ALEXANDRIA, Va. - Following is a statement for attribution from Bruce Johnson, MD, a Board Member of the American Society of Clinical Oncology (ASCO), and lung cancer expert with the Dana-Farber Cancer Institute, on The New England Journal of Medicine’s publication of the results of the National Lung Screening Trial (NLST). The NLST was sponsored by the National Cancer Institute (NCI) and conducted by the Lung Screening Study group and the American College of Radiology Imaging Network (ACRIN) at 33 trial sites nationwide.
This randomized national trial involved more than 53,000 current and former heavy smokers ages 55-74 randomly assigned to receive three annual screens with either a low-dose helical computed tomogram (LDCT) or a posteroanterior (PA) projection chest x-ray (CXR). These results (released in preliminary form in November of 2010), showed a relative reduction of 20 percent fewer lung cancer deaths among trial participants screened with LDCT than with a CXR. Since the 2002 launch of the NLST, a total of 356 deaths from lung cancer had occurred among participants in the LDCT arm of the study versus 443 in the CXR group.
“This is a very exciting and important result, with a reduction in deaths that could be as high as 20 percent. Lung cancer is by far the leading cancer killer in the United States, with more than 157,000 deaths annually. One of our greatest challenges has been catching it early enough to treat it effectively. This study fills a huge gap in lung cancer control and ASCO is currently examining the most appropriate method for implementing its findings.
“But we must remember that screening is not a substitute for quitting smoking. The overwhelming majority of lung cancer is caused by smoking, and smoking cessation will always have a far greater impact on lung cancer deaths than any screening tool. For Americans who wish to prevent deaths from cancer, respiratory illness or heart disease, the first step is to quit smoking.
“The tens of millions of smokers and former smokers in the United States will have many questions about the risks and benefits of CT scans. ASCO is developing a clinical practice guideline on lung cancer screening with the National Comprehensive Cancer Network, American Cancer Society and the American College of Chest Physicians, which will be published in the coming months. The guideline will be updated as the results of other ongoing randomized lung cancer screening trials around the world are reported. We also look forward to recommendations from the U.S. Preventive Services Task Force on implementing lung cancer screening. As with any screening tool, the benefits can be fully realized when the technology is accompanied by guidelines for appropriate use and follow-up, quality control, and insurance payment.
“ASCO congratulates the NCI for the conception, implementation and completion of this randomized large-scale, long-term screening trial. This is an example of clinical research at its best."
The American Society of Clinical Oncology (ASCO) is the world’s leading professional organization representing physicians who care for people with cancer. With more than 30,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. Patient-oriented cancer information is available at www.Cancer.Net.