Patients screened with low-dose helical CT (computed tomography)have a 20% lower risk of dying from lung cancer compared to those screened with chest X-rays, researchers reportedin the New England Journal of Medicine (NEJM) . The authors revealed their findings from NLST (National LungScreening Trial), involving 53,000 individuals who either smokedheavily during the trial or used to do so. With over 94 million current or ex-smokers in the USA, lung canceris the country's leading cause of cancer-related deaths. In themajority of cases, when lung cancer is diagnosed, it has alreadyadvanced and is very difficult to cure. Denise R. |
Aberle, M.D., said: "The trial results provide hard evidence of the mortality benefitfrom low-dose helical CT screening for lung cancer in an older andheavy smoker population. These findings, and the vast amount ofadditional data generated by the NLST that are still being studied,offer a rich resource of information that will inform thedevelopment of clinical guidelines and policy recommendations." The study, which lasted nearly ten years, enrolled individuals for20 months. They were randomly assigned to receive three annualscreenings, either with standard chest X-ray or low-dose helicalCT. The trial was sponsored by the National Cancer Institute, partof the NIH (National Institutes of Health). Principal researcher, .William C.
Black, MD, said: "During the screening phase of the trial, 39.1% of participants inthe low-dose helical CT arm and 16.0% of those in the chest X-rayarm had a positive screening result. Across all three screeningexamination rounds, when a positive result was found, 96.4% of thelow-dose helical CT and 94.5% of the chest X-ray examinations werefalse-positive. The follow-up for positive screening examinations most frequentlyinvolved further imaging tests and the data show that follow-upwith invasive procedures was uncommon. We also found that lowerrates of follow-up resulting from a positive scan occurred at laterscreening rounds." The authors explained that in most cases the false-positive resultswere likely due to normal lymph node or inflamed tissue detection.
There were relatively few events in the National Lung ScreeningTrial. Fewer than 2% of patients experienced complications as aresult of the diagnostic evaluations prompted by a positivescreening. Researcher, Constantine Gatsonis, Ph.D., said: "Although the NLST provides definitive evidence about theeffectiveness of low-dose helical CT screening for lung cancer,significant further work is required to answer questions criticalfor the development of public policy recommendations." Further trials using NLST data should be carried out, the authorsadd. These should include the use of statistical modeling to betterdetermine patient risk profiles.
Gatsonis stressed: "Given the considerable costs associated with low-dose helical CTscreening, a cost-effectiveness analysis using the NLST data isunderway that will guide decisions about the best use of finitehealth care resources." Blood, sputum and urine specimens as well as samples of early-stagelung cancer were collected at the American College of RadiologyImaging Network sites and banked in the NILST-ACRIN Biorepository.These samples are available to outside researchers. Aberle said: "These specimens provide a rich resource to validate molecularmarkers that may complement imaging to detect early lung cancer. Bycoupling biospecimen collection with imaging-based screening, theNLST-ACRIN Biorepository is relatively enriched for earlyclinical-stage lung cancers and associated biospecimens, andprovides a unique resource of extremely well-characterizedbiospecimens with longitudinal data." Fellow researcher, Mitchell D. Schnall, M.D., Ph.D., said: "The knowledge that low-dose CT is a viable screening tool fordetecting lung cancers at a curable stage is a tremendous firststep for better understanding its implications for clinical care.Working with the Eastern Cooperative Oncology Group through therecently announced alliance, will allow us to extend thesesignificant results to answer future questions critical fortranslating today's findings into clinical practice.
Furthermore, ACRIN is engaged in a research project with BostonUniversity funded by the United States Department of Defense toinvestigate the role of blood and sputum-based laboratory tests tobetter define patient populations who would most benefit from lungcancer screening and, thereby, reducing false-positive screenings." "Reduced Lung-Cancer Mortality with Low-Dose Computed TomographicScreening" The National Lung Screening Trial Research Team NEJM June 29, 2011 (10.1056/NEJMoa1102873) Written by Christian Nordqvist Copyright: Medical News Today Not to be reproduced without permission of Medical News Today Additional References Citations.
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