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Lung cancer: the American view
1Section of Thoracic Diseases, Mayo Clinic Scottsdale, Arizona 85259.
The European Respiratory Journal
|November 1, 1989
Summary
Lung cancer screening trials in the 1970s showed improved early detection but no significant mortality reduction. Public policy shifted to prevention through smoking cessation programs.
Area of Science:
- Oncology
- Public Health
- Preventive Medicine
Background:
- Bronchogenic carcinoma (lung cancer) is a leading cause of cancer death in the U.S.
- Early 1970s National Cancer Institute (NCI) trials investigated screening for lung cancer in high-risk male smokers.
- Screening involved sputum cytology and chest X-rays.
Purpose of the Study:
- To assess the impact of screening (sputum cytology, chest X-ray) on lung cancer mortality.
- To evaluate the effectiveness of early detection versus prevention strategies.
Main Methods:
- Multicentre clinical trials sponsored by the NCI.
- Comparison of screened populations (high-risk male smokers) with unscreened controls.
- Analysis of cancer detection rates, stage at diagnosis, resection rates, survival, and mortality.
Main Results:
- Screened groups had more early-stage lung cancers detected and resected.
- Five-year survival rates were improved in screened populations.
- No significant difference in overall lung cancer mortality rates between screened and unscreened groups.
- Similar numbers of advanced lung cancers were found in both groups.
Conclusions:
- Mass screening for early lung cancer detection was not adopted as U.S. public policy due to lack of significant mortality benefit.
- Emphasis shifted to lung cancer prevention via smoking cessation and prevention programs starting in the 1980s.
- NCI set a 1984 goal to reduce lung cancer mortality by 50% by 2000 through behavioral modification and educational initiatives.
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