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Annual CT Detects Early-Stage Lung Cancers, Saves Lives

It has long been known that lung cancer is the number one cancer killer of men and women.  While smoking is the number one risk factor for lung cancer, it would still be nice if we had an effective screening test.  As with most cancers, early-stage lung cancer is the most curable form of the disease.  While prevention is the ideal way to reduce mortality from lung cancer, early detection and treatment is our next best bet.  Good news has come from a recent report from an ongoing 10 year study of 6,318 smokers: the Early Lung Cancer Action Project (ELCAP) found that regular CT screening annually is an effective tool for diagnosing early-stage lung cancer.  If you're a smoker-or a former smoker-who hasn't yet had a screening CT scan, you may want to add discussing this with your physician to your list of things to do.

"More than 80 percent of the diagnosed lung cancers we found in initial and annual repeat CT screenings were Stage I - the most curable form of lung cancer," said Claudia I. Henschke, MD, Ph.D., principal investigator of the studies and professor of radiology and division chief of chest imaging at New York Hospital/Cornell Medical Center in New York City.  Dr. Henschke presented these findings Dec. 1, 2003 at the annual meeting of the Radiological Society of North America (RSNA).

Not only is lung cancer is the leading cause of cancer death among men and women, more people will die from it than from breast, colon and prostate cancers combined, according to the American Cancer Society. Lung cancer has no clear early warning signs and a tumor may be the size of an apple by the time it is detected, often once symptoms like shortness of breath, hoarseness, coughing up blood, and unexplained weight loss have developed.

Stage I cancer is typically small (no larger than 10 millimeters in diameter) and localized in the lungs without spreading to the lymph nodes. The average cure rate for patients when Stage I lung cancer is removed is 60 percent to 70 percent, while the cure rate for more advanced types of lung cancer - Stage II and later - is less than 5 percent, according to Dr. Henschke.

The ELCAP is a cohort study which was conducted from 1993-2003.  It is a large study that will issue several different reports focusing on different aspects of lung cancer risks, detection and screening.  In this study, multiple annual CT screenings were performed on 2,968 high-risk subjects to determine the proportion of lung cancers diagnosed on repeat CT screenings compared to those diagnosed from symptoms or clinical examinations between the screenings. The study also looked at the number of deaths due to lung cancer after long-term follow-up.

Cancers were classified as being either an annual repeat screening diagnosis (findings on a low-dose CT scan 11 to 13 months after the last screening) or as an interim diagnosis (symptoms appearing within 12 months after the last screening). Among the 29 cases diagnosed, 28 were screening-diagnosed and one was interim-diagnosed, indicating that annual screening was frequent enough to diagnose early-stage lung cancer before a clinical diagnosis would have been made.

Long-term follow-up of patients with screen-diagnosed lung cancer who underwent surgery also showed a high cure rate.  "Through these screenings we will determine how many patients are cured," Dr. Henschke said. "Depending on the resulting long-term follow-up, we hope that CT screening will be made widely available to high-risk smokers and former smokers."  Most importantly, we hope that this information along with all the other information out there about the dangers of smoking, will help to influence smokers to quit and non-smokers not to start. 

Created: 1/12/2004  -  Donnica Moore, M.D.

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