Benefits and risks of lung cancer screening.

Accessible online at: www.karger.com/ort Fax +49 761 4 52 07 14 [email protected] www.karger.com Benefits and Risks of Lung Cancer Screening ing. The technique of low-dose CT (LDCT) is based on the fact that even with examination protocols that use less radiation, soft tissue-dense pulmonary nodules of a few millimeters can be detected. Compared to conventional CT from the 1990s, radiation exposure with LDCT is less by a factor of 10. Compared to chest X-ray, radiation exposure with LDCT is 2to 3-fold higher. In the 1990s, 12 different single-arm non-controlled studies were initiated worldwide (table 1). These feasibility studies were supposed to demonstrate the higher sensitivity of LDCT as compared to conventional chest X-ray [16]. The first two Japanese studies showed a 2to 3-fold higher rate of lung cancer diagnosis with LDCT as compared to conventional chest X-ray. The American Early Lung Cancer Action Program (ELCAP) enrolled a total of 1,000 participants who were older than 60, had a smoking history of more than 10 pack-years, were functionally operable, and had no cancer history [17, 18]. The screening consisted of an annual CT scan of the thorax and a conventional chest X-ray. This study also showed that LDCT detected 3 times as many non-calcified pulmonary nodules, 4 times as many malignant lesions, and 6 times as many cases of stage I disease. The ELCAP was then extended to the International-ELCAP (I-ELCAP). The I-ELCAP enrolled 31,567 asymptomatic participants for the baseline screening and 27,456 for the follow-up screening. A total of 484 participants were diagnosed with lung cancer. Of these, 412 (85%) had stage I disease, and the 10-year survival calculated for this group was 88% [19]. The other single arm studies were in keeping with these findings. One problem associated with these studies was the high proportion of detected pulmonary nodules and the subsequent surgical treatment of benign nodules. In order to demonstrate the efficacy of lung cancer screening by LDCT, ultimately randomized controlled Benefits and Risks of Lung Cancer Screening Pro: Karl-Matthias Deppermann a 1. Medizinische Klinik, Klinik für Pneumologie, Schlafund Beatmungsmedizin, HELIOS Klinikum Erfurt GmbH, Erfurt, Germany