CT screening for lung cancer: five-year prospective experience.

PURPOSE To report results of a 5-year prospective low-dose helical chest computed tomographic (CT) study of a cohort at high risk for lung cancer. MATERIALS AND METHODS After informed written consent was obtained, 1520 individuals were enrolled. Protocol was approved by institutional review board and National Cancer Institute and was compliant with Health Insurance Portability and Accountability Act, or HIPAA. Participants were aged 50 years and older and had smoked for more than 20 pack-years. Participants underwent five annual (one initial and four subsequent) CT examinations. A significant downward shift was evaluated in non-small cell lung cancers detected initially from advanced stage down to stage I by using a one-sided binomial test of proportions. Poisson regression and Fisher exact tests were used for comparisons with Mayo Lung Project. RESULTS In 788 (52%) men and 732 (48%) women, 61% (927 of 1520) were current smokers, and 39% were former smokers. After five annual CT examinations, 3356 uncalcified lung nodules were identified in 1118 (74%) participants. Sixty-eight lung cancers were diagnosed (31 initial, 34 subsequent, three interval cancers) in 66 participants. Twenty-eight subsequent cases of non-small cell cancers were detected, of which 17 (61%; 95% confidence interval: 41%, 79%) were stage I tumors. Diameter of cancers detected subsequently was 5-50 mm (mean, 14.4 mm; median, 10.0 mm). Analysis for a more than 50% shift in proportion of stage I non-small cell cancer detection did not show statistical significance. Forty-eight participants died of various causes since enrollment. Lung cancer mortality rate for incidence portion of trial was 1.6 per 1000 person-years. There was no significant difference in lung cancer mortality rates of cancers detected in subsequent examinations between this trial and Mayo Lung Project after separation of participants into subsets (2.8 vs 2.0 per 1000 person-years, P = .43). CONCLUSION CT allows detection of early-stage lung cancers. Benign nodule detection rate is high. Results suggest no stage shift.

[1]  B J Flehinger,et al.  Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study. , 2015, The American review of respiratory disease.

[2]  W F Taylor,et al.  Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. , 2015, The American review of respiratory disease.

[3]  Feng Li,et al.  Mass screening for lung cancer with mobile spiral computed tomography scanner , 1998, The Lancet.

[4]  G. Byrnes,et al.  Screening for lung cancer: a systematic review and meta-analysis of controlled trials , 2003, Thorax.

[5]  M E Baker,et al.  Ten criteria for effective screening: their application to multislice CT screening for pulmonary and colorectal cancers. , 2001, AJR. American journal of roentgenology.

[6]  M. E. Lores,et al.  Major pulmonary resection for suspected but unconfirmed malignancy. , 1984, The Annals of thoracic surgery.

[7]  C. Mountain,et al.  Revisions in the International System for Staging Lung Cancer. , 1997, Chest.

[8]  D. Mark,et al.  Patient and hospital characteristics related to in-hospital mortality after lung cancer resection. , 1992, Chest.

[9]  Hajime Nakata,et al.  Lung cancer screening using low-dose spiral CT: results of baseline and 1-year follow-up studies. , 2002, Chest.

[10]  Hironobu Ohmatsu,et al.  Screening for lung cancer with low-dose helical computed tomography: anti-lung cancer association project. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  E A Zerhouni,et al.  CT of the solitary pulmonary nodule. , 1980, AJR. American journal of roentgenology.

[12]  S. Lam,et al.  Lung cancer screening: a different paradigm. , 2003, American journal of respiratory and critical care medicine.

[13]  D. Sugarbaker,et al.  Video-assisted thoracic surgery in the elderly. A review of 307 cases. , 1996, Chest.

[14]  M. Celik,et al.  Video-assisted thoracoscopic surgery: experience with 341 cases. , 1998, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[15]  M. Schnall,et al.  American College of Radiology Imaging Network: future clinical trials. , 2003, Radiology.

[16]  P C Prorok,et al.  Lung cancer mortality in the Mayo Lung Project: impact of extended follow-up. , 2000, Journal of the National Cancer Institute.

[17]  M. Melamed,et al.  The effect of surgical treatment on survival from early lung cancer. Implications for screening. , 1992, Chest.

[18]  R. Stanley Inherent dangers in radiologic screening. , 2001, AJR. American journal of roentgenology.

[19]  S J Mentzer,et al.  The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases. , 1996, Journal of the American College of Surgeons.

[20]  S. Swensen,et al.  Lung cancer screening with CT: Mayo Clinic experience. , 2003, Radiology.

[21]  W. Heindel,et al.  Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. , 2002, Radiology.

[22]  A. Bernard,et al.  Resection of pulmonary nodules using video-assisted thoracic surgery. The Thorax Group. , 1996, The Annals of thoracic surgery.

[23]  Edward F Patz,et al.  Estimate of lung cancer mortality from low-dose spiral computed tomography screening trials: implications for current mass screening recommendations. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  W C Black,et al.  Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy. , 1993, The New England journal of medicine.

[25]  S. Swensen,et al.  Computed tomographic screening for lung cancer: home run or foul ball? , 2003, Mayo Clinic proceedings.

[26]  S. Swensen,et al.  Respecting patient autonomy: screening at CT and informed consent. , 2003, Radiology.

[27]  S. Swensen,et al.  Screening for lung cancer with low-dose spiral computed tomography. , 2000, American journal of respiratory and critical care medicine.

[28]  W. Holland Screening for Disease , 1969, Nature.

[29]  O. Miettinen,et al.  Early Lung Cancer Action Project: overall design and findings from baseline screening , 1999, The Lancet.

[30]  N. Müller,et al.  Lung nodule enhancement at CT: multicenter study. , 2000, Radiology.

[31]  W. C. Ball,et al.  Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. , 2015, The American review of respiratory disease.

[32]  M. Mack,et al.  Thoracoscopy for the diagnosis of the indeterminate solitary pulmonary nodule. , 1993, The Annals of thoracic surgery.

[33]  P. Goldstraw,et al.  Open lung biopsy: a safe, reliable and accurate method for diagnosis in diffuse lung disease. , 1992, Respiration; international review of thoracic diseases.

[34]  D K Owens,et al.  Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. , 2001, JAMA.

[35]  John Eng,et al.  Lung cancer screening with helical computed tomography in older adult smokers: a decision and cost-effectiveness analysis. , 2003, JAMA.

[36]  H. Ohmatsu,et al.  Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. , 1996, Radiology.

[37]  S. Sone,et al.  Characteristics of small lung cancers invisible on conventional chest radiography and detected by population based screening using spiral CT. , 2000, The British journal of radiology.

[38]  W. Fry,et al.  Ten‐year survey of lung cancer treatment and survival in hospitals in the United States , 1999, Cancer.

[39]  D. Parkin,et al.  Czech study on lung cancer screening , 2000, Cancer.