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?
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4 comments - CLICK HERE to read & add your own!:
The million (or billion) dollar question:
Will institution of this as standard practice effect survival? I believe further study is required.
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...
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.
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/
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