‘Early and often’ lung cancer screening increases long-term survival
Click Here to Manage Email Alerts
Key takeaways:
- Ten-year lung cancer-specific survival data of 80% reported in 2006 has persisted at the 20-year mark.
- Many eligible individuals fail to receive early and often low-dose CT screening.
Diagnosing early-stage lung cancer through low-dose CT screening significantly improves its cure rate, according to data published in Radiology.
Study findings analyzed from 20-year follow-up data show that patients diagnosed with lung cancer via CT screening have a survival rate of approximately 81%. With more than 80% of study participants having been diagnosed during stage I disease, the results highlight the importance of routine early screening to increase chances of curative treatment, according to researchers.
“At the moment, the best thing for patients is the low-dose CT scan and to do it on an annual basis, but the uptake is very low for whatever reason,” Claudia I. Henschke, PhD, MD, professor of diagnostic, molecular and interventional radiology and director of the Early Lung and Cardiac Action Program at Mount Sinai’s Icahn School of Medicine, told Healio.
“If you had a pill that you could give somebody and say this pill changes the cure rate from 20% to 80%, then this would be the greatest cancer killer,” she added. “But, unfortunately, people are reluctant to get the screenings.”
Background and methodology
The International Early Lung Cancer Action Program collaboration enrolled 31,567 study participants to receive annual low-dose CT screening between 1992 and 2005, leading researchers to publish 10-year lung cancer-specific survival data in 2006.
Researchers reported 10-year lung cancer-specific survival of 80% for the 484 participants diagnosed with a first primary lung cancer through annual screening, with a high frequency of clinical stage I lung cancer at 85%.
Henschke and colleagues sought to update the cure rate by determining the 20-year lung cancer-specific survival of an expanded cohort of 89,404 participants diagnosed with a first primary lung cancer through such screening.
Eligible study participants included current or former smokers at least 40 years of age or individuals who never smoked but had been exposed to secondhand tobacco smoke.
Results
Researchers reported that, of the expanded cohort, 1,257 (1.4%) received a first primary lung cancer diagnosis (54.4% male; median age, 66 years). Study participants had a median smoking history of 43 pack-years (interquartile range [IQR], 29.0–60.0).
At a median follow-up of 105 months (IQR, 41–182), investigators noted a frequency of clinical stage I disease at pretreatment CT of 81% among the expanded cohort, with a 10-year lung cancer-specific survival rate among participants of 81% (95% CI, 79-84) and a 20-year lung cancer-specific survival rate of 81% (95% CI, 78-83).
Notably, results showed an 87% (95% CI, 85-90) 20-year lung cancer–specific survival rate among the 998 patients who underwent surgical resection following diagnosis. Similarly, researchers reported a 95% (95% CI, 91-98) 20-year lung cancer–specific survival rate among those with the earliest stage I pathology (pT1aN0M0) at diagnosis.
Next steps
The results validate previous findings showing that screening early and often for lung cancer is the most effective way to ensure a positive cure rate, according to Henschke.
However, the average 5-year survival rate for all patients with lung cancer is 25.4% because only approximately 21% of lung cancers are diagnosed at an early stage, according to background data provided by the researchers. Meanwhile, recent study findings showed that patients diagnosed in stage I had a survival rate of 95%.
Such data highlight the importance of screening early and often, and the need for expanding screening guidelines, the researchers added.
“I was not surprised by this high cure rate because we confirmed that it’s still high .... I’ve seen it with my own eyes that [patients] do very well with early and often screening,” Henschke told Healio. “What still surprises me is that, despite this, people still go unscreened. In California it’s something like 1%, and among people who are eligible across the country it’s still very low, and the eligibility criteria are still very strict as well.”
In an accompanying editorial, Philippe A. Grenier, MD, thoracic radiologist and head of the artificial intelligence project at Foch Hospital in Suresnes, France, said these reported data “are particularly welcome for both screening and health authorities.”
Also in an accompanying editorial, Lecia V. Sequist, MD, MPH, director of the early detection and diagnostics program at Massachusetts General Hospital, and Coral Olazagasti, MD, an assistant professor at University of Miami’s Sylvester Comprehensive Cancer Center, agreed that “concerted and long-term efforts to change the status quo of lung cancer screening are needed. Indeed, many leaders from a variety of disciplines around the globe have made this goal their life’s work, and things are slowly but surely improving” they wrote. “As a field, we must thank the [International Early Lung Cancer Action Program] leadership for being among the first of these luminaries and applaud this landmark publication encompassing nearly 90,000 screened participants.”
References:
Grenier PA. Radiology. 2023;doi:10.1148.radiol.232698.
Henschke CI, et al. Radiology. 2023;doi:10.1148/radiol.231988.
Sequist LV, et al. Radiology. 2023;doi:10.1148/radiol.232850.
For more information:
Claudia I. Henschke, PhD, MD, can be reached at cihenschke@gmail.com.
Collapse
Read more about
Click Here to Manage Email Alerts