of cancer cases identified by annual CT lung screening in high-risk patients were early stage, according to the latest findings of the New York-Early Lung Cancer Action Project (NY-ELCAP) (Radiology 243:239-249, 2007). The study focused on the diagnostic performance of the NY-ELCAP regimen. Of the 134 recommended biopsies, 125 (93.3%) resulted in a diagnosis of lung cancer or another malignancy vs none of the 24 biopsies performed outside of the regimen recommendations. "Following the appropriate regimen markedly decreases unnecessary workup and biopsies," said Claudia Henschke, PhD, MD, of New York-Presbyterian/Weill Cornell Medical College.
NY-ELCAP provided baseline CT screening to 6,296 patients with no symptoms of cancer and a single round of annual screening. Participants were age 60 or older with a history of smoking but no prior cancer and no chest CT in the past 3 years. All but 3 of the 124 lung cancer diagnoses were based on CT screening results; most patients had no evidence of metastases when recommended for biopsy: 91% in the baseline and 85% in the repeat screening. Some patients (37%) did not immediately have the recommended diagnostic workup, which "detracted from the full benefit of CT screening," Dr. Henschke said.
She criticized the JAMA study showing that CT screening does not reduce lung cancer mortality (see p. 1) as having too short follow-up (median 3.9 years). "The decrease in deaths from lung cancer only begins to be seen after the first 5 years of screening," she said, adding that there are numerous concerns about the validity of the model used in the study to predict expected lung cancer deaths.
