Extended Lung Cancer Incidence Follow-up in the Mayo Lung Project and Overdiagnosis

Marcus, Pamela M.; Bergstralh, Erik J.; Zweig, M H; Harris, Ann H.; Offord, Kenneth P.; Fontana, Robert S.

doi:10.1093/jnci/djj207

Cited by 205 publications

(135 citation statements)

References 26 publications

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“…Quite unexpectedly, the 25-year followup of the Mayo trial showed that overall mortality was higher in the CXR arm compared with the standard care arm (difference not reaching statistical significance, P ¼ 0.09), even though the survival rate of lung cancer patients diagnosed at an early stage in the CXR arm was much higher (69 vs 54% at 5 years, median 16 years vs 5 years, respectively) (Marcus et al, 2006). These results confirmed the inefficacy of CXR monitoring, as well as the occurrence of overdiagnosis in the intervention arm.…”

Section: Previous Research Involving Other Modalitiesmentioning

confidence: 99%

“…Detection and treatment of slow-growing disease, also called overdiagnosis, represents one of the most likely explanations for the lack of mortality reduction observed in chest X-ray-screening trials, despite a significant increase in the overall resectability rate and proportion of stage I cancers in the intervention arm (Marcus et al, 2006). Overdiagnosis bias refers to the screening-related detection of cancers that would not have contributed to the death of the patient because of competing causes of death or because the lesion is indolent.…”

Section: Overdiagnosis Of Indolent Tumoursmentioning

confidence: 99%

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Lung cancer screening

Pastorino

2010

Br J Cancer

114

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Lung cancer is the primary cause of cancer mortality in developed countries. First diagnosis only when disease has already reached the metastatic phase is the main reason for failure in treatment. To this regard, although low-dose spiral computed tomography (CT) has proven to be effective in the early detection of lung cancer (providing both higher resectability and higher long-term survival rates), the capacity of annual CT screening to reduce lung cancer mortality in heavy smokers has yet to be demonstrated. Numerous ongoing large-scale randomised trials are under way in high-risk individuals with different study designs. THE MAGNITUDE OF THE PROBLEMLung cancer kills more than 1.3 million people every year (Peto et al, 1996), with figures registering a continual increase in the Far East in countries such as China (Yang et al, 2004). Improvements in clinical management have been modest over the past 20 years, with an overall 5-year survival rate just above 10% in Europe (Verdecchia et al, 2007). Presence of metastatic disease at diagnosis is the main reason for treatment failure, and 5-year survival of patients resected in stage Ia is 470% (Goldstraw et al, 2007). In developed countries, smoking sanctions have achieved a significant reduction in the prevalence of active smokers and lung cancer mortality in males, but not yet in females (Levi et al, 2003). Despite the success of early prevention, a large cohort of former smokers remain at high risk of cancer for many years. PREVIOUS RESEARCH INVOLVING OTHER MODALITIESEarly detection trials with chest radiography (CXR) and sputum cytology, funded by the US National Cancer Institute in the 1970s, were ineffective in decreasing lung cancer mortality, despite the higher proportion of early-stage cancer identified through screening (Melamed et al, 1984). Quite unexpectedly, the 25-year followup of the Mayo trial showed that overall mortality was higher in the CXR arm compared with the standard care arm (difference not reaching statistical significance, P ¼ 0.09), even though the survival rate of lung cancer patients diagnosed at an early stage in the CXR arm was much higher (69 vs 54% at 5 years, median 16 years vs 5 years, respectively) (Marcus et al, 2006). These results confirmed the inefficacy of CXR monitoring, as well as the occurrence of overdiagnosis in the intervention arm. OBSERVATIONAL STUDIES WITH LOW-DOSE SPIRAL CTThe advent of low-dose spiral chest computed tomography (LDCT) opened a new perspective for early diagnosis, and initial studies conducted in Japan in the 1990s demonstrated the potential value of LDCT for lung cancer screening (Kaneko et al, 1996). Since then, the rapid technological development in multislice machines has improved the sensitivity and reliability of spiral CT, providing the concrete possibility of detecting pulmonary lesions of 3 -4 mm in size in a few seconds, without the use of intravenous contrast.In 1999, the Cornell University of New York published the first results of the Early Lung Cancer Action Project (ELCAP), showing...

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Section: Previous Research Involving Other Modalitiesmentioning

confidence: 99%

Section: Overdiagnosis Of Indolent Tumoursmentioning

confidence: 99%

Lung cancer screening

Pastorino

2010

Br J Cancer

114

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“…The extended follow-up data for 16 years from the Mayo Lung Project, which demonstrate a persistent excess of cancers in the screened group compared with the control, suggest that overdiagnosis does occur. [44] However, it is uncertain to what extent it occurs in LC screening as reported rates vary widely (5 -51%). [45] Although it is a potentially harmful effect of screening, the current estimates available from LDCT trials suggest that the rate of overdiagnosis is relatively low (reported rate in the NLST was 18.5%, or 1.38 cases of overdiagnosis per 320 individuals needed to screen to prevent one LC death).…”

Section: Reviewmentioning

confidence: 99%

Lung Cancer Screening

Schar¹

2015

S Afr Res J

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Lung cancer (LC) is the leading cause of cancer-related death worldwide. Its overall poor prognosis is attributable to the fact that most patients remain asymptomatic until the disease is advanced and, therefore, present with late-stage incurable disease. e rationale for LC screening is that early detection of asymptomatic disease oers the opportunity for earlier intervention, at a stage when denitive cure is still feasible, which has the potential to reduce LC-related mortality and morbidity. e ndings of the National Lung Screening Trial provided the rst strong evidence in support of this rationale. Since its publication, several professional organisations and societies have developed guidelines recommending the implementation of LC screening with low-dose computed tomography in asymptomatic, high-risk individuals. Although the benets of such screening programmes may be signicant, they must be carefully weighed against the potential harms to the relatively large number of healthy individuals who would undergo screening. is review examines the available evidence and current recommendations for LC screening, including benets, potentials harms and requirements for implementation of a high-quality, safe and eective programme. In addition, the costs and availability of LC screening programmes in both the global and local settings are considered.

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“…The clinical course of treated cancer patients all too often culminates in relapse and death. Ironically, growing evidence also suggests that many patients with premalignancy or even malignancy follow benign courses and die far more often of non-cancer causes than of cancer (3)(4)(5). These paradoxical phenomena form the dilemma of early detection-underdetection of life-threatening early disease and overdetection of indolent early disease.…”

mentioning

confidence: 99%

“…Morphology is the current standard for diagnosis of premalignant conditions and cancer itself, but morphologic assessment may be limited in its ability to distinguish asymptomatic indolent conditions from those that will progress to advanced malignancies and death (3)(4)(5)13). Examining cancer from an evolutionary perspective can open new approaches for cancer risk assessment, diagnosis, therapy and prevention.…”

mentioning

confidence: 99%