Lung cancer screening trial compares CT and standard x-ray

September 18, 2002

Emory University has been awarded a $5 million grant to participate in a multi-institutional investigation to study the best way to detect lung cancer in smokers, with an end goal of saving more lives following diagnosis of the disease. The National Lung Screening Trial (NLST) will compare two methods of detecting lung cancer in healthy older individuals: computed tomography (CT) and standard chest X-ray.

"Both CT scans and chest X-rays are now used to detect lung cancer," says Kay Vydareny, M.D., professor of radiology, Emory University School of Medicine and principal investigator of the NLST at Emory. "In fact, chest X-rays have been the primary means of lung cancer diagnosis for more than 100 years. Through past data, we now know that CT scans can pick up smaller nodules than X-rays, some of which will be cancer. But what we don't know is if detecting these smaller cancers early will help us decrease lung cancer deaths. This trial will help us learn whether CT scans or chest X-rays are better at reducing lung cancer deaths."

Funded by the National Cancer Institute and the American College of Radiology Imaging Network (ACRIN), this study will enroll 50,000 current or former smokers across the U.S. over a period of eight years. ACRIN will directly fund Emory's trial, which will enroll 1,500 participants. Those participants will be randomly selected to receive either CT scans or X-rays to screen for lung cancer. Screening will take place once a year for three years. Participants will then be followed for five years after the screenings end to monitor their health. The follow-up period will help to determine the long-term benefits of these two detection methods.

For years, cigarette smoking has been considered a major cause of lung cancer. Lung cancer is the leading cause of cancer deaths among both men and women, according to the American Cancer Society. In 2002, an estimated 154,900 people will die from lung cancer, accounting for 28 percent of all cancer deaths. More people die of lung cancer than of colon, breast and prostate cancers combined.

Lung cancer is one of the most difficult cancers to treat. When it is in the earliest, most treatable stage, it is very hard to detect. CT scans can pick up tumors under one centimeter in size, while chest X-rays can detect most tumors larger than one centimeter (about 1/2 inch) in size. One would assume that smaller tumors and more rapid detection would result in a better chance of survival. But smaller cancers are not necessarily "early" cancers and no scientific studies have shown that screening or early detection of lung cancer can actually save lives. Now, the NLST should be able to provide answers needed to determine whether CT scans or standard chest X-rays are better at reducing a person's chances of dying from lung cancer.

There are some risks with using CT scans, however. The scans can sometimes detect suspicious abnormalities which do not turn out to be lung cancer - known as false positives. Many of these abnormalities are scars from smoking, areas of inflammation or other noncancerous conditions that may require additional testing to determine that they are not harmful. These tests have been known to cause undue anxiety for patients and may sometimes lead to biopsies or surgeries.

"Still, in some screening cases, true cancers have been detected, many of which are in an early stage," Dr. Vydareny says. "If there are positive findings, we will contact participants and their primary care physicians and encourage a consultation with a cancer specialist so that there can be appropriate follow-up."

A diagnostic radiologist at Emory for 11 years, Dr. Vydareny specializes in cardiopulmonary radiology in the Division of Thoracic Imaging.
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Recruitment for the NLST will begin soon. Current or former smokers who are between the ages of 55-74 may be eligible for this research study. Participants cannot have had any previous history of lung cancer, but patients with emphysema, bronchitis or other smoking-related conditions will be accepted. For more information or to find out if you qualify for this study, please contact Emory Health Connection at (404) 778-7777 or the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Media Contacts: Janet Christenbury, 404/727-8599, jmchris@emory.edu
Kathi Ovnic Baker, 404/727-9371, kobaker@emory.edu

Emory University Health Sciences Center

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