Background The outcome among patients with clinical stage Icancer that is detected on annual screening using spiral computedtomography (CT) is unknown.
Methods In a large collaborative study, we screened 31,567 asymptomaticpersons at risk for lung cancer using low-dose CT from 1993through 2005, and from 1994 through 2005, 27,456 repeated screeningswere performed 7 to 18 months after the previous screening.We estimated the 10-year lung-cancer–specific survivalrate among participants with clinical stage I lung cancer thatwas detected on CT screening and diagnosed by biopsy, regardlessof the type of treatment received, and among those who underwentsurgical resection of clinical stage I cancer within 1 month.A pathology panel reviewed the surgical specimens obtained fromparticipants who underwent resection.
Results Screening resulted in a diagnosis of lung cancer in484 participants. Of these participants, 412 (85%) had clinicalstage I lung cancer, and the estimated 10-year survival ratewas 88% in this subgroup (95% confidence interval [CI], 84 to91). Among the 302 participants with clinical stage I cancerwho underwent surgical resection within 1 month after diagnosis,the survival rate was 92% (95% CI, 88 to 95). The 8 participantswith clinical stage I cancer who did not receive treatment diedwithin 5 years after diagnosis.
Conclusions Annual spiral CT screening can detect lung cancerthat is curable.
In 1993, the Early Lung Cancer Action Project (ELCAP) initiateda study of the early diagnosis of lung cancer in cigarette smokerswith the use of annual screening with spiral computed tomography(CT).1,2 The principal finding was that more than 80% of personsgiven a diagnosis of lung cancer as a result of annual CT screeninghad clinical stage I cancer.3 This result has been confirmedby others4 who have adopted the updated protocol.5,6 The questionremains, however, whether early intervention in such patientsis sufficiently effective to justify screening large asymptomaticpopulations who are at risk for lung cancer.7,8 We report theresults of all patients in the study with stage I lung cancerdetected with the use of spiral CT screening, including thosewho underwent surgical resection.
Methods
Screening was defined according to the International ELCAP (I-ELCAP)protocol6 so that data from participating institutions couldbe pooled. Each institution was required to document the initiationof screening in each participant and all subsequent screeningsof that participant for as long as the screening continued,transmit the data and images to the coordinating center at WeillMedical College of Cornell University by means of the study'sWeb-based management system for CT screening for lung cancer,9submit pathological specimens to the coordinating center, andfollow quality-assurance procedures specified by the protocol.All participants gave written informed consent, and the institutionalreview board at each participating institution approved theprotocols (Figure 1).
Figure 1. Diagnoses of Lung Cancer Resulting from Baseline Screening and Annual Screening with CT.
A description of the I-ELCAP management algorithm for baseline CT and repeated CT screening is available in the study protocol.6
The protocol specified a common regimen of screening but allowedeach participating institution to specify its criteria for enrollment.The regimen included the technical variables for the initiallow-dose spiral CT scan, which were the same for the baselineand annual screenings. However, the definition of a positiveresult on the initial CT scan and the diagnostic workup leadingto a diagnosis of lung cancer were different for the baselinescreening and annual screening.
For baseline screening, a positive result on the initial low-doseCT scan was defined as the identification of at least one solidor partly solid noncalcified pulmonary nodule 5 mm or more indiameter, at least one nonsolid noncalcified pulmonary nodule8 mm or more in diameter, or a solid endobronchial nodule.10If none of the noncalcified nodules identified met the studycriteria for a positive result or if the test was negative,CT was repeated 12 months later. The diameter of the nodulewas defined as the average of the length and width of the cross-sectionalarea of the largest nodule in the CT images. The consistencyof the nodule was defined as solid if the nodule obscured theentire lung parenchyma, partly solid if it obscured part ofthe lung parenchyma, and nonsolid if it obscured none of theparenchyma.11 If the result was positive, the type of workupdepended on the diameter of the largest nodule. For nodules5 to 14 mm in diameter, the preferred option was to performanother CT at 3 months; if the images showed growth of the nodule,12then biopsy, ideally by fine-needle aspiration, was to be performed,whereas if there was no growth, the workup was stopped. Theother option was to perform positron-emission tomography (PET)immediately, and if the results were positive, biopsy was tobe performed; otherwise, CT was to be performed at 3 months.For nodules 15 mm in diameter or larger (whether solid, partlysolid, or nonsolid), immediate biopsy was an option in additionto the options already specified for smaller nodules. When infectionwas suspected, a 2-week course of antibiotics followed 1 monthlater by CT was an alternative to all the options mentioned,13and if no resolution or growth was observed, biopsy was to beperformed; otherwise, the workup was stopped. For all participantsfor whom the workup was stopped or for whom the biopsy did notlead to a diagnosis of lung cancer, CT was to be repeated 12months after the baseline CT.
For annual screenings, a positive result was considered to beany newly identified noncalcified nodule, regardless of size.If no new nodule was identified, CT was to be repeated 12 monthslater. If one or more new nodules were identified, the workupdepended on the diameter of the largest nodule. If all noduleswere less than 3.0 mm in diameter, or if the largest nodulewas more than 3.0 mm but less than 5.0 mm in diameter, CT 6or 3 months later, respectively, was to be performed. If nogrowth was seen in any of the nodules, the workup was stopped.If at least one of the noncalcified nodules was 5.0 mm or largerin diameter, then an immediate 2-week course of a broad-spectrumantibiotic was prescribed, followed 1 month later by CT. Ifthe nodules showed no resolution or growth, biopsy was to beperformed; otherwise, the workup was stopped. PET was an alternativeto immediate biopsy; if the result was positive, biopsy wasto follow. If the result was indeterminate or negative, CT wasto be performed 3 months later, and if the scans showed growth,biopsy was to follow. Otherwise, the workup was stopped. Forall patients for whom the workup was stopped or when biopsydid not result in a diagnosis of lung cancer, CT was to be repeated12 months after the previous annual CT.
The protocol provided recommendations for the diagnostic workupin participants with a positive result on CT, with the decisionregarding how to proceed left to each participant and the referringphysician. The I-ELCAP protocol did not require that its recommendationsfor the workup of a nodule be followed, but it did require afirmly established final diagnosis of lung cancer and documentationof the workup in the management system. After the diagnosisof lung cancer was established, the type of intervention, ifany, was left to the discretion of the participant and the physician.Documentation in the management system of the timing and typeof intervention, if any, and follow-up with respect to manifestationsof spread or death up to 10 years after diagnosis, were required.
A total of 31,567 asymptomatic men and women underwent baselinescreening between 1993 and 2005 (median, 2001). The participants,who were 40 years of age and older, were at risk for lung cancerbecause of a history of cigarette smoking, occupational exposure(to asbestos, beryllium, uranium, or radon), or exposure tosecondhand smoke without having smoked themselves; in Azumi,Japan, they participated as part of the annual health screeningprogram (Table 1). All participants were considered fit to undergothoracic surgery. A total of 27,456 annual screenings were conductedbetween 1994 and 2005 (median, 2002), each of which was performed7 to 18 months after the previous screening. At baseline, themedian age of the participants was 61 years (range, 40 to 85),and the median number of pack-years of smoking was 30 (range,0 to 141); on annual CT, the median values were an age of 62years (range, 41 to 86) and 35 pack-years (range, 0 to 141).Among the participants, 13% (4186 of 31,567) who underwent baselineCT and 5% (1460 of 27,456) who underwent annual CT had a positiveresult that required immediate further workup. A biopsy of apulmonary nodule as recommended in the protocol was performedin 535 of the participants with a positive result on the baselineor annual CT and led to a diagnosis of malignant disease in492 of the participants (lung cancer was diagnosed in 479 andlymphoma or metastases from cancers other than lung cancer in13) and no evidence of malignant disease in 43. The diagnosiswas classified as having been identified during baseline screeningwhen the nodule was first identified on the baseline CT, evenfor cases not meeting the criteria for a positive result, regardlessof when the diagnosis was made. When the nodule was first identifiedon an annual CT, it was attributed to the annual screening.If the result on the baseline or annual CT was negative anda diagnostic workup was subsequently prompted by suggestivesymptoms (or incidental findings) before the next scheduledannual CT, the finding was classified as an interim diagnosis.To fully document interim diagnoses of lung cancer, the protocolrequired that each enrolled participant who had not returnedfor the next scheduled screening be contacted 1 year after theprevious screening. If contact could not be made either directlyor through relatives of the participant, the referring physicianwas contacted to ascertain whether a diagnosis of lung cancerhad been made.
Table 1. I-ELCAP Participants, According to the Smoking Status, Exposure to Secondhand Smoke, and Occupational Exposures.
We determined the distribution of the baseline and annual screeningsand the resulting diagnoses according to age and median pack-yearsof cigarette smoking (Table 2). Each diagnosis of lung cancerwas classified according to clinical stage with the use of standardcriteria based on the clinical examination and the results ofimaging.14 The presence or absence of lymph-node (N) and distantmetastases (M) was assessed on the most recent CT obtained beforediagnosis and from PET (performed in 166 of the 484 participantswho received a diagnosis of lung cancer). The cancer was classifiedas N0M0 if on CT the widths of all mediastinal lymph nodes wereless than 10 mm and no hilar lymph nodes or distant metastaseswere identified (and PET, if performed, showed no abnormal uptake).For the purpose of this study, stage I cancers included thoseclassified as N0M0 with more than 1 adenocarcinoma so long asall adenocarcinomas were 30 mm or less in diameter.6
Table 2. Frequency Distribution of Lung-Cancer Diagnoses on Baseline and Annual CT Screening, According to Age and Median Pack-Years of Cigarette Smoking.
The specimens obtained from participants who underwent surgicalresection were examined at each institution according to theI-ELCAP pathology protocol,15 which specified the preparationof the specimen and the findings that were to be documentedby the pathologist at the hospital where the resection was performed.The protocol also specified the review process: a five-memberpathology-review panel consisting of expert pulmonary pathologistswas to reach a consensus diagnosis for each case of cancer andidentify lymph-node involvement, additional cancers, and pleural,lymphatic, vascular, bronchial, and basement-membrane invasionby the cancer. For 22 of the 411 participants who underwentresection (5%), specimens could not be obtained from a nonparticipatinghospital, and the panel therefore reviewed the detailed surgicaland pathological reports for the relevant information.
All patients given a diagnosis of lung cancer were followedannually by the principal investigator and by the study coordinatorat each participating institution, who submitted the informationrequired by the protocol to the coordinating center. When aparticipant was known to have died, the date and cause wereobtained from the participant's physician, family members, orboth. Death resulting from treatment was considered to havebeen caused by lung cancer. Follow-up from diagnosis to deathfrom lung cancer, the last contact, or May 30, 2006, whichevercame first, was documented for each participant. The durationof follow-up ranged from 1 to 123 months (median, 40).
Kaplan–Meier curves were calculated for lung-cancer–specificsurvival as of the date of diagnosis, irrespective of the typeof treatment, including no treatment, for all participants withlung cancer, irrespective of the stage of the cancer, and forthe subgroup with clinical stage I cancer. Survival curves werealso calculated for participants who underwent resection ofclinical stage I cancer within 1 month after diagnosis and thosewho did not receive treatment. On the basis of these curves,we estimated the 10-year survival rates. The curves were constructedwith the use of SAS statistical software (version 8), whichalso produced the standard error for the estimates.
Results
Baseline screening of 31,567 asymptomatic persons who were atrisk for lung cancer and annual screening of 27,456 resultedin the diagnosis of lung cancer in 405 and 74 participants,respectively (Figure 1). Another five participants receivedinterim diagnoses of lung cancer that were prompted by the developmentof symptoms within 12 months after the baseline screening. Ofthese 484 participants given a diagnosis of lung cancer, 411underwent resection; 57 received radiation, chemotherapy, orboth; and 16 received no treatment. Because survival rates amongthe participants who underwent baseline screening and thosewho underwent annual screening did not differ significantly,Kaplan–Meier estimates of lung-cancer–specific survivalwere calculated for all 484 participants (Figure 2). The estimated10-year survival rate for all participants, regardless of tumorstage and treatment, was 80% (95% confidence interval [CI],74 to 85); as of May 2006, 75 of the 484 participants had diedof lung cancer, including 2 who died within 4 weeks after surgery,yielding an operative mortality rate of 0.5% (2 of 411 participants).
Figure 2. Kaplan–Meier Survival Curves for 484 Participants with Lung Cancer and 302 Participants with Clinical Stage I Cancer Resected within 1 Month after Diagnosis.
The diagnoses were made on the basis of CT screening at baseline combined with cycles of annual CT.
Of the 484 participants who received a diagnosis of lung cancer,412 (85%) had clinical stage I lung cancer. In this subgroup,the estimated 10-year survival rate regardless of treatmentwas 88% (95% CI, 84 to 91); as of May 2006, 39 of these 412patients had died of lung cancer. Of these 412 participants,375 had undergone surgical resection (284 lobectomy, 60 wedgeresection, 21 segmentectomy, and 10 bilobectomy); 29 did notundergo resection but received chemotherapy, radiation, or both;and the remaining 8 did not receive treatment. Figure 2 alsoshows the lung-cancer–specific survival rate among the302 participants who underwent resection within 1 month afterdiagnosis, among whom the estimated 10-year survival rate was92% (95% CI, 88 to 95). All eight untreated patients died within5 years after diagnosis.
Among the 412 participants with clinical stage I cancer, thedistribution according to the type of cell is shown in Table 3.The median tumor diameter was 13 mm at baseline and 9 mm onannual CT. The pathology-review panel confirmed the diagnosisof clinical stage I cancer in the specimens obtained from the375 participants who underwent resection according to WorldHealth Organization criteria of 2004.16 With regard to spreador invasion (Table 4), the panel identified lymph-node metastases(hilar or ipsilateral mediastinal) in 28 participants (7%) andmore than one cancer, either in the same or in different lobes,in another 35 (9%). Among the remaining participants, each witha solitary cancer, the panel identified invasion of the pleurain 62 (17%); bronchial, vascular, or lymphatic invasion or acombination in another 28 (7%); invasion of the basement membranealone in 203 (54%), and no invasion in the remaining 19 (5%).(Because of rounding, percentages may not total 100.) Thus,of the 375 participants who underwent resection, 347 had pathologicalstage I cancer, and their estimated 10-year survival rate was94% (95% CI, 91 to 97).
Table 4. Extent of Spread of Cancer in 375 Participants Who Underwent Resection of Clinical Stage I Lung Cancer According to Whether Cancer was Detected on Baseline or Annual CT Screening.
Discussion
In making decisions about instituting CT screening for lungcancer, a major consideration is the outcome of treating a cancerdetected on screening. In our study, the estimated 10-year lung-cancer–specificsurvival rate among the 484 participants with disease diagnosedon CT, regardless of the stage at diagnosis or type of treatment(including no treatment), was 80% (95% CI, 74 to 85) (Figure 2).Among the 412 participants with clinical stage I lung cancer— the only stage at which cure by surgery is highly likely— the estimated 10-year survival rate was 88% (95% CI,84 to 91), and among those with clinical stage I lung cancerwho underwent surgical resection within 1 month after the diagnosis,the rate was 92% (95% CI, 88 to 95). The diagnosis of lung cancerof one type or another was verified by a panel of five expertpulmonary pathologists. In our series, the operative mortalityrate was low — 0.5% — and was less than the 1.0%reported with lobectomy in a large cooperative study.17
Sobue et al.18 reported a 5-year survival rate of 100% in theirseries of 29 patients who underwent resection after pathologicalstage I cancer was detected on CT. Before CT screening, reportsbased on registries showed 10-year survival rates of 80% among17 patients with pathological stage I lung cancer 20 mm or lessin diameter19 and 93% among 35 patients with pathological stageI cancer less than 10 mm in diameter.20 The National CancerInstitute's Surveillance, Epidemiology, and End Results (SEER)registry, the largest U.S. cancer registry, reported an 8-yearsurvival rate of 75% among patients with pathological stageI cancer with nodules less than 15 mm in diameter who had undergoneresection.8 Although the lung cancers in these three serieswere not detected on CT screening, most were presumably incidentallydetected on imaging performed for other reasons in people whohad no symptoms of lung cancer.
CT screening according to the I-ELCAP regimen can detect clinicalstage I lung cancer in a high proportion of persons when itis curable by surgery. In a population at risk for lung cancer,such screening could prevent some 80% of deaths from lung cancer.In comparison, in the United States at present, annually approximately173,000 persons are diagnosed with lung cancer and 164,000 deathsare attributed to this disease,21 so that approximately 95%of those who are diagnosed with lung cancer die from it.
Are these results sufficiently effective to justify screeningpeople who are at risk of lung cancer? As compared with mammographicscreening for breast cancer, for lung cancer the rates of detectionamong the participants in this study who were 40 years of ageand older were 1.3% on baseline CT screening and 0.3% on annualscreening (Table 2), values that were slightly higher than thosefor the detection of breast cancer (0.6 to 1.0% on baselinescreening) and similar to those for annual screening (0.2 to0.4%) among women 40 years of age and older.22 The rate of cancerdetection depends on the risk profile of those undergoing screening;the higher the risk, the more productive the screening. Thus,as expected, CT screening of the original participants in ELCAP,who were former and current smokers 60 years of age and older,1,2was more productive in detecting lung cancer (detection rates,2.7% on baseline screening and 0.6% on annual screening) thanamong participants in the expanded study. The cost of low-doseCT is below $200,23,24,25,26 and surgery for stage I lung canceris less than half the cost of late-stage treatment.26,27 Usingthe original ELCAP data and the actual hospital costs for theworkup, we found CT screening for lung cancer to be highly cost-effective.23Other estimates of the cost-effectiveness of CT screening forlung cancer for various risk profiles24,25,26,28 are similarto that for mammography screening.29,30
Supported in part by the National Institutes of Health (grantsR01-CA-633931, to Dr. Henschke, and R01-CA-78905, to Dr. Yankelevitz);the Department of Energy (DE-FG02-96SF21260, to Dr. Markowitz);the Department of Defense to Dr. Tockman; Department of Healthand Mental Hygiene of the City of New York; New York State Officeof Science, Technology, and Academic Research; American CancerSociety; Israel Cancer Association; Starr Foundation; New YorkCommunity Trust; Rogers Family Fund; Foundation for Lung Cancer:Early Detection, Prevention, and Treatment; Foundation for EarlyDetection of Lung Cancer; Dorothy R. Cohen Foundation; ResearchFoundation of Clinic Hirslanden; Clinic Hirslanden; SwedishHospital; Yad-Hanadiv Foundation; Jacob and Malka Goldfarb CharitableFoundation; Auen–Berger Foundation; Princess MargaretFoundation; Tenet Healthcare Foundation; Ernest E. Stempel Foundation,Academic Medical Development; Empire Blue Cross and Blue Shield;Eastman Kodak; General Electric; Weill Medical College of CornellUniversity; New York Presbyterian Hospital; Christiana CareHelen F. Graham Cancer Center; Holy Cross Hospital; EisenhowerHospital; Jackson Memorial Hospital Health System; and EvanstonNorthwestern Healthcare.
Drs. Henschke and Yankelevitz report receiving royalties fromCornell Research Foundation as inventors of methods to assesstumor growth and regression on imaging tests for which pendingpatents are held by Cornell Research Foundation and licensedto General Electric. No other potential conflict of interestrelevant to this article was reported.
* The International Early Lung Cancer Action Program investigatorsare listed in the Appendix.
Source Information
The members of the Writing Committee (Claudia I. Henschke, M.D., Ph.D., David F. Yankelevitz, M.D., Daniel M. Libby, M.D., Mark W. Pasmantier, M.D., and James P. Smith, M.D., New York Presbyterian Hospital–Weill Medical College of Cornell University, New York; and Olli S. Miettinen, M.D., Ph.D., McGill University, Montreal) of the International Early Lung Cancer Action Program assume responsibility for the overall content and integrity of the article.
Address reprint requests to Dr. Henschke at New York Presbyterian Hospital–Weill Medical College of Cornell University, 525 E. 168th St., New York, NY 10021, or at chensch{at}med.cornell.edu.
References
Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999;354:99-105. [CrossRef][Web of Science][Medline]
Henschke CI, Naidich DP, Yankelevitz DF, et al. Early Lung Cancer Action Project: initial findings on repeat screening. Cancer 2001;92:153-159. [CrossRef][Web of Science][Medline]
Henschke CI, Yankelevitz DF, Smith JP, et al. CT screening for lung cancer: assessing a regimen's diagnostic performance. Clin Imaging 2004;28:317-321. [Web of Science][Medline]
Henschke CI, Yankelevitz DF, Miettinen OS, I-ELCAP Investigators. Computed tomographic screening for lung cancer: the relationship of disease stage to tumor size. Arch Intern Med 2006;166:321-325. [Free Full Text]
Henschke CI, Yankelevitz DF, Smith JP, Miettinen OS, ELCAP Group. Screening for lung cancer: the Early Lung Cancer Action approach. Lung Cancer 2002;35:143-148. [CrossRef][Web of Science][Medline]
International Early Lung Cancer Action Program protocol. (Accessed September 29, 2006, at http://www.IELCAP.org.)
Henschke CI, Yankelevitz DF, Smith JP, Miettinen OS. The use of spiral CT in lung cancer screening. In: DeVita VT, Hellman S, Rosenberg SA, eds. Progress in oncology 2002. Sudbury, MA: Jones and Barlett, 2002.
Henschke CI, Wisnivesky JP, Yankelevitz DF, Miettinen OS. Screen-diagnosed small stage I cancers of the lung: genuineness and curability. Lung Cancer 2003;39:327-330. [CrossRef][Web of Science][Medline]
Reeves AP, Kostis WJ, Yankelevitz DF, Henschke CI. A Web-based data system for multi-institutional research studies on lung cancer. Presented at the 87th annual meeting of the Radiologic Society of North America, Chicago, November 25–30, 2001.
Henschke CI, Yankelevitz DF, Naidich D, et al. CT screening for lung cancer: suspiciousness of nodules at baseline according to size. Radiology 2004;231:164-168. [Free Full Text]
Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley DI, Miettinen OS. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 2002;178:1053-1057. [Free Full Text]
Kostis WJ, Yankelevitz DF, Reeves AP, Fluture SC, Henschke CI. Small pulmonary nodules: reproducibility of three-dimensional volumetric measurement and estimation of time to follow-up CT. Radiology 2004;231:446-452. [Free Full Text]
Libby DM, Wu N, Lee IJ, et al. CT screening for lung cancer: the value of short-term CT follow-up. Chest 2006;129:1039-1042. [Free Full Text]
Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest 1997;111:1710-1717. [Free Full Text]
Vazquez M, Flieder D, Travis W, et al. Early Lung Cancer Action Project pathology protocol. Lung Cancer 2003;39:231-232. [CrossRef][Web of Science][Medline]
Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC, eds. World Health Organization classification of tumours: pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon, France: IARC Press, 2004.
Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ASOSOG Z0030 trial. Ann Thorac Surg 2006;81:1013-1020. [Free Full Text]
Sobue T, Moriyama N, Kaneko M, et al. Screening for lung cancer with low-dose helical computed tomography: anti-lung cancer association project. J Clin Oncol 2002;20:911-920. [Free Full Text]
Buell PE. The importance of tumor size in prognosis for resected bronchogenic carcinoma. J Surg Oncol 1971;3:539-551. [Medline]
Martini N, Bains MS, Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 1995;109:120-129. [Free Full Text]
Cancer facts and figures: statistics, 2005. Atlanta: American Cancer Society, 2005. (Also available at http://www.cancer.org.)
Quality determinants of mammography. In: Clinical practice guideline no. 13. Rockville, MD: Agency for Health Care Policy and Research, 1994:82-6. (Publication no. 95-0632.)
Wisnivesky JP, Mushlin A, Sicherman N, Henschke CI. Cost-effectiveness of low-dose CT screening for lung cancer: preliminary results of baseline screening. Chest 2003;124:614-621. [Free Full Text]
Miettinen OS. Screening for lung cancer: can it be cost-effective? CMAJ 2000;162:1431-1436. [Medline]
Marshall D, Simpson KN, Earle CC, Chu C. Potential cost-effectiveness of one-time screening for lung cancer (LC) in a high risk cohort. Lung Cancer 2001;32:227-236. [CrossRef][Web of Science][Medline]
Marshall D, Simpson KN, Earle CC, Chu C. Economic decision analysis model of screening for lung cancer. Eur J Cancer 2001;37:1759-1767. [CrossRef][Web of Science][Medline]
Riley GF, Potosky AL, Lubitz JD, Kessler LG. Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Med Care 1995;33:828-841. [CrossRef][Web of Science][Medline]
Chirikos TN, Hazelton T, Tockman M, Clark R. Screening for lung cancer with CT: a preliminary cost-effectiveness analysis. Chest 2002;121:1507-1514. [Free Full Text]
Lindfors KK, Rosenquist CJ. The cost-effectiveness of mammographic screening strategies. JAMA 1995;274:881-884. [Erratum, JAMA 1996;275:112.] [Free Full Text]
Rosenquist CJ, Lindfors KK. Screening mammography beginning at age 40 years: a reappraisal of cost-effectiveness. Cancer 1998;82:2235-2240. [CrossRef][Web of Science][Medline]
Appendix
The following investigators participated in I-ELCAP: Joan andSanford I. Weill Medical College of Cornell University, NewYork: C.I. Henschke (principal investigator), D.F. Yankelevitz,D.I. McCauley; Azumi General Hospital, Nagano, Japan: S. Sone,T. Hanaoka; Center for the Biology of Natural Systems, CityUniversity of New York at Queens College, Queens: S. Markowitz,A. Miller; LungenZentrum Hirslanden, Zurich: K. Klingler, T.Scherer, R. Inderbitzi; Clinica Universitaria de Navarra, Pamplona,Spain: J. Zulueta, L. Montuenga, G. Bastarrika; National CancerInstitute Regina Elena, Rome: S. Giunta, M. Crecco, P. Pugliese;H. Lee Moffitt Cancer Center and Research Institute, Tampa,FL: M. Tockman; Hadassah Medical Organization, Jerusalem, Israel:D. Shaham; Swedish Medical Center, Seattle: K. Rice, R. Aye;University of Toronto, Princess Margaret Hospital, Toronto:H. Roberts, D. Patsios; Christiana Care Helen F. Graham CancerCenter, Newark, DE: T. Bauer, J. Lally; Columbia UniversityMedical Center, New York: J.H.M. Austin, G.D.N. Pearson; NewYork University Medical Center, New York: D. Naidich, G. McGuinness;State University of New York at Stony Brook, Stony Brook: M.Rifkin, E. Fiore; Maimonides Medical Center, Brooklyn, NY: S.Kopel; Roswell Park Cancer Institute, Buffalo, NY: D. Klippenstein,A. Litwin, P.A. Loud; State University of New York Upstate MedicalUniversity, Syracuse: L.J. Kohman, E.M. Scalzetti; North Shore–LongIsland Jewish Health System, New Hyde Park, NY: A. Khan, R.Shah; Georgia Institute for Lung Cancer Research, Atlanta: M.V.Smith, H.T. Williams, L. Lovett; Mount Sinai School of Medicine,New York: D.S. Mendelson; Jackson Memorial Hospital, Universityof Miami, Miami: R. Thurer; Memorial Sloan-Kettering CancerCenter, New York: R.T. Heelan, M.S. Ginsberg; Holy Cross HospitalCancer Institute, Silver Spring, MD: F. Sullivan, M. Ottinger;Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA: D. Vafai;New York Medical College, Valhalla: T.A.S. Matalon; Mount SinaiComprehensive Cancer Center, Miami Beach, FL: S.-L. Odzer; FifthAffiliated Hospital (Zhuhai Hospital), of Sun Yat-Sen University,Zhuhai, China: X. Liu; Dorothy E. Schneider Cancer Center, Mills-PeninsulaHealth Services, San Mateo, CA: B. Sheppard; St. Agnes CancerCenter, Baltimore: E. Cole; Our Lady of Mercy Medical Center,Bronx, NY: P.H. Wiernik; Evanston Northwestern Healthcare MedicalGroup, Evanston, IL: D. Ray; Karmanos Cancer Institute, Detroit:H. Pass, C. Endress; Greenwich Hospital, Greenwich, CT: D. Mullen;Sharp Memorial Hospital, San Diego, CA: M. Kalafer; City ofHope National Medical Center, Duarte, CA: F. Grannis, A. Rotter;ProHealth Care Regional Cancer Center, Waukesha and OconomowocMemorial Hospitals, Oconomowoc, WI: M.K. Thorsen, R. Hansen;Comprehensive Cancer Center, Desert Regional Medical Center,Palm Springs, CA: E. Camacho; St. Joseph Health Center, St.Charles, MO: D. Luedke; Coordinating Center: C.I. Henschke,N. Altorki, A. Farooqi, J. Hess, D. Libby, D.I. McCauley, O.S.Miettinen, J. Ostroff, M.W. Pasmantier, A.P. Reeves, J.P. Smith,M. Vazquez, D.F. Yankelevitz, R. Yip, L. Zhang, K. Agnello;Pathology Review Panel: D. Carter, E. Brambilla, A. Gazdar,M. Noguchi, W.D. Travis.
CT Screening for Lung Cancer
Gould M. K., Berg C. D., Aberle D. R., the National Lung Screening Trial Executive Committee , Bach P. B., Kulaga S., Karp I., Yee A. J., Lynch T. J., Silvestri G. A., Miller A., Markowitz S., Miller J. A., Lee P., Postmus P. E., Sutedja T. G., Dehavenon A., Henschke C. I., Smith J. P., Miettinen O. S.
Extract |
Full Text |
PDF
N Engl J Med 2007;
356:743-747, Feb 15, 2007.
Correspondence
This article has been cited by other articles:
Blomquist, T., Crawford, E. L., Mullins, D., Yoon, Y., Hernandez, D.-A., Khuder, S., Ruppel, P. L., Peters, E., Oldfield, D. J., Austermiller, B., Anders, J. C., Willey, J. C.
(2009). Pattern of Antioxidant and DNA Repair Gene Expression in Normal Airway Epithelium Associated with Lung Cancer Diagnosis. Cancer Res.
69: 8629-8635
[Abstract][Full Text]
MacHaalany, J., Yam, Y., Ruddy, T. D., Abraham, A., Chen, L., Beanlands, R. S., Chow, B. J.W.
(2009). Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography.. J Am Coll Cardiol
54: 1533-1541
[Abstract][Full Text]
Hlatky, M. A., Iribarren, C.
(2009). The dilemma of incidental findings on cardiac computed tomography.. J Am Coll Cardiol
54: 1542-1543
[Full Text]
Colice, G. L
(2009). Haemoptysis with a normal chest radiograph: how concerned should we be?. Thorax
64: 829-830
[Full Text]
van den Bergh, K. A. M., Essink-Bot, M. L., van Klaveren, R. J., de Koning, H. J.
(2009). Informed participation in a randomised controlled trial of computed tomography screening for lung cancer. Eur Respir J
34: 711-720
[Abstract][Full Text]
Ye, C., Masterman, J. R., Huberman, M. S., Gangadharan, S. P., McDonald, D. C., Kent, M. S., DeCamp, M. M.
(2009). Subdivision of the T1 Size Descriptor for Stage I Non-small Cell Lung Cancer Has Prognostic Value: A Single Institution Experience. Chest
136: 710-715
[Abstract][Full Text]
Infante, M., Cavuto, S., Lutman, F. R., Brambilla, G., Chiesa, G., Ceresoli, G., Passera, E., Angeli, E., Chiarenza, M., Aranzulla, G., Cariboni, U., Errico, V., Inzirillo, F., Bottoni, E., Voulaz, E., Alloisio, M., Destro, A., Roncalli, M., Santoro, A., Ravasi, G., for the DANTE Study Group,
(2009). A Randomized Study of Lung Cancer Screening with Spiral Computed Tomography: Three-year Results from the DANTE Trial. Am. J. Respir. Crit. Care Med.
180: 445-453
[Abstract][Full Text]
Silvestri, G. A, Alberg, A. J, Ravenel, J.
(2009). The changing epidemiology of lung cancer with a focus on screening. BMJ
339: b3053-b3053
[Full Text]
Rodig, S. J., Mino-Kenudson, M., Dacic, S., Yeap, B. Y., Shaw, A., Barletta, J. A., Stubbs, H., Law, K., Lindeman, N., Mark, E., Janne, P. A., Lynch, T., Johnson, B. E., Iafrate, A. J., Chirieac, L. R.
(2009). Unique Clinicopathologic Features Characterize ALK-Rearranged Lung Adenocarcinoma in the Western Population. Clin. Cancer Res.
15: 5216-5223
[Abstract][Full Text]
Lee, P., van den Berg, R. M., Lam, S., Gazdar, A. F., Grunberg, K., McWilliams, A., LeRiche, J., Postmus, P. E., Sutedja, T. G.
(2009). Color Fluorescence Ratio for Detection of Bronchial Dysplasia and Carcinoma In situ. Clin. Cancer Res.
15: 4700-4705
[Abstract][Full Text]
Horvath, I., Lazar, Z., Gyulai, N., Kollai, M., Losonczy, G.
(2009). Exhaled biomarkers in lung cancer. Eur Respir J
34: 261-275
[Abstract][Full Text]
Miller, A., Markowitz, S. B., Miller, J. A.
(2009). Follow-up Diagnostic Procedures in Lung Cancer Screening. Am. J. Respir. Crit. Care Med.
180: 102-103
[Full Text]
Ghosal, R, Kloer, P, Lewis, K E
(2009). A review of novel biological tools used in screening for the early detection of lung cancer. Postgrad. Med. J.
85: 358-363
[Abstract][Full Text]
Yee, J., Sadar, M. D., Sin, D. D., Kuzyk, M., Xing, L., Kondra, J., McWilliams, A., Man, S.F. P., Lam, S.
(2009). Connective Tissue-Activating Peptide III: A Novel Blood Biomarker for Early Lung Cancer Detection. JCO
27: 2787-2792
[Abstract][Full Text]
Caoili, E. M., Cohan, R. H., Ellis, J. H., Dillman, J., Schipper, M. J., Francis, I. R.
(2009). Medical Decision Making Regarding Computed Tomographic Radiation Dose and Associated Risk: The Patient's Perspective. Arch Intern Med
169: 1069-1071
[Full Text]
Brambilla, E., Gazdar, A.
(2009). Pathogenesis of lung cancer signalling pathways: roadmap for therapies. Eur Respir J
33: 1485-1497
[Abstract][Full Text]
Detterbeck, F.
(2009). The fruits of our efforts: time for a different view of lung cancer and CT screening. Thorax
64: 465-466
[Full Text]
Stanbrook, M. B., Flegel, K.
(2009). A pause for thought on lung cancer screening. CMAJ
180: 793-793
[Full Text]
Stanbrook, M. B., Flegel, K.
(2009). Reflexion sur le depistage du cancer du poumon. CMAJ
180: E10-E10
[Full Text]
van Klaveren, R. J., van't Westeinde, S. C., de Hoop, B.-J., Hoogsteden, H. C.
(2009). Stem Cells and the Natural History of Lung Cancer: Implications for Lung Cancer Screening. Clin. Cancer Res.
15: 2215-2218
[Abstract][Full Text]
Tao, C., Gierada, D. S., Zhu, F., Pilgram, T. K., Wang, J. H., Bae, K. T.
(2009). Automated Matching of Pulmonary Nodules: Evaluation in Serial Screening Chest CT. Am. J. Roentgenol.
192: 624-628
[Abstract][Full Text]
Nakanishi, H., Matsumoto, S., Iwakawa, R., Kohno, T., Suzuki, K., Tsuta, K., Matsuno, Y., Noguchi, M., Shimizu, E., Yokota, J.
(2009). Whole Genome Comparison of Allelic Imbalance between Noninvasive and Invasive Small-Sized Lung Adenocarcinomas. Cancer Res.
69: 1615-1623
[Abstract][Full Text]
Petitti, D. B., Teutsch, S. M., Barton, M. B., Sawaya, G. F., Ockene, J. K., DeWitt, T., on behalf of the U.S. Preventive Services Task For,
(2009). Update on the Methods of the U.S. Preventive Services Task Force: Insufficient Evidence. ANN INTERN MED
150: 199-205
[Abstract][Full Text]
Carter, R. E., Huang, P.
(2009). Cautionary Note Regarding the Use of CIs Obtained From Kaplan-Meier Survival Curves. JCO
27: 174-175
[Full Text]
Brambilla, C.
(2009). From surgical to molecular scalpel: ERJ lung cancer series for 2009. Eur Respir J
33: 9-10
[Full Text]
Alberts, W. M.
(2009). Lung Cancer. ACCP Pulmonary Med Brd Rev
25: 39-62
[Full Text]
Veeramachaneni, N. K., Crabtree, T. D., Kreisel, D., Zoole, J. B., Musick, J. F., Taylor, N. G., Krupnick, A. S., Gierada, D. S., Patterson, G. A., Meyers, B. F.
(2009). A thoracic surgery clinic dedicated to indeterminate pulmonary nodules: too many scans and too little pathology?. J. Thorac. Cardiovasc. Surg.
137: 30-35
[Abstract][Full Text]
Smith, R. A., Cokkinides, V., Brawley, O. W.
(2009). Cancer screening in the United States, 2009: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin
59: 27-41
[Abstract][Full Text]
Weitzman, S. A.
(2008). Lung Cancer Risk Following Detection of Pulmonary Scarring by Chest Radiography in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial--Invited Commentary. Arch Intern Med
168: 2332-2332
[Full Text]
Gill, R. K., Vazquez, M. F., Kramer, A., Hames, M., Zhang, L., Heselmeyer-Haddad, K., Ried, T., Shilo, K., Henschke, C., Yankelevitz, D., Jen, J.
(2008). The Use of Genetic Markers to Identify Lung Cancer in Fine Needle Aspiration Samples. Clin. Cancer Res.
14: 7481-7487
[Abstract][Full Text]
Kodama, K., Higashiyama, M., Takami, K., Oda, K., Okami, J., Maeda, J., Koyama, M., Nakayama, T.
(2008). Treatment strategy for patients with small peripheral lung lesion(s): intermediate-term results of prospective study. Eur. J. Cardiothorac. Surg.
34: 1068-1074
[Abstract][Full Text]
Byrne, M. M., Weissfeld, J., Roberts, M. S.
(2008). Anxiety, Fear of Cancer, and Perceived Risk of Cancer following Lung Cancer Screening. Med Decis Making
28: 917-925
[Abstract]
Wilson, D. O., Weissfeld, J. L., Fuhrman, C. R., Fisher, S. N., Balogh, P., Landreneau, R. J., Luketich, J. D., Siegfried, J. M.
(2008). The Pittsburgh Lung Screening Study (PLuSS): Outcomes within 3 Years of a First Computed Tomography Scan. Am. J. Respir. Crit. Care Med.
178: 956-961
[Abstract][Full Text]
Chin, L. J., Ratner, E., Leng, S., Zhai, R., Nallur, S., Babar, I., Muller, R.-U., Straka, E., Su, L., Burki, E. A., Crowell, R. E., Patel, R., Kulkarni, T., Homer, R., Zelterman, D., Kidd, K. K., Zhu, Y., Christiani, D. C., Belinsky, S. A., Slack, F. J., Weidhaas, J. B.
(2008). A SNP in a let-7 microRNA Complementary Site in the KRAS 3' Untranslated Region Increases Non-Small Cell Lung Cancer Risk. Cancer Res.
68: 8535-8540
[Abstract][Full Text]
Pelosi, G., Rosai, J.
(2008). Invited Commentary. Ann. Thorac. Surg.
86: 1090-1091
[Full Text]
Titulaer, M. J., Wirtz, P. W., Willems, L. N.A., van Kralingen, K. W., Smitt, P. A.E. S., Verschuuren, J. J.G.M.
(2008). Screening for Small-Cell Lung Cancer: A Follow-Up Study of Patients With Lambert-Eaton Myasthenic Syndrome. JCO
26: 4276-4281
[Abstract][Full Text]
Grogan, E. L., Stukenborg, G. J., Nagji, A. S., Simmons, W., Kozower, B. D., Jones, D. R., Daniel, T. M.
(2008). Radiotracer-Guided Thoracoscopic Resection is a Cost-Effective Technique for the Evaluation of Subcentimeter Pulmonary Nodules. Ann. Thorac. Surg.
86: 934-940
[Abstract][Full Text]
Veronesi, G., Bellomi, M., Scanagatta, P., Preda, L., Rampinelli, C., Guarize, J., Pelosi, G., Maisonneuve, P., Leo, F., Solli, P., Masullo, M., Spaggiari, L.
(2008). Difficulties encountered managing nodules detected during a computed tomography lung cancer screening program. J. Thorac. Cardiovasc. Surg.
136: 611-617
[Abstract][Full Text]
Berrington de Gonzalez, A., Kim, K. P., Berg, C. D
(2008). Low-dose lung computed tomography screening before age 55: estimates of the mortality reduction required to outweigh the radiation-induced cancer risk. J Med Screen
15: 153-158
[Abstract][Full Text]
Grgic, A., Wilkens, H., Kubale, R., Groschel, A., Buecker, A., Sybrecht, G. W.
(2008). Low-Dose MDCT for Surveillance of Patients with Severe Homogeneous Emphysema After Bronchoscopic Airway Bypass. Am. J. Roentgenol.
191: W112-W119
[Abstract][Full Text]
Soubani, A O
(2008). The evaluation and management of the solitary pulmonary nodule. Postgrad. Med. J.
84: 459-466
[Abstract][Full Text]
Bach, P. B.
(2008). Untreated Patients in "CT Screening for Lung Cancer: Update 2007". The Oncologist
13: 1030-1032
[Full Text]
Henschke, C. I.
(2008). Clarifying Enrollment Procedures in the Trial of CT Screening for Lung Cancer. NEJM
359: 871-873
[Full Text]
Russo, P., Paleari, L., Granone, P., Cesario, A., Pastorino, U.
(2008). Computed Tomography Screening for Lung Cancer in a High-Risk Population: Update on Current Status. JNCI J Natl Cancer Inst
100: 1043-1044
[Full Text]
McMahon, P. M., Kong, C. Y., Johnson, B. E., Weinstein, M. C., Weeks, J. C., Kuntz, K. M., Shepard, J.-A. O., Swensen, S. J., Gazelle, G. S.
(2008). Estimating Long-term Effectiveness of Lung Cancer Screening in the Mayo CT Screening Study. Radiology
248: 278-287
[Abstract][Full Text]
Burger, I. M., Kass, N. E., Sunshine, J. H., Siegelman, S. S.
(2008). The Use of CT for Screening: A National Survey of Radiologists' Activities and Attitudes. Radiology
248: 160-168
[Abstract][Full Text]
Watson, P. M., Miller, S. W., Fraig, M., Cole, D. J., Watson, D. K., Boylan, A. M.
(2008). CaSm (LSm-1) Overexpression in Lung Cancer and Mesothelioma Is Required for Transformed Phenotypes. Am. J. Respir. Cell Mol. Bio.
38: 671-678
[Abstract][Full Text]
Paleari, L, Cesario, A, Granone, P, D'Angelillo, R M., Russo, P
(2008). Early detection of cancer: lessons from lung cancer CT screening. Thorax
63: 566-566
[Full Text]
LAUTIN, E M, NOVICK, M K, JEAN-BAPTISTE, R
(2008). Tailored CT: primum non nocere. Br. J. Radiol.
81: 442-443
[Abstract][Full Text]
Washko, G. R., Hoffman, E., Reilly, J. J.
(2008). Radiographic Evaluation of the Potential Lung Volume Reduction Surgery Candidate. Proc Am Thorac Soc
5: 421-426
[Abstract][Full Text]
Dubey, S., Powell, C. A.
(2008). Update in Lung Cancer 2007. Am. J. Respir. Crit. Care Med.
177: 941-946
[Full Text]
HALL, E J, BRENNER, D J
(2008). Cancer risks from diagnostic radiology. Br. J. Radiol.
81: 362-378
[Abstract][Full Text]
Smith, R. A., Cokkinides, V., Brawley, O. W.
(2008). Cancer Screening in the United States, 2008: A Review of Current American Cancer Society Guidelines and Cancer Screening Issues. CA Cancer J Clin
58: 161-179
[Abstract][Full Text]
Molina, J. R., Yang, P., Cassivi, S. D., Schild, S. E., Adjei, A. A.
(2008). Non-Small Cell Lung Cancer: Epidemiology, Risk Factors, Treatment, and Survivorship. Mayo Clin Proc.
83: 584-594
[Abstract][Full Text]
Moy, B.
(2008). Medical Integrity Up in Smoke? Conflicts of Interest and the Lung Cancer Screening Controversy. The Oncologist
13: 474-476
[Full Text]
Bach, P. B.
(2008). Response to "CT screening for lung cancer: update 2007".. The Oncologist
13: 608-609
[Full Text]
Henschke, C. I., Yankelevitz, D. F.
(2008). In Reply. The Oncologist
13: 610-612
[Full Text]
Henschke, C.
(2008). Clarification of Funding of Early Lung Cancer Study. NEJM
358: 1862-1862
[Full Text]
Schwartz, R. S., Curfman, G. D., Morrissey, S., Drazen, J. M.
(2008). Full Disclosure and the Funding of Biomedical Research. NEJM
358: 1850-1851
[Full Text]
Bach, P.
(2008). Computed Tomography Screening for Lung Cancer. Clin. Cancer Res.
14: 2511-2511
[Full Text]
Silvestri, G. A.
(2008). Deaths among Patients with Screen-Detected Lung Cancer. Clin. Cancer Res.
14: 2511-2511
[Full Text]
Henschke, C. I.
(2008). Reply to the Letters to the Editor from Bach and Silvestri. Clin. Cancer Res.
14: 2511-2511
[Full Text]
Kozower, B. D., Meyers, B. F., Reed, C. E., Jones, D. R., Decker, P. A., Putnam, J. B. Jr
(2008). Does Positron Emission Tomography Prevent Nontherapeutic Pulmonary Resections for Clinical Stage IA Lung Cancer?. Ann. Thorac. Surg.
85: 1166-1170
[Abstract][Full Text]
Grannis, F. W. Jr, Alberts, W. M., Addrizzo-Harris, D.
(2008). There Are Major Problems With the American College of Chest Physicians Second Lung Cancer Guidelines. Chest
133: 1049-1051
[Full Text]
Bach, P. B
(2008). Overdiagnosis in lung cancer: different perspectives, definitions, implications. Thorax
63: 298-300
[Full Text]
Wu, M.-T., Yang, P., Huang, Y.-L., Chen, J.-S., Chuo, C.-C., Yeh, C., Chang, R.-S.
(2008). Coronary Arterial Calcification on Low-Dose Ungated MDCT for Lung Cancer Screening: Concordance Study with Dedicated Cardiac CT. Am. J. Roentgenol.
190: 923-928
[Abstract][Full Text]
Mulshine, J. L.
(2008). Commentary: Lung Cancer Screening--Progress or Peril. The Oncologist
13: 435-438
[Full Text]
Jett, J. R., Midthun, D. E.
(2008). Commentary: CT Screening for Lung Cancer--Caveat Emptor. The Oncologist
13: 439-444
[Full Text]
Meguid, R. A., Brooke, B. S., Chang, D. C., Sherwood, J. T., Brock, M. V., Yang, S. C.
(2008). Are Surgical Outcomes for Lung Cancer Resections Improved at Teaching Hospitals?. Ann. Thorac. Surg.
85: 1015-1025
[Abstract][Full Text]
Ravenel, J. G., Costello, P., Silvestri, G. A.
(2008). Screening for Lung Cancer. Am. J. Roentgenol.
190: 755-761
[Abstract][Full Text]
Slatore, C. G., Littman, A. J., Au, D. H., Satia, J. A., White, E.
(2008). Long-Term Use of Supplemental Multivitamins, Vitamin C, Vitamin E, and Folate Does Not Reduce the Risk of Lung Cancer. Am. J. Respir. Crit. Care Med.
177: 524-530
[Abstract][Full Text]
Wilck, E. J.
(2008). Computed Tomography Screening for Lung Cancer. Ann. Thorac. Surg.
85: S699-S700
[Full Text]
Grogan, E. L., Jones, D. R., Kozower, B. D., Simmons, W. D., Daniel, T. M.
(2008). Identification of Small Lung Nodules: Technique of Radiotracer-Guided Thoracoscopic Biopsy. Ann. Thorac. Surg.
85: S772-S777
[Abstract][Full Text]
Jonsson, S., Varella-Garcia, M., Miller, Y. E., Wolf, H. J., Byers, T., Braudrick, S., Kiatsimkul, P., Lewis, M., Kennedy, T. C., Keith, R. L., Bjornsson, J., McWilliams, A., Lam, S., Hirsch, F. R., Franklin, W. A.
(2008). Chromosomal Aneusomy in Bronchial High-Grade Lesions Is Associated with Invasive Lung Cancer. Am. J. Respir. Crit. Care Med.
177: 342-347
[Abstract][Full Text]
Byers, T., Wolf, H. J., Franklin, W. A., Braudrick, S., Merrick, D. T., Shroyer, K. R., Hirsch, F. R., Zeng, C., Baron, A. E., Bunn, P. A., Miller, Y. E., Kennedy, T. C.
(2008). Sputum Cytologic Atypia Predicts Incident Lung Cancer: Defining Latency and Histologic Specificity. Cancer Epidemiol. Biomarkers Prev.
17: 158-162
[Abstract][Full Text]
Stearman, R. S., Dwyer-Nield, L., Grady, M. C., Malkinson, A. M., Geraci, M. W.
(2008). A Macrophage Gene Expression Signature Defines a Field Effect in the Lung Tumor Microenvironment. Cancer Res.
68: 34-43
[Abstract][Full Text]
Lee, P, Sutedja, T G
(2008). Population screening for lung cancer using CT. Thorax
63: 87-87
[Full Text]
Henschke, C. I., Yankelevitz, D. F.
(2008). CT Screening for Lung Cancer: Update 2007. The Oncologist
13: 65-78
[Abstract][Full Text]
Linos, E., Linos, E., Colditz, G.
(2007). Screening programme evaluation applied to airport security. BMJ
335: 1290-1292
[Full Text]
Schnoll, R. A., Wileyto, E. P., Hornik, R., Schiller, J., Lerman, C.
(2007). Spiral Computed Tomography and Lung Cancer: Science, the Media, and Public Opinion. JCO
25: 5695-5697
[Full Text]
Barr, R. G., Mesia-Vela, S., Austin, J. H. M., Basner, R. C., Keller, B. M., Reeves, A. P., Shimbo, D., Stevenson, L.
(2007). Impaired Flow-mediated Dilation Is Associated with Low Pulmonary Function and Emphysema in Ex-smokers: The Emphysema and Cancer Action Project (EMCAP) Study. Am. J. Respir. Crit. Care Med.
176: 1200-1207
[Abstract][Full Text]
Patz, E. F. Jr, Campa, M. J., Gottlin, E. B., Kusmartseva, I., Guan, X. R., Herndon, J. E. II
(2007). Panel of Serum Biomarkers for the Diagnosis of Lung Cancer. JCO
25: 5578-5583
[Abstract][Full Text]
Schnipper, L. E.
(2007). Update in Oncology. ANN INTERN MED
147: 775-782
[Full Text]
de Torres, J. P., Bastarrika, G., Wisnivesky, J. P., Alcaide, A. B., Campo, A., Seijo, L. M., Pueyo, J. C., Villanueva, A., Lozano, M. D., Montes, U., Montuenga, L., Zulueta, J. J.
(2007). Assessing the Relationship Between Lung Cancer Risk and Emphysema Detected on Low-Dose CT of the Chest. Chest
132: 1932-1938
[Abstract][Full Text]
Paleari, L., Granone, P., Grozio, A., Cesario, A., Russo, P.
(2007). Commentary: Early Diagnosis of Lung Cancer: Where Do We Stand?. The Oncologist
12: 1433-1436
[Full Text]
Brenner, D. J., Hall, E. J.
(2007). Computed Tomography -- An Increasing Source of Radiation Exposure. NEJM
357: 2277-2284
[Full Text]
Welch, H. G., Woloshin, S., Schwartz, L. M., Gordis, L., Gotzsche, P. C., Harris, R., Kramer, B. S., Ransohoff, D. F.
(2007). Overstating the Evidence for Lung Cancer Screening: The International Early Lung Cancer Action Program (I-ELCAP) Study. Arch Intern Med
167: 2289-2295
[Abstract][Full Text]
International Early Lung Cancer Action Program Inv,
(2007). Computed tomographic screening for lung cancer: individualising the benefit of the screening. Eur Respir J
30: 843-847
[Abstract][Full Text]
Sedjo, R. L., Byers, T., Barrera, E. Jr., Cohen, C., Fontham, E. T. H., Newman, L. A., Runowicz, C. D., Thorson, A. G., Thun, M. J., Ward, E., Wender, R. C., Eyre, H. J., for the ACS Cancer Incidence & Mortality Ends Comm,
(2007). A Midpoint Assessment of the American Cancer Society Challenge Goal to Decrease Cancer Incidence by 25% Between 1992 and 2015. CA Cancer J Clin
57: 326-340
[Abstract][Full Text]
Lee, K. W., Kim, M., Gierada, D. S., Bae, K. T.
(2007). Performance of a Computer-Aided Program for Automated Matching of Metastatic Pulmonary Nodules Detected on Follow-Up Chest CT. Am. J. Roentgenol.
189: 1077-1081
[Abstract][Full Text]
Greenberg, A. K., Rimal, B., Felner, K., Zafar, S., Hung, J., Eylers, E., Phalan, B., Zhang, M., Goldberg, J. D., Crawford, B., Rom, W. N., Naidich, D., Merali, S.
(2007). S-Adenosylmethionine as a Biomarker for the Early Detection of Lung Cancer. Chest
132: 1247-1252
[Abstract][Full Text]
A correction has been published: N Engl J Med 2008;358(17):1862.
Previous
