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Early Detection of Lung Cancer- FACTS

The five-year survival rate for those whose lung cancer is found when it is localized (before it has spread to other organs) is nearly 50%.

Only 15% of lung cancer cases are found at the localized stage.

Research indicates that when lung cancer is diagnosed/detected in an early-stage and surgery is possible, the five-year survival rates can reach 85%.

Survival rates decline dramatically after the cancer has spread to other organs: 16% at regional site, 2.1% at distant site.

The majority of the people diagnosed with lung cancer are 55-65 years old.

Screening Controversy

A newer and more controversial diagnostic tool for detecting lung cancer is the spiral, or helical, CT scan. The spiral CT scan is a CT scan that can image the lungs in a single breath hold. Although spiral CT scans can detect tumors in the earliest stages of disease, there is a debate about whether this earlier detection saves lives. Some experts are concerned that screening will lead to over diagnosis, or the detection of cancers that would not have caused symptoms prior to patients dying of other causes. False positives also are common with baseline CT scans (the first time a person has one) because the test can mistake scar tissues from an old infection, or a benign lump, for cancer. In addition to the mental anguish resulting from a false positive, patients may undergo a needle biopsy, which may result in the collapse of the lung. Many medical professionals feel this risk can be managed by monitoring the growth rather than immediately performing a biopsy.

A study published in The Lancet (Henschke, Claudia I et al. Early Lung Cancer Action Project: overall design and finding from baseline screening. 354:99-104) compared the use of spiral CT scans to chest X-rays for the early detection of lung cancer at New York Weill Cornell Medical Center, New York University Medical Center and McGill University. Among the 1,000 patients tested in the study, 27 cancers were found at baseline screening with the CT scan. Eighty-three percent of these were stage I, the earliest stage of disease, as opposed to seven cancers found with X-rays. An additional seven cancers were detected in annual repeat screening, 85 percent of which were stage I. The cancers were confirmed by biopsies. The patients in the study were all 60 years or older with a history of more than 10 pack-years. These findings were similar to the studies in Japan.

“We have evidence that spiral CTs save lives and should be made available to all potential lung cancer patients,” according to Claudia Henschke, MD, Ph.D., professor of radiology, Weill Cornell Medical Center of New York.

Based on her earlier study, Dr. Henschke currently is leading a second spiral CT trial in New York State. This trial, known as the New York Early Lung Cancer Action Program (NY-ELCAP), is seeking to screen 10,000 current or former heavy smokers to determine whether they have early-stage lung cancer and to provide data on participants’ 10-year survival rate. The findings will be supplemented by similar trials that are taking place around the world.

Another trial designed to research the benefits of the spiral CT scan is the National Lung Screening Trial (NLST). This randomized controlled trial, sponsored by the National Cancer Institute, will enroll 50,000 participants at high risk for lung cancer to determine if there is a 20 percent or greater difference in lung cancer mortality between low-dose spiral CT or chest X-ray.

There is debate as to which trial is the most beneficial to patients. The NY-ELCAP study does not compare people who receive the test with those who do not. According to an editorial published in the June 15, 2002 issue of The Lancet, the result is that the study does not determine whether or not detecting the disease in the early stages actually extends the lives of patients. This, along with the previously mentioned higher rate of false positives, may result in unnecessary mental anguish and health risks.

On the other side of the debate, according to an article published in Radiological Society of North America, Inc News in July 2002, Dr. Henschke identifies the major problem with the NLST to be the focus on overall mortality rate rather than on the case-fatality during the time when the screening shows benefit (meaning death rates from lung cancer of the entire population and not just the specific group being screened). This misdirected focus on overall mortality rates has affected already established screening methods, such as mammography screening for breast cancer (The Lancet, February 2002).

Yet, despite all of the controversy, strides are being made in lung cancer screening that will help improve the survival of patients. “The primary goal of all oncologists is to increase the curability of lung cancer patients,” said Dr. Henschke. “Even though mortality rates have been declining, it is still the number one cancer killer in the United States. We need to do everything we can to ensure that we develop safe, effective detection methods to help increase patients’ survival.”


American Cancer Society (2004).

Cancer Facts & Figures 2004. Atlanta, GA

Lung Cancer Alliance Learns of National Survey

LCA recently learned of a new national survey that reinforces the lack of understanding about lung cancer testing. In early March 2006, ConMed Corporation, an American medical device company, commissioned a telephone survey to determine Americans’ attitudes toward getting tested for lung cancer.

The survey asked people what they know about lung cancer testing. The survey results reveal a disparity between men and women when they think of being tested for lung cancer. While twenty-three percent of men thought of being tested for lung cancer, only 9% of women did. Another knowledge gap identified by the survey is that younger people are more likely to think about being tested for lung cancer than older people (19% of people ages 18-54 compared to 9% of people age 55 and older). This is the exact opposite as the risk profile, which rises with age and is greatest for those over 55. A revealing indication about the lack of general public knowledge and awareness about lung cancer testing and diagnostics is that 48% of respondents said they have heard of a blood test for lung cancer, a test that does not exist at this time. Another indication is that new technologies are not widely understood.

The survey was conducted by ORC International’s Caravan® Survey. The Caravan® Survey is based on a random-digit-dialing (RDD) probability sample of all households in the United States. The data was weighted to ensure the results reflect a representative U.S. population in terms of age, gender, geographic region, and ethnicity. Overall, 1,013 respondents age 18 and older participated in the survey, for a sampling error of plus or minus three percentage points at the 95% confidence level.

For more information, visit ConMed's website.

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Novel promising methods for the early detection of disease

In the last years new, significantly more sensitive methods have been developed. These are presently available and are the basis for future research projects.

A diagnostic technique using computer tomography has been

developed which enables the detection of very small nodules in

the lung tissue, which are only very few millimeters in size.

Today, an automated, computer-based detection method allows

to discriminate normal from abnormal cells in expectorated

bronchial mucous.

A novel method of visualizing early stages of lung cancer with

an endoscope has been developed.

By utilising these technologies in a broad and targeted manner in individuals who are at high risk for developing lung cancer it is possible to detect early stages of cancer, in order to cure these patients accordingly. Preliminary data have shown that these methods are successful if used correctly.

Lack of support for research

Private institutions receive almost no public funds to support research endeavours, although their results in research in development have been proven to be significant – Reasons to establish a private foundation.

Focussing on early detection

The foundation aims to focus it’s activities in the research and development of methods for the early detection of disease, because early detected cases of lung cancer may be cured. In the past two decades research funding has not been directed at early cancer detection. Major focus has been placed on primary

prevention, including smoking cessation, the efficacy of chemotherapies and the issue of quality of life in advanced disease stages.

Early detection as a public health instrument

The long-term goal of the foundation is to develop methods for the early detection of lung cancer as a public health benefit, similar to prostate, colon and breast cancer screening. In addition to the prevention of human suffering, lower treatment costs also support the screening process.

Costs of early detection

If 10 curable early cancers are detected among 1000 individuals, the quantifiable benefit is tremendously high. The costs of a single test may be reduced to a level comparable with the financial expenditure for prostate, breast and colon cancer


Treatment costs of early stage disease are 25% lower as compared with later, non curable stages. This yields costs per life year saved of a few thousand Swiss francs.

As a victim of this terrible

disease I will put all my efforts in the service of establishing a foundation for the early detection of lung cancer and hence the avoidance of great human suffering.

Dr. Helmut Winter, Architect

Early Lung Cancer Detection Does Not Increase Survival

Popular wisdom says the earlier a cancer is detected, the more successful the treatment and the better the chances of survival. But this does not seem to hold true for at least one kind of lung cancer, according to new research.

The surprise finding of the study, which appears in the June issue of the journal Chest, was that there was no correlation between tumor size and survival. ?It remains to be seen whether detecting smaller nodules with newer [more sensitive] technologies such as computed tomography (CT) scans will alter the natural history of the disease,? said lead investigator Edward F. Patz, M.D., of the department of radiology at Duke University Medical Center in Durham, N.C.

Patz and colleagues studied 510 consecutive patients, average age 63, who had been diagnosed with early-stage non-small cell lung cancer (which accounts for about 80 percent of all lung cancers) between 1981 and 1999. Their tumors were considered small, at 3 centimeters (a little more than an inch) or less. The patients were treated with chemotherapy or radiation.

Currently, the smallest-size nodule detectable by chest X-ray is close to 5 cm (about two inches). According to Patz, earlier preliminary trials using CT scanning showed that in up to 30 percent of cases, upon initial examination the small primary lung cancers had already spread to regional lymph nodes or distant sites.

Typically lung cancer does not cause symptoms early in the course of the disease, and there is no effective screening method. Lung cancer is the leading cause of death from cancer in both men and women in this country, killing approximately 160,000 people annually, according to the National Cancer Institute. This year, about 177,000 new primary lung cancers will be diagnosed in the U.S. About 25 percent of patients will receive surgery in hopes of curing the disease (see a related story). The overall five-year survival rate is only 13 percent.

?Despite continued advances in diagnostic techniques, treatment protocols and [understanding of] tumor biology,? said Patz, ?the survival rate for lung cancer has shown only minimal improvement over the past several decades. Most patients still present with advanced disease, at which time therapeutic options are less than optimal.? The point at which cancer spreads or turns aggressive has not been well defined.

But by the time a tumor has grown to 5 cm--close to the detectable range of chest X-ray--that point may already have been reached, the Duke team believes. Their findings suggest that the size of nodules does not reliably predict how the cancer will behave.

In an accompanying editorial, William C. Black, M.D., associate professor of radiology at Dartmouth Medical School in Hanover, New Hampshire, wrote that ?the unexpected observations on survival in [early-stage] lung cancer are timely and provocative. Although they can probably be explained by some combination of chance and confounding [other factors], these findings nevertheless force us to think hard about screening with CT.

?As the authors caution, we should not rush headlong into screening before its effectiveness has been demonstrated by randomized clinical trials or mathematical models that properly account for lead time [yielding an apparent increased survival due to earlier diagnosis], overdiagnosis and variations in tumor biology.?

Rasim Gucalp, M.D., a specialist in the department of oncology at Montefiore Medical Center in the Bronx, N.Y., noted that the results of the study might well have been affected by the small number of patients analyzed. In addition, he said, the age range is very large and the causes of deaths were not listed as cancer-specific, so, for example, older smokers in the study may well have died of heart disease rather than lung cancer.

Gucalp added that several large international studies are under way to examine whether there is a difference in outcome if people are screened by chest X-rays or low-dose CT scans. The cost-effectiveness of using the more sensitive CT called helical CT, which can detect even smaller tumors, for screening is also being investigated. A 1999 study published in The Lancet found that helical CT increased detection of small lung tumors?many under one centimeter in size--fourfold over chest X-rays, but whether this will result in a survival advantage remains to be seen.

Gucalp said he expects the cost of CT screening in general to decrease over time, much as that of mammography did.

So what may have an impact on lung cancer survival?

?As more is understood about the biology of lung cancer, it seems that an integration of imaging findings, molecular characteristics of the tumor and host response to this malignancy will be necessary,? concluded the authors. The Duke research team advises against routine widespread use of early-detection methods until more appropriate prospective randomized trials are completed.

A-Z topics: Science in the News

Cheek-Cell Test Under Development for Early Detection of Lung Cancer


A–Z Topic: Smoking Cessation

Read More "Science in the News"


WebMD , Health Day News , The Atlanta Journal-Constitution and other news outlets have reported on a new test that uses inner cheek cells to screen patients at high risk of developing lung cancer. This screening method, developed by Perceptronix Inc. ( Vancouver, British Columbia), was recently presented at CHEST 2005, the annual scientific assembly of the American College of Chest Physicians .

According to a CHEST 2005 press release , Perceptronix is currently developing two tests for the screening of early-stage lung cancer: a sputum test and a cheek-cell test that uses epithelial cells scraped from the buccal mucosa. Both tests use automated quantitative cytometry (AQC), a computer-based technology, to analyze hundreds of cell nuclei for changes in shape, density and other parameters that predict the likelihood of lung cancer. The company is conducting clinical studies on both AQC tests to validate their sensitivity and specificity as early screening methods for patients at risk for lung cancer.

At this time, there are no FDA-approved, oral-based tests for early lung cancer detection, and the AQC-based tests being developed by Perceptronix require further clinical testing. Nevertheless, emerging technologies could soon provide dentists and other health-care professionals with an initial screening tool to detect early-stage lung cancer .

As noted in a recent Report to the Nation on the Status of Cancer , lung cancer is the second most common form of cancer in the United States and the leading cause of cancer death for American men and women. Since tobacco smoking is a primary risk factor for developing lung cancer and oral cancer, tobacco-use cessation is a key step for preventing or lowering the risks of these cancers and other primary diseases (e.g., cardiovascular disease and chronic obstructive pulmonary disease).

Dentists are encouraged to become fully informed about tobacco-use intervention techniques and to educate patients in overcoming their addiction to tobacco and the primary prevention of tobacco use. In addition, dentists can provide a valuable service by reminding former or current smokers of their increased risk of developing lung cancer, and refer at-risk patients to their primary-care physician for a complete health assessment.

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