Screening for lung cancer in a high-risk group: but I still haven't found what I'm looking for

Our plain-English summary of Screening for lung cancer in a high-risk group: but I still haven't found what I'm looking for, by G.A. Silvestri (The European Respiratory Journal, 2007).

The study

• Author: G.A. Silvestri
• Journal: The European Respiratory Journal
• Published: 2007;29(1):6-7
• Type of article: Comment, Editorial
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial discussed whether lung cancer screening with low-dose computed tomography (CT) was justified. It was prompted by a study in the same journal issue by Vierikko et al., who used CT to screen asbestos-exposed workers. The author reviewed the background. Randomised trials of chest radiography screening in the 1970s and 1980s detected more early-stage cancers but did not reduce lung cancer mortality, possibly because of lead, length and overdiagnosis bias. The International Early Lung Cancer Action Project had reported an estimated 88–92% 10-year survival in 412 resected stage I patients whose cancers were found by screening. However, mortality modelling studies did not appear favourable, and cost-effectiveness estimates had varied widely. The author stated that individual lung cancer risk is affected by age, smoking history, sex, airflow obstruction and asbestos exposure, so screening an "ultra high-risk" group might improve results. In the Vierikko study of asbestos-exposed persons, some of whom smoked, benign nodules (14%) far outnumbered malignant ones (0.8%). Four patients had unnecessary thoracotomies, and 44% had incidental findings. The author found it surprising that more cancers were not detected. There was no statistical difference in age, asbestos exposure or smoking history between the five subjects with cancer and the rest of the group. The author concluded that many questions would remain unanswered until results of the randomised CT screening trials were available.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was an editorial, an opinion piece, and reported no new data of its own. The author discussed screening for lung cancer with low-dose computed tomography (CT) and noted that a person's lung cancer risk is affected by age, smoking history, sex, airflow obstruction and asbestos exposure. The editorial commented on a separate study by Vierikko and colleagues, published in the same journal issue, which screened asbestos-exposed persons, some of whom also smoked. As the author described that study, screening this high-risk group did not find more cancers. Benign nodules (14%) far outnumbered malignant ones (0.8%). Four patients had unnecessary thoracotomies (chest operations), and an additional 44% of those screened had incidental findings. The author noted that smoking history in that group was lower than in other screening studies. The author also noted that the five people diagnosed with cancer showed no statistical difference from the rest of the group in age, asbestos exposure or smoking history. The author concluded that many questions remained unanswered and that results of randomised screening trials were still awaited.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: editorial (commentary; no original data)
• Who was studied: No study population of its own. The editorial commented on a CT screening study by Vierikko et al. of asbestos-exposed persons, a subset of whom were smokers.
• Exposure: Asbestos exposure, in some persons combined with smoking, discussed in the context of low-dose CT screening for lung cancer. No fiber types were named.
• Main results:
  • The author stated that individual lung cancer risk is affected by age, smoking history, sex, airflow obstruction and asbestos exposure (citing other work).
  • As described by the author, in the Vierikko et al. screening of asbestos-exposed persons, benign nodules (14%) far outnumbered malignant ones.
  • As described by the author, malignant nodules made up 0.8% in the Vierikko et al. screened group.
  • As described by the author, four patients in the Vierikko et al. study had unnecessary thoracotomies.
  • As described by the author, an additional 44% of those screened in the Vierikko et al. study had incidental findings, some needing further evaluation.
  • The author noted that pack-year smoking history in the Vierikko et al. population was lower than in other screening studies.
  • As described by the author, there was no statistical difference between the five subjects diagnosed with cancers and the rest of the screened group in age, asbestos exposure and smoking history.
• The authors' conclusion: The author concluded that many questions about lung cancer screening remained unanswered, pending the results of randomised screening trials.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Low-Dose CT Screening, Obstructive Lung Disease, Asbestos Exposure.

Related studies

• Yield of Low-Dose Computerized Tomography Screening for Lung Cancer in High-Risk Workers: The Case of 7189 US Nuclear Weapons Workers — S.B. Markowitz, A. Manowitz, et al. (2018)
• Lung cancer risk in past asbestos workers a few decades after exposure cessation and prospects for screening — G. Mastrangelo, G. Marangi, et al. (2016)
• Factors determining early adherence to a lung cancer screening protocol — U. Montes, L.M. Seijo, et al. (2007)
• CT scan screening for lung cancer: risk factors for nodules and malignancy in a high-risk urban cohort — A.K. Greenberg, F. Lu, et al. (2012)
• Strategies in lung cancer detection. Achieving early identification in patients at high risk — J.J. Bechtel, T.L. Petty (2003)
• Medical screening for lung cancer: perspective and strategy — K.H. Kilburn (1986)

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