The philadelphia pulmonary neoplasm research project. Thwarting factors in periodic screening for lung cancer.
This report describes the problems of the Philadelphia Pulmonary Neoplasms Research Project, begun in 1951, when 6,027 male volunteers 45 years of age and older were enrolled in a study designed to screen them every 6 months for 10 years with questionnaires and chest photofluorograms. These volunteers tended to be slightly younger and to include fewer nonwhites that the corresponding Philadelphia population. The volunteers included more smokers than older American urban men in general, but among smokers the distribution by smoking habits was similar. The average probability of having 2 consecutive semiannual screening examinations was 57 per cent. The risk of lung cancer was higher among noncompliant men than among compliant ones. During the 10-year period of observation, 121 men developed lung cancer; only 8 per cent survived 5 years. Aside from the screening method, the factors that thwarted early detection and surgery among the men with lung cancer were (1) the interval between a negative roentgenogram and detection of cancer, which exceeded 6 months in 45 per cent; (2) an interval of 6 months or less between a negative roentgenogram and detection of cancer in 20 per cent, with a delay of 3 months or more before appropriate action was taken; (3) advanced age (70+ years) in 25 per cent at the time of detection of cancer; (4) nonmalignant disease contraindicating surgery in 31 per cent. One or more of these factors was present in 84 per cent of the men with lung cancer, leaving only a small segment for whom improvements in the screening method would be expected to be of value.
D000367:Age Factors; D006801:Humans; D008170:Lung Compliance; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010414:Pennsylvania; D011336:Probability; D011379:Prognosis; D044469:Racial Groups; D011859:Radiography; D012106:Research; D012907:Smoking / Q000150:complications; D011795:Surveys and Questionnaires; D013997:Time Factors; D044465:White People