New York, NY -- Annual computed tomography (CT) screening is an effective diagnostic tool for detecting early-stage lung cancer in smokers and for reducing mortality rates, according to the latest data from two ongoing studies. The new findings, which confirm earlier published studies, were presented by Dr. Claudia henschke of New York-Presbyterian Hospital/Weill Cornell Medical Center, at the 89th scientific assembly and annual meeting of the Radiological Society of North America (RSNA) in Chicago earlier this month.
Dr. Henschke is principal investigator of the two studies -- the Early Lung Cancer Action Program (ELCAP), the first major study of low-dose CT creening in smokers and former smokers age 60 and older, and NY-ELCAP, a collaboration between 11 of New York-based medical centers that are investigating annual CT screenings.
"The most current data of ELCAP, which includes more than four times as many study participants as previously published, confirms our finding that CT screening results in the discovery of 80 percent of lung cancers in the earliest, most curable stage when the cancer has not yet spread to the lymph nodes," said Dr. Henschke, Professor of Radiology at Weill Cornell Medical College and Division Chief of Chest Imaging and Attending Radiologist at NewYork-Presbyterian Hospital/Weill Cornell.
The ELCAP results from the first, baseline screening were published in the July 10, 1999 issue of Lancet, demonstrating that low-dose CT can detect lung cancer at an earlier, more curable stage than ordinary chest x-ray. The results of annual repeat screening, published in the July 1, 2001, issue of Cancer, also confirmed that with repeated annual CT screenings, 83 percent of lung cancers were discovered in the earliest, most curable stage.
The NY-ELCAP study confirmed the ELCAP findings, both for the baseline and annual repeat screenings. "NY-ELCAP was important as it demonstrated that similar results were obtained in a more diverse patient population than was studied in the ELCAP," said Dr. Henschke.
Lung cancer is the leading cause of cancer death among men and women, and more people will die of lung cancer than of breast, colon and prostate cancers combined, according to the American Cancer Society. Lung cancer has no early warning signs and, for that reason, it is often detected at a late stage, at which time tumors may be the size of an apple. Late-stage symptoms include shortness of breath, hoarseness, coughing up blood, and unexplained weight loss.
Since its start in 1993, ELCAP has administered 4,538 annual repeat screenings. Among the 29 cancers found, 97 percent were made by the screenings and 96 percent were of Stage I, indicating that annual screening was frequent enough to diagnose early-stage lung cancer. The study also looked at the long-term follow-up of patients with screen-diagnosed lung cancer who underwent surgery and found that they showed a high cure rate.
Co-authors are Dr. David Yankelevitz, Professor of Radiology at Weill Cornell Medical College and Attending Radiologist at NewYork-Presbyterian Hospital/Weill Cornell; Dr. Dorothy I. McCauley, Professor of Radiology at Weill Cornell Medical College and Attending Radiologist at NewYork-Presbyterian Hospital/Weill Cornell; Dr. William J. Kostis, Assistant Professor of Radiology at Weill Cornell Medical College and Assistant Attending Radiologist at NewYork-Presbyterian Hospital/Weill Cornell; and O. Farooqi, Radiology Fellow, Weill Cornell Medical College.
The ELCAP study was partially funded by the National Cancer Institute, GE, and Kodak.
The effectiveness of annual CT screening in high-risk subjects was evaluated at 11 medical institutions throughout the state of New York. Participants -- 6,316 men and women, age 60 or older, who had no history of cancer and smoked at least one pack of cigarettes a day for 10 years -- received a low-dose CT scan of the lungs and chest. As of November 2003, annual CT screenings have been performed on 4,658 subjects. Both in the first, baseline screening and in the subsequent, annual repeat screening, more than 80 percent of the lung cancers detected were Stage I, confirming the initial results of ELCAP.
"CT screening can help save lives," Dr. Henschke said. "Without it, 85 percent of lung cancers are not diagnosed until they reach a more advanced stage."
Stage I cancer is small (no larger than 10 millimeters in diameter) and localized in the lungs without spreading to the lymph nodes. The average survival rate for patients treated for Stage I lung cancer is about 70 percent, while the cure rate for more advanced types of lung cancer -- Stage II and later -- is about 5 percent, according to Dr. Henschke.
Co-authors of the study were Dr. Matthew Rifkin of the State University of New York at Stony Brook; Dr. Samuel Kopel of Maimonides Medical Center; Dr. Donald L. Klippenstein of Roswell Park Cancer Insitute; Dr. Arfa Khan of North-Shore-Long Island Jewish Health System; Dr. Leslie J. Kohman of State University of New York, Upstate Medical Center; Dr. John Austin of Columbia University College of Physicians & Surgeons; Dr. David D. Mendelson of Mount Sinai School of Medicine; Dr. Robert Heelan of Memorial Sloan-Kettering Cancer Center; Dr. Terence Matalon of New York Medical College; Peter H. Wiernik of Our Lady of Mercy Medical Center; and Dr. David H. Gordon of State University of New York, Downstate Medical Center.
NY-ELCAP evolved from the ELCAP study, created in 1993 by researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and New York University Medical Center.
NY-ELCAP is funded by the Academic Medicine Development Company (AMDeC), which was created in 1998 using funds from the tobacco settlement.
Radiological Society of North America
RSNA is an association of more than 35,000 radiologists, radiation oncologists and related scientists committed to promoting excellence in radiology through education and by fostering research, with the ultimate goal of improving patient care. The Society is based in Oak Brook, Ill.
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