Many Abnormalities on CT Screening for Lung Cancer Do Not

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Cancer News Article

Researchers from Cornell University have reported that many abnormalities detected on annual computerized tomography (CT) screening scans for lung cancer clear with observation with or without antibiotics. Only persistent or growing nodules required further evaluation. The details of this report appeared in the April 2006 issue of Chest.

Lung cancer is the most common cancer in the world and is the leading cause of cancer death with 160,000 deaths in the United States annually. Lung cancer is a disease that commonly goes undetected until the cancer has progressed to a point where it can no longer be cured. For this reason, the development of accurate screening methods to detect lung cancer early, before symptoms arise, is of great importance. However, there is currently no consensus on the benefits of routine screening of high-risk patients with chest X-rays or sputum cytology.

Computerized tomography is a very sensitive test that has been used to detect early lung cancer. In the U.S. , the Early Lung Cancer Action Project was designed to evaluate whether annual CT screening is useful for detecting early lung cancer in high-risk individuals. There have now been two reports from this study suggesting that CT screening allows for the diagnosis of lung cancer at substantially earlier and more curable stages when compared with no screening. In these studies, false-positive test results were uncommon when biopsies were performed after documented growth of small nodules. The Early Lung Cancer Action Project is currently performing a randomized trial of CT screening versus no screening in high-risk individuals; the results of this trial will probably not be known for at least 10 years. In the meantime, the question for physicians is whether or not to screen high-risk patients with CT scans.

The current study looked at short-term follow-up of abnormalities detected in annual CT screening for lung cancer. They looked at initial 1,968 baseline and 2,343 annual repeat screening CTs performed between 1999 and 2002. They were specifically trying to determine how many patients had inflammatory processes that resolved with time with or without antibiotics. They identified 41 individuals who had abnormalities on baseline screening and a repeat CT two months later. They reported that 29% resolved completely or partially and none had lung cancer. They also found that 39 patients on repeat scanning had a follow-up CT, and 74% had complete or partial resolution of their abnormality. A total of 29 patients had nodules at baseline that were unchanged or grew; 15 of these had lung cancer. On repeat scanning there were 10 patients with persistent or growing nodules and two had lung cancer. These authors concluded that observation with or without antibiotics helped clarify whether or not lung abnormalities on CT scanning were growing or stable and required further evaluation.

Comments: One of the main problems with CT screening for lung cancer is the relatively large number of non-cancerous abnormalities detected. The data in this paper helps clarify the need for conservative observation with or without antibiotic treatment of abnormalities and a follow-up CT. Only lesions that persist or grow should be further evaluated with invasive procedures. This approach should make CT screening for lung cancer less controversial. However, it remains to be determined if this approach improves overall survival. Until the results of randomized trials are completed, annual CT scanning would appear to be the best approach for early detection of lung cancer in high-risk individuals.