Thursday, October 26, 2006

Lung cancer screening

The International Early Lung Cancer Action Program Investigators published the results from CT screening >30,000 patients with chest CTs in today's NEJM.
They found a shift towards picking up more early stage disease.
Have you had a chance to see the study? How do you think this will affect our practice?

5 comments - CLICK HERE to read & add your own!:

Barcelona Doc said...

The million (or billion) dollar question:
Will institution of this as standard practice effect survival? I believe further study is required.

grumpy old doc said...

The study found that stage 1 cancer has a good prognosis. Didn't we already know this? The study did not address survival compared to NOT screening for it. This is what we *don't* know. Of course intuitively one would think that early detection would effect survival, but then that's what they thought prior to all those previous (and much older)lung cancer screening trials...

Arenberg said...

I am kind of surprised that this study was in the NEJM and not in a Pulmonary journal. The real novelty of this study is the applicability of the algorhithm they used. Of course this didn't answer the most importnat question about mortaility. It was not powered to do so. The only answer to that will come from the NLST which is closed to enrollment and should start to yield meaningful data in about two years.

This study just keeps the debate open.

Big advances to come in lung cancer screening will come from studies that give us refined estimates of any one individuals risk for lung cancer....biomarkers, and genetic susceptibility testing (chromosome 6p is an area of hot interest as is studies of DNA repair capacity, methylated tumor suppressor genes etc.,). These studies will improve the cost effectiveness of screening programs by focusing the most expensive tests on those with the highest risk. We have a LONG way to go in this area if we can just get the public to buy into these complex concepts. The average politician and average joe on the street doesn't have a clue.

Mike L said...

As Doug mentions, the truly applicable information from these Lung Cancer Screening studies is MORTALITY.
Survival (defined as number of patients alive following diagnosis of cancer divided by the number of cancers detected expressed as a percentage over a particular time period) is improved in the CXR and sputum cytology studies of the 1970's and 1980's. Mortality in these studies, however, is unchanged leading to many biases that we could spend hours reviewing.
The other sticky issue is who to screen. If you choose patients over 60 years old with a > 10 pack year history (ELCAP I study), the number of nodules increases vs. screening everyone older than 40 years old. This alone could increase the cost per year of life saved $2500 to $120,000.
Putting this study in the NEJM was probably bad as it is going to increase the lay press coverage and distort the issue further.
Hopefully, the answers will come from the NLST in 2009.

See, Doug, I have learned something.

Emily said...

I agree with the previous posts - survival is not the same as mortality, and an uncontrolled trial does not tell you much. Fortunately most of the media reports I have seen so far acknowledge the controversy, as I summarized in my blog yesterday: http://health-counterspin.blogspot.com/