CT lung cancer screening offers pros and cons

NEW YORK (Reuters Health) - New research indicates that while low-dose CT of the chest can identify lung cancers at an early, more treatable stage, it can also lead to unnecessary major surgery that detects no cancer.

The Pittsburgh Lung Screening Study is the largest single-institution investigation of CT lung cancer screening in current and former cigarette smokers, according to the report in the American Journal of Respiratory and Critical Care Medicine.

The study included 3,642 subjects, between 50 and 79 years of age, who were screened with low-radiation CT. Repeat screening at 1 year was performed in 3423 of the subjects. To be eligible for the study, the subjects had to have smoked at least a half pack of cigarettes per day for 25 years or longer and have no history of lung cancer.

A noncalcified lung nodule was identified in 40.6 percent of patients on the initial screening, Dr. David O. Wilson and colleagues, from the University of Pittsburgh, note. Prior to repeat screening, 55.6 percent of these patients underwent one or more diagnostic imaging studies.

During 3 years of follow-up, 80 subjects were diagnosed with lung cancer, including 53 who had a tumor detected on the first test.

Overall, 36 subjects (1 percent) who had an abnormality detected on the initial or repeat CT screen ended up undergoing a major thoracic (chest) operation that resulted in a noncancer diagnosis. Of 82 subjects who underwent chest surgery to removal all or part of the lung or less-invasive video-assisted thorascopic surgery to rule out malignancy. Twenty-eight of these patients ultimately received a noncancer diagnosis.

Among 69 patients with non-small cell lung cancer, 40 had stage 1 disease at diagnosis, the report indicates.

The challenge now is how to avoid major surgery and illness from interventions “triggered by nodule discovery on CT,” Dr. York E. Miller, from the University of Colorado, Denver, writes in a related editorial.

Treatment guidelines for non-calcified lung nodules “have been suggested by several groups, with ‘watchful waiting’ the preferred option in some situations,” Miller adds. If adhered to, these guidelines should be effective in reducing unnecessary surgical procedures.

American Journal of Respiratory and Critical Care Medicine, November 1, 2008.


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