Consider The Evidence: Med/Peds Journal Roundup

October 27, 2006

should we screen smokers with serial spiral CTs?

Filed under: lung cancer, NEJM — medblog @ 2:37 pm

NEJM – This weeks New England has been getting alot of publicity for an article by Henschke and other investigators from the Early Lung Cancer Action Project (ELCAP).

In 1993 the ELCAP investigators began the annual screening of asymptomatic subjects that were at high risk for developing lung cancer. Over 27,000 subjects were screened by spiral CT with a positive result in 405 at baseline screening and 74 more over the 12 years that the study ran. 85% of those had stage I cancer with an estimated 10 year survival of 88%. Detection of lung cancer at an early stage  dramatically improves the survival outcome. The authors compared this data to the value of mammography for breast cancer and found it to similar detection rates.

The accompanying ediorial by Unger points out some of the pearls and pitfalls. The study was cohort control rather than RCT, but it was large and multi-center. There is also the question of how to define the “high-risk” population – apparently the criteria varied by center in the study.

From the numbers in the study, it seems as though the biggest yield is from the baseline scan – Im sure there will be further debate about the best interval for screening, among many other details.  But for now the debate is whether this study is enough to justify screening at all….

 N Engl J Med. 2006 Oct 26;355(17):1763-71

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