Diagnosis of Lung Cancer — Improving Survival Rates (original) (raw)
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Thorax, 2016
Low-dose CT screening for lung cancer is effective but expensive. Therefore, cheaper or more focused screening strategies may be required. LungSEARCH is a randomised prospective trial of 1568 high-risk individuals (ie, current or former moderate to heavy smokers with mild/moderate COPD) who undergo either annual sputum cytology/cytometry testing or no screening. Those with abnormal sputum then receive annual CT and fluorescent bronchoscopy for the remainder of 5 years, to identify early stage lung cancer. It is hoped that these simple initial tests could identify those requiring expensive CT scans, and the aim is to demonstrate a stage shift towards early stage cancers.Trial registration numbers ISRCTN80745975, clinicaltrials.gov: NCT00512746.
Ongoing challenges in implementation of lung cancer screening
Translational Lung Cancer Research, 2021
Lung cancer is the leading cause of cancer deaths in Europe and around the world. Although available therapies have undergone considerable development in the past decades, the five-year survival rate for lung cancer remains low. This sobering outlook results mainly from the advanced stages of cancer most patients are diagnosed with. As the population at risk is relatively well defined and early stage disease is potentially curable, lung cancer outcomes may be improved by screening. Several studies already show that lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality. However, for a successful implementation of LCS programmes, several challenges have to be overcome: selection of high-risk individuals, standardization of nodule classification and measurement, specific training of radiologists, optimization of screening intervals and screening duration, handling of ancillary findings are some of the major points which should be addressed. Last but not least, the psychological impact of screening on screened individuals and the impact of potential false positive findings should not be neglected. The aim of this review is to discuss the different challenges of implementing LCS programmes and to give some hints on how to overcome them. Finally, we will also discuss the psychological impact of screening on quality of life and the importance of smoking cessation.
Diagnosis of Lung Cancer – Improving Survival Rates
European Oncology and Haematology, 2010
Lung cancer is a major global health burden: it was responsible for 1.3 million deaths in 2004, equating to 2.3% of all deaths. Death rates from lung cancer are predicted to continue to rise, with the disease being responsible for 2.8% of all deaths (1.67 million) by 2015. 1 Despite advances in treatment, survival rates from lung cancer in the UK have improved by only a few per cent in the last 40 years. The fiveyear survival rate for patients diagnosed between 1991 and 1993 was 5%. 2 The EUROpean CAncer REgistry-based study on survival and CARE of cancer patients 4 (EUROCARE-4) 3 has highlighted the difference in survival between England and other European countries. The five-year survival rate in England for patients diagnosed between 1995 and 1999 was 8.4% compared with the average European rate of 12%. These figures are in even greater contrast to reported five-year survival rates in the US of 15.7% for patients diagnosed between 1995 and 2001. 4 Analysis of EUROCARE-4 also showed that one-year survival rates in England were lower than the European average, probably reflecting poorer access to care. This would suggest a particular need to promote earlier diagnosis in the UK, to try to improve survival. Survival is dependent on the disease stage at diagnosis, with a marked variation between earlier-and later-stage disease. Five-year survival for localised disease is around 49% compared with 2% for disease with distant metastases at presentation. 4 Unfortunately, the majority of lung cancers have already been disseminated at the time of presentation. 4,5 Screening Much interest has focused on diagnosing lung cancer earlier in order to try to improve radical treatment rates and reduce mortality. Initially, this interest focused on screening. The first randomised controlled trial took place in London in the 1960s. 6 This looked at a chest X-ray every six months for three years versus a chest X-ray at the beginning and end of the three-year period. Diagnosis and resection rates were higher in the group receiving more frequent chest X-rays, but lung cancer mortality was similar in both groups. Three US studies 7 in the 1970s and 1980s looked at the use of either chest X-ray alone or in combination with sputum cytology. The Mayo Lung Project 8 compared chest X-ray and sputum cytology every four months with standard care. Participants randomised to the standard care arm were advised to have a yearly chest X-ray and sputum cytology. This showed that resection rates increased by 14% (32-46%) in the group undergoing screening compared with the group receiving standard care alone, but no stage shift was evident. Fiveyear survival in the screened group reached 33% compared with 15% in the non-screened group. To avoid confusion due to the biases inherent in screening, the ultimate proof of benefit is disease-specific mortality. Unfortunately, lung cancer mortality was not different in the two groups (3.2/1,000 person-years versus 3.0/1,000 person-years). This lack of improvement in mortality was also evident in the other two studies: the Johns Hopkins 8 and Memorial Sloan-Kettering studies. 9 Both looked at the addition of sputum cytology every four months to annual chest X-ray. There was also a contemporaneous study 10 in Czechoslovakia comparing chest X-ray plus sputum cytology every six months for three years versus chest X-ray and sputum cytology at the beginning and end of the three years. This study essentially replicated the findings of the Mayo Lung Project, with an increased
Early diagnosis with alternative approaches: innovation in lung cancer care
Shanghai Chest, 2021
Cancer is one of the primary concerns of mortality throughout the world in the present day. Among different types of cancers, lung cancer (LC) is predominant (21.77% of overall cancer caused death). It is classified into two major categories: oat cell or small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). The mortality due to NSCLC (~85%) is almost six times higher than the SCLC (15%). The identification of risk factors can reduce cancer burden and human fatality; however, this cannot prevent the severity of LC. In this case, the early diagnosis of LC can be an effective pathway in providing better treatment to the patients, which eventually may result in less fatality. This article offers an overview of several existing screening methods for the early diagnosis of LC. Nevertheless, these methodologies have limitations of reliability towards the diagnosis of cancer malignancy. Therefore, the prospects of different alternative approaches and their challenges to overcome this barrier for the early diagnosis of malignant tumor cells have been articulated in this article.
Cancers, 2014
Lung cancer remains the leading cause of cancer-related death in the United States. Cigarette smoking is a well-recognized risk factor for lung cancer, and a sustained elevation of lung cancer risk persists even after smoking cessation. Despite identifiable risk factors, there has been minimal improvement in mortality for patients with lung cancer primarily stemming from diagnosis at a late stage when there are few effective therapeutic options. Early detection of lung cancer and effective screening of high-risk individuals may help improve lung cancer mortality. While low dose computerized tomography (LDCT) screening of high risk smokers has been shown to reduce lung cancer mortality, the high rates of false positives and potential for over-diagnosis have raised questions on how to best implement lung cancer screening. The rapidly evolving field of lung cancer screening and early-detection biomarkers may ultimately improve the ability to diagnose lung cancer in its early stages, id...
Moving to the routine management of pre symptomatic lung cancer
Lung Cancer, 2001
Lung cancer is the world's leading cause of cancer death. Since progress in the treatment of this cancer has been exceedingly slow, the upswing in tobacco consumption in many sectors becomes even more tragic. One area for cautious optimism is the recent pilot reports of improved early lung cancer detection using new spiral CT techniques from institutions in Japan and New York. The prospect of improved early detection in a major cancer raises a number of public health concerns and highlights the importance of critical validation of this proposed new tool. From experience with early detection-based management of other cancers, it is evident that the entire process of detection, case validation, intervention, monitoring and public education needs to be carefully developed. The International Association for the Study of Lung Cancer has worked with the National Cancer Institute over the last decade to nurture interest and expertise in conducting population-based management of early lung cancer. A distillation of this process up to the current time is reviewed in this manuscript.
Lung cancer * 2: Screening and early diagnosis of lung cancer
Thorax, 2002
Technical developments in spiral CT scanning mean that considerably smaller lung cancers can now be identified than with previous methods of detection. Only time will tell whether this enhanced capability will result in a reduction in the number of deaths from lung cancer. The implications and problems of screening for lung cancer are discussed. Screening implies a careful refinement of a range of clinical activities that must be routinely delivered in a carefully coordinated fashion to allow for the possibility of improved outcome. Critical analyses of the nuances of this process are essential if the field is to move forward.