Early lung cancer action project: a summary of the findings on baseline screening.
OBJECTIVE
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 persons at high-risk for lung cancer.


METHODS
Since starting in 1993, the ELCAP has enrolled 1,000 asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term high-resolution CT follow-up for the smallest nodules. Baseline


RESULTS
On low-dose CT at baseline compared to chest radiography, NCN were detected three times as commonly (23% versus 7%), malignancies four times as commonly (2.7% versus 0.7%), and stage I malignancies six times as commonly (2.3% versus 0.4%). Of the 27 CT-detected cancers, 96% (26/27) were resectable; 85% (23/27) were stage I, and 83% (19 of the 23 stage I) were not seen on chest radiography. Following the ELCAP recommendations, biopsies were performed on 28 of the 233 subjects with NCN; 27 had a malignant and one a benign NCN. Another three individuals underwent biopsy outside of the ELCAP recommendations; all had benign NCNS: No one had thoracotomy for a benign nodule.


CONCLUSIONS
Baseline CT screening for lung cancer provides for detecting the disease at earlier and presumably more commonly curable stages in a cost-effective manner.
Henschke
C I
CI
Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA.
McCauley
D I
DI
Yankelevitz
D F
DF
Naidich
D P
DP
McGuinness
G
G
Miettinen
O S
OS
Libby
D
D
Pasmantier
M
M
Koizumi
J
J
Altorki
N
N
Smith
J P
JP
D002986:Clinical Trials as Topic; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008403:Mass Screening; D009367:Neoplasm Staging; D015995:Prevalence; D013902:Radiography, Thoracic; D012107:Research Design; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed