title: How have we diagnosed early-stage lung cancer without radiographic screening? A contemporary single-center experience.
abstract: BACKGROUND
  The National Lung Screening Trial (NLST), which demonstrated a reduction in lung cancer mortality, may result in widespread computed tomography (CT)-based screening of select populations. How early-stage lung cancer has been diagnosed without screening, and what proportion of these cases would be captured by a screening program modeled on the NLST, is not currently known. We therefore evaluated current patterns of early-stage lung cancer presentation.
  
  
  RESULTS
  We performed a single-institution retrospective analysis of patients diagnosed with stage I-II non-small cell lung cancer (NSCLC) from 2000-2009. Associations between patient and imaging characteristics were assessed using univariate and multivariate analyses. A total of 412 patients met criteria for analysis. Among those with available reason for initial imaging, the reason was symptoms in 51%, follow-up of other conditions in 43%, and screening in 6%. Reason for imaging was associated with race (P<0.001), insurance type (P=0.005), and disease stage (P<0.001). Type of initial imaging was associated with reason for imaging (P<0.001), year (chest x-ray 67% in 2000-2004 vs. 49% in 2005-2009; P<0.001), and disease stage (P = 0.005). Among patients with available quantified smoking history, 48% were age 55-74 years and smoked 30-plus pack-years, therefore meeting NLST entry criteria.
  
  
  CONCLUSIONS
  Symptoms remain a dominant but declining reason for detection of early-stage NSCLC. The proportion of cases detected initially by CT scan without antecedent chest x-ray has increased considerably. Because as few as half of cases meet NLST eligibility criteria, clinicians should remain aware of the diverse circumstances of early-stage lung cancer presentation to expedite therapy.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Evelyn O
authors.initials: EO
authors.lastname: Taiwo
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Yorio
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Yan
authors.forename: David E
authors.initials: DE
authors.lastname: Gerber
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies