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I-ELCAP study: Lung cancer can be detected early with annual low-dose CT screening
Oct 26, 2006 - 7:24:00 PM, Reviewed by: Dr. Rashmi Yadav
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"We believe this study provides compelling evidence that CT screening for lung cancer offers new hope for millions of people at risk for this disease and could dramatically reverse lung cancer death rates"
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By Weill Cornell Medical Center,
Lung cancer can be detected at its very earliest stage in 85 percent of patients using annual low-dose CT screening, and when followed by prompt surgical removal, the 10-year survival rate is 92 percent. These results, to be reported in the October 26 New England Journal of Medicine, would dramatically decrease the number of deaths from lung cancer � the number one cause of cancer deaths among both men and women in the U.S.
The study was launched by a team of researchers at New York-Presbyterian Hospital/Weill Cornell Medical Center in 1993 and has expanded into an international collaboration of 38 institutions in 7 countries, the International Early Lung Cancer Action Project (I-ELCAP). The I-ELCAP study is the largest, long-term study to determine the usefulness of annual screening by CT.
Stage I lung cancer is the only stage at which cure by surgery is highly likely. While survival rates have been climbing for other forms of cancer, the survival rates for lung cancer have remained dismal. Approximately 95 percent of the 173,000 people diagnosed each year die from the disease � more than breast, prostate and colon cancer combined. The high death rates are a consequence of lung cancer not being detected early enough for treatment to be curative.
Among the 31,567 people in the study, CT screening detected 484 people who were diagnosed with lung cancer, 412 of whom were Stage I. Of the Stage I patients who chose not to be treated, all died within five years. Overall, the estimated 10-year survival rate for the 484 participants with lung cancer was 80 percent. The participants were 40 years of age and older and at risk for lung cancer because of a history of cigarette smoking, occupational exposure (to asbestos, beryllium, uranium or radon), or exposure to secondhand smoke.
"We believe this study provides compelling evidence that CT screening for lung cancer offers new hope for millions of people at risk for this disease and could dramatically reverse lung cancer death rates," said Dr. Claudia Henschke, the study's lead author and principal investigator who is chief of the chest imaging division at NewYork-Presbyterian/Weill Cornell and professor of radiology and cardiothoracic surgery at Weill Cornell Medical College.
Since the early 1990s, there have been remarkable advances in CT scanners. Sub-millimeter "slicing" can now be applied to the entire chest in a single breath-hold. As a result, lung cancer may be detected when it is smaller than it was possible to diagnose previously. Although CT scans once yielded only 30 images, current technology yields over 600 images. As the technology advanced, the approaches for studying the usefulness of this technology have also advanced.
The charge for a low-dose CT screening varies, but ranges from $200 to $300. Treatment for Stage I lung cancer is less than half the cost of late-stage treatment. Estimates of the cost-effectiveness of CT screening for lung cancer are similar or better than those for mammography screening for breast cancer. 
- October 26 New England Journal of Medicine
www.med.cornell.edu
Members of the study's writing committee were New York-Presbyterian/Weill Cornell's Drs. David F. Yankelevitz (attending radiologist and professor of radiology and cardiothoracic surgery at Weill Cornell Medical College), Daniel Libby (attending pulmonologist and professor of pulmonary and critical care medicine at Weill Cornell), James P. Smith (attending pulmonologist and professor of pulmonary and critical care medicine), Mark Pasmantier (attending oncologist and professor of medicine), and Olli S. Miettinen (epidemiologist and professor of medicine).
Also contributing to the study at New York-Presbyterian/Weill Cornell were Drs. Nasser Altorki (director of thoracic surgery and professor of cardiothoracic surgery at Weill Cornell Medical College), Dorothy I. McCauley (attending radiologist and professor of radiology at Weill Cornell), Madeline Vazquez (attending pathologist and professor of pathology), Ali Farooqi (radiology fellow), and at Cornell University in Ithaca, Anthony Reeves (professor of electrical and computer engineering).
Additionally, physician-scientists from New York-Presbyterian Hospital/Columbia University Medical Center participated in the current study: Dr. John H.M. Austin (attending radiologist and professor of radiology at Columbia University College of Physicians and Surgeons) and Dr. Gregory D.N. Pearson (associate attending radiologist and associate professor of radiology at Columbia University College of Physicians and Surgeons).
The current study was supported by numerous private and public grants, including a grant from the National Institutes of Health (NIH).
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