Early Lung Cancer Action Project

Abstract

Since the publication of four major lung cancer screening studies,1Melamed MR Flehinger BJ Zaman MB et al.Screening for lung cancer: results of the Memorial Sloan-Kettering Study in New York.Chest. 1984; 86: 44-53Summary Full Text Full Text PDF PubMed Scopus (469) Google Scholar, 2Tockman MS Survival and mortality from lung cancer in a screened population: the Johns Hopkins Study.Chest. 1986; 89: 324-325Summary Full Text Full Text PDF PubMed Google Scholar, 3Kubik A Parkin DM Khlat M et al.Lack of benefit from semi-annual screening for cancer of the lung: follow-up report of a randomized controlled trial on a population of high-risk males in Czechoslovakia.Int J Cancer. 1990; 45: 26-33Crossref PubMed Scopus (219) Google Scholar, 4Fontana RS Sanderson DR Woolner LB et al.Lung cancer screening: the Mayo program.J Occup Med. 1986; 28: 746-750Crossref PubMed Scopus (455) Google Scholar which were interpreted as failing to improve the outcome of lung cancer cases, all active case-finding activities were judged to be useless and as a policy without scientific evidence. In this atmosphere, it was difficult to continue annual Mass Miniature Radiography (MMR) for detecting early stage lung cancer cases which was the practice in Hungary for decades. But we did it and its results provided justification of this programme.In 1998, there were 6359 lung cancer cases notified in Hungary (62·7 per 100 000 people)—probably the highest lung cancer morbidity rate in Europe. Among them, 2059 cases were detected by MMR and 4300 cases by symptoms. The number of cases in stage I was 388 (19%) and 339 (8%), respectively. The operability rate among MMR-detected stage I cases was 68% (265 cases), among stage I cases detected by symptoms 49% (166 cases). The overall operability rate (all cases stages I, II, IIIa) was 37% of MMR-detected cases and 15% of cases detected by symptoms.ELCAP5Henschke CI McCauley DI Yankelebitz DF et al.Early Lung Cancer Action Project: overall design and findings from baseline screening.Lancet. 1999; 354: 99-105Summary Full Text Full Text PDF PubMed Scopus (2143) Google Scholar provided evidence that our policy is correct. At the same time, ELCAP showed the superiority of CT over conventional radiography for early detection of lung cancer. Unfortunately, financial conditions do not allow us to apply CT for screening now. Therefore, we cannot save as many patients with lung cancer as we would be able to do with more sophisticated tools. Nevertheless, we shall continue screening with traditional radiography. Since the publication of four major lung cancer screening studies,1Melamed MR Flehinger BJ Zaman MB et al.Screening for lung cancer: results of the Memorial Sloan-Kettering Study in New York.Chest. 1984; 86: 44-53Summary Full Text Full Text PDF PubMed Scopus (469) Google Scholar, 2Tockman MS Survival and mortality from lung cancer in a screened population: the Johns Hopkins Study.Chest. 1986; 89: 324-325Summary Full Text Full Text PDF PubMed Google Scholar, 3Kubik A Parkin DM Khlat M et al.Lack of benefit from semi-annual screening for cancer of the lung: follow-up report of a randomized controlled trial on a population of high-risk males in Czechoslovakia.Int J Cancer. 1990; 45: 26-33Crossref PubMed Scopus (219) Google Scholar, 4Fontana RS Sanderson DR Woolner LB et al.Lung cancer screening: the Mayo program.J Occup Med. 1986; 28: 746-750Crossref PubMed Scopus (455) Google Scholar which were interpreted as failing to improve the outcome of lung cancer cases, all active case-finding activities were judged to be useless and as a policy without scientific evidence. In this atmosphere, it was difficult to continue annual Mass Miniature Radiography (MMR) for detecting early stage lung cancer cases which was the practice in Hungary for decades. But we did it and its results provided justification of this programme. In 1998, there were 6359 lung cancer cases notified in Hungary (62·7 per 100 000 people)—probably the highest lung cancer morbidity rate in Europe. Among them, 2059 cases were detected by MMR and 4300 cases by symptoms. The number of cases in stage I was 388 (19%) and 339 (8%), respectively. The operability rate among MMR-detected stage I cases was 68% (265 cases), among stage I cases detected by symptoms 49% (166 cases). The overall operability rate (all cases stages I, II, IIIa) was 37% of MMR-detected cases and 15% of cases detected by symptoms. ELCAP5Henschke CI McCauley DI Yankelebitz DF et al.Early Lung Cancer Action Project: overall design and findings from baseline screening.Lancet. 1999; 354: 99-105Summary Full Text Full Text PDF PubMed Scopus (2143) Google Scholar provided evidence that our policy is correct. At the same time, ELCAP showed the superiority of CT over conventional radiography for early detection of lung cancer. Unfortunately, financial conditions do not allow us to apply CT for screening now. Therefore, we cannot save as many patients with lung cancer as we would be able to do with more sophisticated tools. Nevertheless, we shall continue screening with traditional radiography.