Editors' ChoiceLUNG CANCER

A Picture Is Worth a Thousand Dollars?

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Science Translational Medicine  24 Aug 2011:
Vol. 3, Issue 97, pp. 97ec135
DOI: 10.1126/scitranslmed.3003065

Although the rate of smoking continues to decline in the United States, there are still 94 million current or former smokers who are at high risk of developing smoking-related disease such as lung cancer. Lung cancer remains the number one cancer-related cause of death in men in both developed and underdeveloped countries, with 70% of patients initially diagnosed with incurable disease.

Mass screening of high-risk individuals for lung cancer with chest radiography and cytologic analysis of sputum does not reduce lung-cancer mortality; molecular markers for lung cancer in sputum, blood, or bronchial washings are too early in development to be useful. The most hopeful prospects for early detection have come from advances in computed tomography (CT), which allow more sensitive and specific identification of tumor nodules.

Now a large study—The National Lung Screening Trial—has shown that screening with low-dose CT imaging, in comparison with standard single-view posterior chest x-rays, can reduce lung cancer mortality by 20%. From August 2002 though April 2004, the investigators enrolled 53,454 persons at high risk for lung cancer at 33 medical centers. In this large randomized data set, they analyzed lung cancer occurrences and deaths from lung cancer through 21 December 2009.

They observed 247 deaths from lung cancer (per 100,000 person-years) in the group that had been screened with low-dose CT and 309 deaths in the group screened with standard radiography, a relative reduction in mortality of 20% (95% CI, 6.8 to 26.7; P = 0.004)

The reduction in mortality is promising, but what remains unclear is the economic impact of the screening CTs, which cost more than a standard chest x-ray. Given the current medical economic climate, whether this evidence-based approach would be truly affordable remains uncertain.

The National Lung Screening Trial Research Team, Reduced lung-cancer mortality with low-dose computed tomographic screening. N. Engl. J. Med. 365, 395–409 (2011). [Abstract]

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