CT lung cancer screening offers moderate benefit in smokers

June 16, 2008 CT lung cancer screening offers moderate benefit in smokers Shalmali Pal -------------------------------------------------------------------------------- A new study finds that CT screening can reduce lung cancer mortality among smokers but won't protect them from the other adverse effects of lighting up. Results from an evaluation of the long-term efficacy of screening fell between more positive outcomes reported by the International Early Lung Cancer Action Program (I-ELCAP) and another investigation that declared CT screening was not entirely advantageous. The latest study was published online by the RSNA June 11 and will appear in the July issue of Radiology (2008;248(1):278-287). "Smoking cessation should be the primary message to any continuing smokers," lead investigator Pamela McMahon, Ph.D., told Diagnostic Imaging. "Our analysis suggests that lung cancer screening may offer some additional benefit, but patients should be made aware that our study was a modeling study, not a randomized clinical trial." McMahon and colleagues took data concerning 1520 current and former smokers, screened as part of the Mayo Clinic helical CT trial, and used the information to populate a model of lung cancer development. "The Lung Cancer Policy Model is a comprehensive microsimulation model of lung cancer development, disease progression, lung cancer detection, treatment results, and survival," McMahon's group said. "The model predicted diagnosed cases of lung cancer and deaths per simulated study arm (five annual screening examinations versus no screening)" McMahon is a senior scientist at the Institute for Technology Assessment at Massachusetts General Hospital. Her coauthors are from the departments of radiology and medicine at Harvard Medical School and Dana Farber Cancer Institute, both in Boston, University of Minnesota in Minneapolis, and Mayo Clinic in Rochester, MN. The initial data were compiled from the Mayo Clinic's single-arm evaluation of helical CT in current and former smokers (61% of the total study population). All patients underwent baseline screening and four annual CT exams. Nodules found on a screening exam were followed up with thin-section CT imaging. At six-year follow-up in the simulation, the screening arm had an estimated 37% relative increase in lung cancer detection compared with subjects who had not been screened. Lung cancer-specific mortality was 28% lower in subjects who received CT screening, while all-cause mortality was 4% lower, compared with subjects who were not screened. At 15 years, the relative reduction in lung cancer-specific mortality was 15% and the reduction in all-cause mortality was only 2%.

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