How Have We Diagnosed Early-Stage Lung Cancer without Radiographic Screening A Contemporary Single-Center ExperienceReport as inadecuate




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Background

The National Lung Screening Trial NLST, which demonstrated a reduction in lung cancer mortality, may result in widespread computed tomography CT-based screening of select populations. How early-stage lung cancer has been diagnosed without screening, and what proportion of these cases would be captured by a screening program modeled on the NLST, is not currently known. We therefore evaluated current patterns of early-stage lung cancer presentation.

Methodology-Principal Findings

We performed a single-institution retrospective analysis of patients diagnosed with stage I–II non-small cell lung cancer NSCLC from 2000–2009. Associations between patient and imaging characteristics were assessed using univariate and multivariate analyses. A total of 412 patients met criteria for analysis. Among those with available reason for initial imaging, the reason was symptoms in 51%, follow-up of other conditions in 43%, and screening in 6%. Reason for imaging was associated with race P<0.001, insurance type P = 0.005, and disease stage P<0.001. Type of initial imaging was associated with reason for imaging P<0.001, year chest x-ray 67% in 2000–2004 vs. 49% in 2005–2009; P<0.001, and disease stage P = 0.005. Among patients with available quantified smoking history, 48% were age 55–74 years and smoked 30-plus pack-years, therefore meeting NLST entry criteria.

Conclusions-Significance

Symptoms remain a dominant but declining reason for detection of early-stage NSCLC. The proportion of cases detected initially by CT scan without antecedent chest x-ray has increased considerably. Because as few as half of cases meet NLST eligibility criteria, clinicians should remain aware of the diverse circumstances of early-stage lung cancer presentation to expedite therapy.



Author: Evelyn O. Taiwo, Jeffrey T. Yorio, Jingsheng Yan, David E. Gerber

Source: http://plos.srce.hr/



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