Does screening for stage I lung cancer improve survival in a high-risk population?
Ugo Pastorino
Correspondence Department of Research on Solid Tumors, Istituto Nazionale Tumori, Via G Venezian 1, Milan 20133, Italy
Email ugo.pastorino@istitutotumori.mi.it
This article has no abstract so we have provided the first paragraph of the full text.
Pilot studies in heavy smokers have proved that low-dose spiral CT can detect early lung cancer, with very high detection and resection rates. The excellent survival rate of patients with CT-detected stage I lung cancer in the International (I-)ELCAP report is not a surprise, particularly considering that median follow-up was only 3 years and the end point was lung-cancer-specific rather than overall survival. What is remarkable is the high proportion of stage I lung cancers detected in this study: over 60% compared with 20% in historical clinical series. Whether this change will translate into significant reductions in mortality is unknown. We must remember the lesson of early randomized trials in which 4-monthly chest X-ray screening improved cancer stage distribution and patient survival after resection, but with no impact on overall lung cancer mortality and a failure to show the more-favorable long-term outcome for the screening arm expected from the initial stage shift.1
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