Lung cancer is the number one cancer killer. Chest computed tomography (CT) for early lung cancer detection is an approach that relies on a presymptomatic phase for identification and intervention. Our objective was to determine if screening with chest CT can identify early-stage lung cancer in high-risk individuals in the Ohio River Valley.
Study subjects were recruited by local advertisement, letters to community and university physicians, and information provided on multiple university web sites. Inclusion criteria were: volunteers able to understand informed consent; age over 50 years; and a minimum of a twenty pack-year smoking history. Exclusion criteria were: symptomatic lung cancer at the time of screening; or a history of cancer in the past five years. Subjects completed a questionnaire conducted by research personnel and then underwent a screening thoracic spiral CT. Management of nodules was based on a defined algorithm including the following criteria: annual follow-up CT for <5mm or no nodules; 6-month follow-up CT for 5-7mm; review by committee for 8-12mm; and biopsy for >12mm.
From August 2001 through April 2005 131 subjects were evaluated. Sex distribution was nearly equal. The average age was 64. The average subject started smoking at 17. The average age of those who quit was 56. The average pack-per-day smoked was 1.6. The average pack-year smoking history was 62. Fifty-six percent had at least one non-calcified nodule. Five subjects had nodules greater than 12mm and four underwent biopsy. Three patients had stage IA non-small cell lung cancer (NSCLC) and one had stage IIIA NSCLC. All patients diagnosed with lung cancer underwent complete resections: two VATS lobectomies, one open lobectomy, and one open bilobectomy. There was no operative mortality. To date no volunteer has undergone biopsy for a benign nodule.
Screening chest CT can identify early-stage lung cancer in high-risk individuals.
Early diagnosis allows surgical resection that is often curative. A larger study will identify the specific parameters that define high-risk patients among whom screening will increase survival.
Lynn Huffman, None.