Screening current or former smokers with the imaging technique of computed tomography may increase the rate of diagnosis and treatment of lung cancer, but may not necessarily reduce the risk of advanced lung cancer or death from lung cancer, according to a study in the March 7 issue of JAMA.

Lung cancer accounts for 25 percent of cancer deaths and 6 percent of all deaths in the United States. Screening with chest x-rays is not effective in reducing the risk of advanced lung cancer or death, according to background information in the article. There is hope that lung cancer screening with computed tomography (CT) will be more effective at reducing deaths from lung cancer because it is more sensitive for the detection of very small nodules.

Peter B. Bach, M.D., M.A.P.P., of Memorial Sloan-Kettering Cancer Center, New York, and colleagues examined the effect of CT screening on individuals by comparing the frequency of lung cancer detection, resection (surgical removal of part of the lung), advanced lung cancer cases, and deaths from lung cancer with what would have occurred in the absence of screening (using a prediction model). The study (a combination of three studies) included 3,246 asymptomatic current or former smokers screened for lung cancer beginning in 1998 either at one of two academic medical centers in the United States or an academic medical center in Italy with follow-up for a median (midpoint) of 3.9 years. Participants received annual CT scans with comprehensive evaluation and treatment of detected nodules.

The researchers found that individuals screened with CT were three times more likely to be diagnosed with lung cancer (144 diagnosed cases vs. 44.5 expected cases), and 10 times more likely to undergo a lung cancer surgery (109 individuals with lung surgery vs. 10.9 expected cases). Computed tomography screening did not appear to reduce the risk of advanced lung cancer diagnoses or deaths due to lung cancer.

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Contact: Joanne Nicholas
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JAMA and Archives Journals
6-Mar-2007