Paula Moyer, MA

December 02, 2003

Dec. 2, 2003 (Chicago) — For patients at risk of lung cancer, annual computed tomography (CT) screening is a sensitive method of finding early resectable tumors, according to findings presented here at the 89th annual meeting of the Radiological Society of North America.

"An annual CT screen prevents death from lung cancer by allowing the opportunity for early intervention," principal investigator Claudia I. Henschke, MD, PhD, said at a press briefing. "In our study, over 80% of tumors that this screening modality identified were at stage I." She added that she and her coinvestigators are continuing to follow those patients to see if early detection improves survival rates in lung cancer patients.

Dr. Henschke stressed that CT screening should be combined with smoking cessation counseling, and that it can improve quit rates. Dr. Henschke is a professor of radiology at New York Hospital–Cornell Medical Center in New York City, where she is the division chief of chest imaging.

"CT screening is actually helpful in promoting smoking cessation," Dr. Henschke told Medscape. "Typically, patients who quit after CT screening have a 25% quit rate." She added that in an ongoing study, investigators are seeking to find the most effective smoking cessation method.

The current research, known as the Early Lung Cancer Action Project (ELCAP), was designed to evaluate the usefulness of annual CT screening in patients at high risk of lung cancer. ELCAP has 34 participating sites through the world; the New York state component (NY-ELCAP) has 12 participating institutions.

The investigators have performed baseline screening on 18,660 participants, and 14,323 have undergone repeat annual screenings. Eligible participants are at least 60 years old and have a history of at least 10 pack-years of cigarette smoking and no history of cancer other than nonmelanoma skin cancer.

The findings in the NY-ELCAP study were representative of the larger study's data, she said. In NY-ELCAP, baseline CT was positive in 812 (13%) of 6,368 screenees. Of these, the investigators identified 79 patients (1.2%) who had lung cancer diagnosed by CT. Two patients of these had malignances that were diagnosed at repeat annual screenings. Of those with negative baseline screenings, annual repeat screenings were positive in 247 patients (10%). Of these, nine patients (0.4%) were diagnosed with lung cancer. Of cancers diagnosed at baseline and at annual repeat screenings, more than 80% were stage I.

Each CT screening typically costs $200 to $400, Dr. Henschke said at the briefing. Because it is a low-dose modality, it involves no injection of contrast dye. "We estimate that CT screening costs $2,500 for every life-year saved," she said. "The benchmark for feasibility of cancer screening is $50,000 per life-year saved."

Michael Brant-Zawadski, MD, expressed optimism about the value of CT screening for lung cancer but pessimism regarding payers reimbursing it. Dr. Brant-Zawadski, who was not involved in the study, is medical director of radiology at Hoag Memorial Hospital in Newport Beach, California.

"Because the mortality rate for lung cancer is so high, any effective early screening will be more expensive than current care," he said at the briefing. "There is no question, though, that CT screening would benefit outcomes in lung cancer."

He agreed with Dr. Henschke that patients who see the results of a CT screen are more likely to stop smoking. "The image of blebs forming, along with other smoking-related lung damage, is a powerful negative reinforcement," Dr. Brant-Zawadski told Medscape. "It's important that physicians interact with patients and discuss all the findings of a CT screen," not just the detection of lung cancer, he said.

RSNA 89th Scientific Assembly and Annual Meeting: Abstract J02-753. Presented Dec. 2, 2003.

Reviewed by Gary D. Vogin, MD

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