Early Lung Cancer Action Project: overall design and findings from baseline screening.
BACKGROUND
The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience.


METHODS
ELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack-years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules.


RESULTS
Non-calcified nodules were detected in 233 (23% [95% CI 21-26]) participants by low-dose CT at baseline, compared with 68 (7% [5-9]) by chest radiography. Malignant disease was detected in 27 (2.7% [1.8-3.8]) by CT and seven (0.7% [0.3-1.3]) by chest radiography, and stage I malignant disease in 23 (2.3% [1.5-3.3]) and four (0.4% [0.1-0.9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant non-calcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule.


CONCLUSIONS
Low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common, they can be managed with little use of invasive diagnostic procedures.
Weill Medical College of Cornell University and New York Presbyterian Hospital, NY 10021, USA. chensch@mail.med.cornell.edu
C I
CI
Henschke
D I
DI
McCauley
D F
DF
Yankelevitz
D P
DP
Naidich
G
G
McGuinness
O S
OS
Miettinen
D M
DM
Libby
M W
MW
Pasmantier
J
J
Koizumi
N K
NK
Altorki
J P
JP
Smith
D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods