Early Lung Cancer Action Project: A Summary of the Findings on Baseline Screening

Abstract

Purpose. The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer.Methods. Since starting in 1993, the ELCAP has enrolled 1,000 asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term highresolution CT follow-up for the smallest nodules.Baseline Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA. Telephone: 212-746-2529; Fax: 212-746-2811 Received October 10, 2000 accepted for publication February 23, 2001. ©AlphaMed Press 1083-7159/2001 INTRODUCTIONIn the United States, the cure rate of lung cancer is a dismal 10%, and the 5-year survival rate is only slightly higher than the cure rate. In stage I lung cancer, by contrast, the 5-year survival rate upon resection is as high as 70%; but if left unresected, that rate is again of the order of a mere 10% [1,2]. While these rates imply that the cure rate of lung cancer can be substantially enhanced by screening and its associated earlier intervention, results of randomized trials have been interpreted as indicating that this is not the case [3].This paradox points to the possibility that the negative results of the randomized trials were a consequence of flaws in their design, execution and/or analysis. To quantify the

Risk‐based selection from the general population in a screening trial: Selection criteria, recruitment and power for the Dutch‐Belgian randomised lung cancer multi‐slice CT screening trial (NELSON)

“…Selection criteria for single armed lung cancer screening studies and ongoing and planned trials show some variability in smoking exposure and age selection criteria. 4,[8][9][10][11][12][13][14][15][16][17] This variability can cause differences in characteristics of the trial population and cancer detection rates. Purpose of this study was to describe a method to come to an optimum selection and recruitment of the eligible population for a lung cancer screening trial, taking into account available resources and screening capacity and the influence that selection criteria have on the estimated lung cancer mortality and the power of such a trial.…”

Gold standards and expert panels: a pulmonary nodule case study with challenges and solutions

“…Instead, their role is to first determine whether the image contains a finding that is not normally present in that set of images (detection); and, then to determine its potential clinical significance (interpretation) and suggest if further assessment is necessary (recommendations). It is well known that most lung nodules that are detected and followed for interval growth are not cancer 8,9 , but the risk of not having at least a minimal follow-up (e.g., repeat CT in 3-6 months) is generally considered to be much greater than the risks associated with having that follow-up. Thus, the class of actionable nodules is much greater than the class of malignant nodules, and it is a subjective construct of current medical practice.…”

Protocolos de rastreamento para o diagnóstico precoce do câncer de pulmão: passado, presente e futuro

“…Radiografias do tórax vs. tomografia computadorizada helicoidal (51)(52)(53)(54)(55)(56) : Os estudos realizados no passado demonstraram as limitações da radiografia do tórax na identificação precoce de nódulos pulmonares. No Mayo Lung Project, em uma análise retrospectiva, 90% dos carcinomas periféricos e 75% dos peri-hilares, já estavam presentes em radiografias anteriores (51) .…”

“…Dos 31 casos, 24 (77%) foram identificados pela TCbd e não foram vistos às radiografias do tórax. Em 1999, Henschke et al (56) , em uma análise de prevalência, em que foram estudados 1.000 indivíduos, a TC revelou 27 casos de carcinoma brônquico, dos quais apenas sete podiam ser vistos nas radiografias. Vinte e dois dos 27 casos de câncer eram estádio IA.…”

“…Em uma análise de prevalência, na qual 1.000 indivíduos fumantes, com mais de 60 anos, foram submetidos ao protocolo ELCAP (56) , a TCbd identificou nódulos não-calcificados em 233 pacientes (23%). Apenas 27 deles (12%) eram malignos.…”