Lung Cancer Screening: The Mayo Program

Rs, Fontana; Dr, Sanderson; Lb, Woolner; Wf, Taylor; We, Miller; Muhm,

doi:10.1097/00043764-198608000-00038

Cited by 498 publications

(229 citation statements)

References 7 publications

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“…However, 15-20% of lung cancers in previous screening trials have been detected only by sputum cytology (53,54). In particular, early squamous cell carcinomas in the large central airways escape CT detection, as do premalignant lesions like severe dysplasia and carcinoma-in-situ (CIS).…”

Section: Beyond Ct Screening-molecular Biomarkersmentioning

confidence: 99%

Lung Cancer Screening with CT

Aberle

Brown

2008

Clinics in Chest Medicine

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Lung cancer is the leading cause of cancer death in the United States. In 2007, it is estimated that 160,390 lung cancer deaths will occur in the US, representing 29% of all cancer deaths (1). Roughly 87% of lung cancers are attributed to cigarette smoking (2). Although cancer risk is attenuated by smoking cessation, the risk is not eliminated, and lung cancer now occurs with equal frequency in current and former smokers (3). Moreover, other factors clearly influence risk, including age; family history; chronic obstructive pulmonary disease; pulmonary fibrosis; and exposures to environmental radon, asbestos, and certain other occupational agents (4). Realistically, lung cancer will likely remain at epidemic proportions for decades to come.Non-small cell lung cancer (NSCLC), which accounts for 75-80% of all lung cancers, is typically diagnosed when disease is locally advanced or there are systemic metastases (5), explaining the dismal overall five-year survival of 15% (6). In contrast, the five-year survival of individuals with surgically resected, early stage NSCLC approaches 75% (6,7). These differences have fueled the impetus to find a screening test that can detect NSCLC in its early preclinical stages, when surgical resection is most likely to prolong life and potentially reduce lung cancer mortality. Although earlier randomized controlled trials of lung cancer screening using chest radiography and sputum cytology failed to show reduced lung cancer mortality, computed tomography (CT) is a much more sensitive test for detecting small lung nodules, and has generated considerable enthusiasm as a potential contemporary screening tool for lung cancer.

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Section: Beyond Ct Screening-molecular Biomarkersmentioning

confidence: 99%

Lung Cancer Screening with CT

Aberle

Brown

2008

Clinics in Chest Medicine

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“…4 In the final report from this study, 206 patients were identified with lung carcinoma in the screened group, and 160 patients were identified with lung carcinoma in the control group. 4 The 5-year survival rate from lung carcinoma was 35% in the screened group and 15% in the control group. However, there was no significant difference in lung carcinoma mortality between the two groups (3.2 vs. 3.0 per 1000 person years for the screened and control groups, respectively).…”

mentioning

confidence: 96%

“…[2][3][4] In the Mayo Clinic trial, participants were randomized to a screened group that received a chest radiograph and sputum cytology every 4 months or a control group that was advised to have a chest radiograph and sputum cytology annually. 4 In the final report from this study, 206 patients were identified with lung carcinoma in the screened group, and 160 patients were identified with lung carcinoma in the control group. 4 The 5-year survival rate from lung carcinoma was 35% in the screened group and 15% in the control group.…”

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confidence: 99%

Pathologic review of the Mayo Lung Project

Colby

Tazelaar

Travis

et al. 2002

Cancer

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BACKGROUNDIn the Mayo Lung Project Screening Trial, there were more carcinomas identified in the screened group compared with the control group. The screened group had better survival, but there was no difference in lung carcinoma mortality between the screened group and the control group. The purpose of this study was to review all available original pathology from the trial to determine whether overdiagnosis (carcinomas that do not result in the death of the patient) or misdiagnosis of lung carcinoma may explain this discrepancy.METHODSAll available lung pathology slides from patients who underwent surgery at the Mayo Clinic were reviewed independently by three blinded lung pathologists. Tumors were classified according to the 1999 World Health Organization criteria. In addition, agreement among the pathologists was assessed.RESULTSAmong 106 patients who underwent surgery at the Mayo Clinic, slides were available for review from 105 patients, including 77 slides from the screened group and 28 slides from the control group. The original diagnosis of carcinoma was confirmed in all patients. In 7 patients (6.7%), there was unanimous agreement that the lesion was preinvasive (carcinoma in situ), and these lesions all were from the screened group. In 90 patients (85.5%), there was unanimous agreement that the tumors were invasive. In 8 patients (7.8%), there was some disagreement between the observers about whether lesions were invasive or preinvasive; 7 of these 8 lesions were from the screened group. The level of agreement among pathologists for invasive carcinomas was > 94% for all comparisons, and the κ statistic ranged from 0.67 (substantial agreement) to 0.84 (almost perfect agreement). There was good agreement among the pathologists about tumor cell type with the κ statistic ≥ 0.65.CONCLUSIONSThe histologic diagnosis of carcinoma was confirmed for all 105 slides that were reviewed. The results of this study indicate that misdiagnosis does not explain the increased numbers of carcinomas identified in the screened group. The increased numbers of in situ carcinomas in the screened group resulted in increased numbers of squamous carcinomas in the screened group compared with the control group and may have contributed to the better survival. It is possible that carcinoma in situ accounted for some instances of overdiagnosis. Cancer 2002;95:2361–5. © 2002 American Cancer Society.DOI 10.1002/cncr.10930

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“…Three large American screening programmes in the 1970s sponsored by the National Institute of Health [6][7][8][9] and another in Czechoslovakia in the 1980s [10] screened high-risk populations using chest radiography and sputum analysis. All showed increased detection of early-stage lung cancer, more resectable cancers and improved 5-yr survival rates in the screened versus control groups.…”

mentioning

confidence: 99%

“…However, only a small percentage of these nodules turn out to be lung cancer. In the Mayo Clinic trial [7] for example, over one-half of all patients had at least one nodule. The logistics of differentiating benign from malignant nodules therefore becomes a very real issue and there have been concerns about the number of biopsies that may need to be performed.…”

mentioning

confidence: 99%

Diagnostic imaging of lung cancer

Hollings¹,

Shaw²

2002

Eur Respir J

120

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Carcinoma of the bronchus is the most common malignancy in the Western world. It is also the leading cause of cancer-related death accounting for 32% of all cancer deaths in males and 25% in females [1]. In the USA it causes more deaths than cancers of the colon, breast and prostate combined [2]. Disappointingly, in a recent UK survey of improvements in cancer survival [3], carcinoma of the bronchus showed the smallest percentage reduction in the number of deaths avoided between 1981-1990 (0.2%). This compares badly with breast (11% reduction) and melanoma (32%). The overall 5-yr survival for lung cancer diagnosed between 1986-1990 was only 5.3% (against 66% for breast and 76% for melanoma). It is on this background that the radiologist remains actively employed in the detection, diagnosis, staging and review of this common malignancy.

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Lung Cancer Screening: The Mayo Program

Cited by 498 publications

References 7 publications

Lung Cancer Screening with CT

Lung Cancer Screening with CT

Pathologic review of the Mayo Lung Project

Diagnostic imaging of lung cancer

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