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Lung cancer: the American view.

D R Sanderson1, J R Jett

  • 1Section of Thoracic Diseases, Mayo Clinic Scottsdale, Arizona 85259.

The European Respiratory Journal
|November 1, 1989
PubMed
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.

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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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