The need for surgery in an unselected bronchial carcinoma population

An epidemiological study of bronchial carcinoma was carried out in the county of Uppsala, Sweden, during a five-year period. The number of cases found was 273. Of these, 25% were operated upon. The operation rate was six operations/100,000 inhibitants per year. Including additional patients with a false preoperative diagnosis of carcinoma, the operation rate was seven operations/100,000 inhabitants per yera. This figure is clearly subject to influence by the level of medical ambition. The expected five-year survival rate of the surgically treated carcinoma cases in 29%. Twenty-nine percent of the surgically treated patients and 45% of the expected survivors were detected by mass miniature chest X-ray during a general health survey. Fifty-five percent of the surgically treated patients and 75% of the expected survivors were discovered by chance. In no group comparisons with comparable non-surgically treated patients were the deceased surgically treated patients found to have a longer survival. Among the patients who were operated upon, a small tumor size, a peripheral location, clinico-anatomical stage 1 of the disease, and detection by chance were favorable prognostic indicators. Twenty-eight percent of the surgically treated patients were over 70 years of age. Their expected five-year survival rate is 21%. Active early diagnosis (increasing the need for surgery) and restriction of surgery only to those most likely to benefit from it (decreasing the need for surgery) may be expected to give maximum effectiveness in the surgical treatment in bronchial carcinoma.