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Mimae T, Okada M. Asian Perspective on Lung Cancer Screening. Thorac Surg Clin 2023; 33:385-400. [PMID: 37806741 DOI: 10.1016/j.thorsurg.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in Japan and worldwide. Early detection of lung cancer is an important strategy for decreasing mortality. Advances in diagnostic imaging have made it possible to detect lung cancer at an early stage in medical practice. Conversely, screening of asymptomatic healthy populations is recommended only when the evidence shows the benefits of regular intervention. Due to a variety of evidence and racial differences, screening methods vary from country to country. This article focused on the perspective of lung cancer screening in Japan.
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Affiliation(s)
- Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Ağababaoğlu İ, Önen A, Demir AB, Aktaş S, Altun Z, Ersöz H, Şanlı A, Özdemir N, Akkoçlu A. Chaperonin (HSP60) and annexin-2 are candidate biomarkers for non-small cell lung carcinoma. Medicine (Baltimore) 2017; 96:e5903. [PMID: 28178129 PMCID: PMC5312986 DOI: 10.1097/md.0000000000005903] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lung cancer is responsible of 12.4% and 17.6% of all newly diagnosed cancer cases and mortality due to cancer, respectively, and 5-year survival rate despite all improved treatment options is 15%. This survival rate reaches 66% in the Stage 1 and surgically treated patients. Early diagnosis which could not be definitely and commonly achieved yet is extremely critical in obtaining high survival rate in this disease. For this reason; proteomic differences were evaluated using matrix assisted laser desorption ionization (MALDI) mass spectrometry in the subgroups of lung adenocarcinoma and squamous cell carcinoma. METHODS Fresh tissue samples of 36 malignant cases involving 83.3% (n = 30) men and 16.7% (n = 6) women patients were distributed into 2 groups as early and end stage lung cancer and each group were composed of subgroups including 18 squamous cell carcinoma (9 early stage cases, 9 end stage cases) and 18 adenocarcinoma cases (9 early stage cases, 9 end stage cases). The fresh tissues obtained from the tumoral and matched normal sites after surgical intervention. The differences in protein expression levels were determined by comparing proteomic changes in each patient. RESULTS In the subgroups of advanced stage adenocarcinoma; tumoral tissue revealed differences in expression of 2 proteins compared with normal parenchymal tissue. Of those; difference in protein expression in heat shock protein 60 (HSP60) was found statistically significant (P = 0.0001). Subgroups of early and advanced stage squamos cell carcinoma have differed in certain 20 protein expression of normal tissue and diseased squamos cell carcinoma. Of those, increased protein expression level of only annexin-2 protein was found statistically significant (P = 0.002). No significant difference was detected in early and advanced stage protein expressions of the tumoral tissues in the subgroups of adenocarcinoma and squamous cell carcinoma. CONCLUSIONS We conclude that with respect to early diagnosis of lung cancer that HSP60 and annexin-2 proteins are the important biomarkers in the subgroups of adenocarcinoma and squamous cell carcinoma. We also consider that these 2 proteins are molecules which may provide critical contribution in evaluation of prognosis, metastatic potential, response to treatment, and in establishment of differential diagnosis between adenocarcinoma and squamous cell carcinoma.
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Affiliation(s)
| | - Ahmet Önen
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Ayşe Banu Demir
- Department of Medical Biology, Izmir University of Economics Faculty of Medicine
| | - Safiye Aktaş
- Department of Basic Oncology, Dokuz Eylül University Institute of Oncology
| | - Zekiye Altun
- Department of Basic Oncology, Dokuz Eylül University Institute of Oncology
| | - Hasan Ersöz
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Aydın Şanlı
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Nezih Özdemir
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Atila Akkoçlu
- Department of Chest Diseases, Dokuz Eylül University Medicine School, İzmir, Turkey
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Sato A, Hamada S, Urashima Y, Tanaka S, Okamoto H, Kawakami K. The Effect of False-Positive Results on Subsequent Participation in Chest X-ray Screening for Lung Cancer. J Epidemiol 2016; 26:646-653. [PMID: 27374136 PMCID: PMC5121433 DOI: 10.2188/jea.je20150106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND High attendance rates and regular participation in disease screening programs are important contributors to program effectiveness. The objective of this study was to examine the effects of an initial false-positive result in chest X-ray screening for lung cancer on subsequent screening participation. METHODS This historical cohort study analyzed individuals who first participated in a lung cancer screening program conducted by Yokohama City between April 2007 and March 2011, and these participants were retrospectively tracked until March 2013. Subsequent screening participation was compared between participants with false-positive results and those with negative results in evaluation periods between 365 (for the primary outcome) and 730 days. The association of screening results with subsequent participation was evaluated using a generalized linear regression model, with adjustment for characteristics of patients and screening. RESULTS The proportions of subsequent screening participation within 365 days were 12.9% in 3132 participants with false-positive results and 6.7% in 15 737 participants with negative results. Although the differences in attendance rates were reduced with longer cutoffs, participants with false-positive results were consistently more likely to attend subsequent screening than patients with negative results (P < 0.01). The predictors of subsequent screening participation were false-positive results (risk ratio [RR] 1.72; 95% confidence interval [CI], 1.54-1.92), older age (RR 1.17; 95% CI, 1.11-1.23), male sex (RR 1.46; 95% CI, 1.29-1.64), being a current smoker (RR 0.80; 95% CI, 0.69-0.93), current employment (RR 0.79; 95% CI, 0.70-0.90), and being screened at a hospital cancer center (vs public health centers; RR 1.36; 95% CI, 1.15-1.60). CONCLUSIONS Our findings indicated that subsequent participation in lung cancer screening was more likely among participants with false-positive results in an initial screening than patients with negative results.
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Affiliation(s)
- Akira Sato
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
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Chen Q, Yu L, Hao C, Wang J, Liu S, Zhang M, Zhang S, Guo L, Quan P, Germain P, Zhang Y, Sun X. Effectiveness evaluation of organized screening for esophageal cancer: a case-control study in Linzhou city, China. Sci Rep 2016; 6:35707. [PMID: 27759094 PMCID: PMC5069626 DOI: 10.1038/srep35707] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/03/2016] [Indexed: 12/27/2022] Open
Abstract
In China, esophageal cancer has remained a large burden, and endoscopic screening is expected to reduce esophageal cancer mortality. Therefore, a population-based case-control study was conducted to evaluate the effect of screening. Cases were defined as individuals who had died of esophageal cancer, and controls were residents from the same area (three per case) who had not died of esophageal cancer, matched by gender and birth year. The exposure status (whether cases and controls had ever attended the screening or not) was acquired by inspecting the well documented screening records. A conditional logistic regression model was used to estimate the odds ratios (OR) and their 95% confidence intervals (95% CI). There were 253 cases and 759 controls. The reduction in risk of esophageal cancer mortality in individuals who had ever attended screening was 47% (OR: 0.53, 95% CI: 0.37–0.77). Compared with never-screened subjects, the ORs for screened subjects within 36 and 48 months before the reference date were 0.59(0.39–0.89) and 0.59(0.40–0.87); the ORs for 50–59 year old subjects were 0.48(0.28–0.85). The results suggest a 47% reduction in esophageal cancer mortality risk due to endoscopic screening, which may have significant implications for esophageal cancer screening in China, especially in rural areas.
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Affiliation(s)
- Qiong Chen
- Department of Cancer Epidemiology, Henan Cancer Hospital/Institute, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China.,School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Liang Yu
- Linzhou Cancer Registry, Linzhou Cancer Hospital, Linzhou, 456500, China
| | - Changqing Hao
- Linzhou Cancer Registry, Linzhou Cancer Hospital, Linzhou, 456500, China
| | - Jinwu Wang
- Linzhou Cancer Registry, Linzhou Cancer Hospital, Linzhou, 456500, China
| | - Shuzheng Liu
- Department of Cancer Epidemiology, Henan Cancer Hospital/Institute, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Meng Zhang
- Department of Cancer Epidemiology, Henan Cancer Hospital/Institute, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Shaokai Zhang
- Department of Cancer Epidemiology, Henan Cancer Hospital/Institute, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Lanwei Guo
- Department of Cancer Epidemiology, Henan Cancer Hospital/Institute, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Peiliang Quan
- Department of Cancer Epidemiology, Henan Cancer Hospital/Institute, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Patrick Germain
- McGill University, 845 Sherbrooke Street West, Montreal, Quebec, Canada
| | - Yawei Zhang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China.,Department of Surgery, Yale School of Medicine, 60 College Street, New Haven, 06520, USA
| | - Xibin Sun
- Department of Cancer Epidemiology, Henan Cancer Hospital/Institute, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
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Abstract
Lung cancer is the leading cause of cancer mortality in the United States and worldwide. Since lung cancer outcomes are dependent on stage at diagnosis with early disease resulting in longer survival, the goal of screening is to capture lung cancer in its early stages when it can be treated and cured. Multiple studies have evaluated the use of chest X-ray (CXR) with or without sputum cytologic examination for lung cancer screening, but none has demonstrated a mortality benefit. In contrast, the multicenter National Lung Screening Trial (NLST) from the United States found a 20 % reduction in lung cancer mortality following three consecutive screenings with low-dose computed tomography (LDCT) in high-risk current and former smokers. Data from European trials are not yet available. In addition to a mortality benefit, lung cancer screening with LDCT also offers a unique opportunity to promote smoking cessation and abstinence and may lead to the diagnoses of treatable chronic diseases, thus decreasing the overall disease burden. The risks of lung cancer screening include overdiagnosis, radiation exposure, and false-positive results leading to unnecessary testing and possible patient anxiety and distress. However, the reduction in lung cancer mortality is a benefit that outweighs the risks and major health organizations currently recommend lung cancer screening using age, smoking history, and quit time criteria derived from the NLST. Although more research is needed to clearly define and understand the application and utility of lung cancer screening in the general population, current data support that lung cancer screening is effective and should be offered to eligible beneficiaries.
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Endo C, Nakashima R, Taguchi A, Yahata K, Kawahara E, Shimagaki N, Kamio J, Saito Y, Ikeda N, Sato M. Inter-rater agreement of sputum cytology for lung cancer screening in Japan. Diagn Cytopathol 2015; 43:545-50. [PMID: 25645403 DOI: 10.1002/dc.23253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/25/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND To compare lung cancer detection rate by sputum cytology, we need some assurance that the estimates do not vary widely if different observers evaluate the same specimens. The aim of this study was to determine inter-rater agreement of sputum cytology diagnoses. METHODS Slides of sputum cytology from 150 subjects were selected from a pool of slides held by six of the laboratories that had participated in a population-based lung cancer screening program over the last ten years in Japan. The cytotechnologists in these laboratories had considerable experience with sputum cytology. Each case was re-evaluated six times. Cases that were diagnosed as the same category by all six laboratories were selected as consensus cases to serve as standardized sputum cytology cases. Thirty-seven cytotechnologists with various levels of experience in sputum cytology then re-evaluated these consensus cases. Inter-rater agreement was calculated by kappa statistics including Fleiss' kappa. RESULTS All pairs of interlaboratory agreement for the 150 cases showed statistically significant kappa values, most pairs showing substantial agreement. Fleiss' kappa value across the six laboratories was 0.5. Fourteen cases were identified as the consensus cases, and the agreement among observers with less experience of sputum cytology showed significantly lower than the agreement among those with considerable experience (Fleiss' kappa value 0.27 vs. 0.45, P < 0.05). Moreover, cytotechnologists with less experience under-diagnosed the slides significantly more often than those with considerable experience. CONCLUSION When the observers have considerable experience with sputum cytology, inter-observer agreement is good.
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Affiliation(s)
- Chiaki Endo
- Department of Thoracic Surgery, Tohoku University Hospital, Sendai, Japan
| | | | - Akemi Taguchi
- Department of Pathology and Cytology, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | - Kazunobu Yahata
- Department of Cytology, Osaka Medical Association, Osaka, Japan
| | - Ei Kawahara
- Department of Clinical Laboratory Science, Kanazawa University, Kanazawa, Japan
| | - Nikako Shimagaki
- Department of Cytology, Niigata Health Service Center, Niigata, Japan
| | - Junko Kamio
- Department of Cytology, Fukushima Preservative Service Association of Health, Fukushima, Japan
| | - Yasuki Saito
- Department of Thoracic Surgery, Sendai Medical Center, Sendai, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masami Sato
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Sagawa M, Kobayashi T, Uotani C, Kibe Y, Tanaka M, Machida Y, Motono N, Maeda S, Usuda K. A survey about further work-up for cases with positive sputum cytology during lung cancer mass screening in Ishikawa Prefecture, Japan: a retrospective analysis about quality assurance of lung cancer screening. Jpn J Clin Oncol 2015; 45:297-302. [PMID: 25583424 DOI: 10.1093/jjco/hyu214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In cancer screening programs, performing appropriate further work-up is essential. In order to elucidate whether the further work-up for the subjects with positive screening results by sputum cytology was performed appropriately, the present study was conducted as the first large-scale thorough survey in Japan. METHODS All of the lung cancer screening records from 2007 to 2012 in Ishikawa Prefecture were reviewed. Additional investigations about the further work-up were performed. RESULTS In total, 2 234 984 people were invited to undergo lung cancer screening, and 494 424 people participated in the screening. Of these, 25 264 people underwent sputum cytology, and 68 positive cases were identified. Three of these 68 cases did not undergo further work-up, and another three cases had already been diagnosed to have lung cancer. Forty-five of the remaining 62 cases did not have suspicious chest shadows, and bronchoscopic examinations were performed in 36 cases. Seventeen of these 36 cases were diagnosed as having cancer, whereas none of the nine cases who did not receive the examination was diagnosed (P = 0.038). A bronchoscopic examination was not performed due to other medical conditions in three cases, due to the patient's refusal in another three cases and in the remaining three cases, the reasons were unknown. CONCLUSION The participation rate for further work-up was very high. However, there are some issues to be resolved regarding the transmission of information. With our new registered hospital system, the quality assurance of our screening program will be improved.
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Affiliation(s)
- Motoyasu Sagawa
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa The Lung Cancer Screening Division of Ishikawa, Prefectural Committee for Management of the Cancer Screening System, Kanazawa, Ishikawa
| | - Takeshi Kobayashi
- The Lung Cancer Screening Division of Ishikawa, Prefectural Committee for Management of the Cancer Screening System, Kanazawa, Ishikawa Ishikawa Medical Center for Cancer and Cardiovascular Diseases, Kanazawa, Ishikawa
| | - Chika Uotani
- The Lung Cancer Screening Division of Ishikawa, Prefectural Committee for Management of the Cancer Screening System, Kanazawa, Ishikawa Ishikawa Health Service Association, Kanazawa, Ishikawa Kanazawa Medical Association, Kanazawa, Ishikawa, Japan
| | | | - Makoto Tanaka
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa
| | - Yuichiro Machida
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa
| | - Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa
| | - Sumiko Maeda
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa
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Patz EF, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammemägi MC, Chiles C, Black WC, Aberle DR. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med 2014; 174:269-74. [PMID: 24322569 PMCID: PMC4040004 DOI: 10.1001/jamainternmed.2013.12738] [Citation(s) in RCA: 545] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Screening for lung cancer has the potential to reduce mortality, but in addition to detecting aggressive tumors, screening will also detect indolent tumors that otherwise may not cause clinical symptoms. These overdiagnosis cases represent an important potential harm of screening because they incur additional cost, anxiety, and morbidity associated with cancer treatment. OBJECTIVE To estimate overdiagnosis in the National Lung Screening Trial (NLST). DESIGN, SETTING, AND PARTICIPANTS We used data from the NLST, a randomized trial comparing screening using low-dose computed tomography (LDCT) vs chest radiography (CXR) among 53 452 persons at high risk for lung cancer observed for 6.4 years, to estimate the excess number of lung cancers in the LDCT arm of the NLST compared with the CXR arm. MAIN OUTCOMES AND MEASURES We calculated 2 measures of overdiagnosis: the probability that a lung cancer detected by screening with LDCT is an overdiagnosis (PS), defined as the excess lung cancers detected by LDCT divided by all lung cancers detected by screening in the LDCT arm; and the number of cases that were considered overdiagnosis relative to the number of persons needed to screen to prevent 1 death from lung cancer. RESULTS During follow-up, 1089 lung cancers were reported in the LDCT arm and 969 in the CXR arm of the NLST. The probability is 18.5% (95% CI, 5.4%-30.6%) that any lung cancer detected by screening with LDCT was an overdiagnosis, 22.5% (95% CI, 9.7%-34.3%) that a non-small cell lung cancer detected by LDCT was an overdiagnosis, and 78.9% (95% CI, 62.2%-93.5%) that a bronchioalveolar lung cancer detected by LDCT was an overdiagnosis. The number of cases of overdiagnosis found among the 320 participants who would need to be screened in the NLST to prevent 1 death from lung cancer was 1.38. CONCLUSIONS AND RELEVANCE More than 18% of all lung cancers detected by LDCT in the NLST seem to be indolent, and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer.
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Affiliation(s)
- Edward F Patz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina2Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina
| | - Paul Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown School of Public Health, Providence, Rhode Island5Department of Biostatistics, Brown School of Public Health, Providence, Rhode Island
| | - Jorean D Sicks
- Center for Statistical Sciences, Brown School of Public Health, Providence, Rhode Island
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Martin C Tammemägi
- Department of Community Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Caroline Chiles
- Department of Radiology, Wake Forest University Health Sciences Center, Winston-Salem, North Carolina
| | - William C Black
- Department of Radiology, Dartmouth Medical School, Hanover, New Hampshire9Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire
| | - Denise R Aberle
- Department of Radiology, University of California, Los Angeles
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Schmidlin EJ, Sundaram B, Kazerooni EA. Computed Tomography Screening for Lung Cancer. Radiol Clin North Am 2012; 50:877-94. [DOI: 10.1016/j.rcl.2012.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ikeda N, Usuda J, Kato H, Ishizumi T, Ichinose S, Otani K, Honda H, Furukawa K, Okunaka T, Tsutsui H. New aspects of photodynamic therapy for central type early stage lung cancer. Lasers Surg Med 2012; 43:749-54. [PMID: 22057502 DOI: 10.1002/lsm.21091] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND and Objective Photodynamic therapy (PDT) has come to be considered as the first choice of treatment for central type early stage lung cancer (CELC). Recent advances in the ability to diagnose CELC, and in photosensitizers, as well as sophisticated clinical management, may improve the therapeutic outcome and expand the indications of PDT. MATERIALS AND METHODS We made the search for papers on PDT for lung cancer to select the most relevant articles. Based on this review and our recent data, we discussed the best available evidence for the diagnosis, the definition of indications, photosensitizers, and clinical management with regard to PDT. RESULTS To obtain complete response (CR) by PDT, the selection of the indications is extremely important, including the extent of the tumor on the bronchial surface and the depth of invasion in the bronchial wall. The development of autofluorescence bronchoscopy (AFB) and endobronchial ultrasonography (EBUS) have had a large impact on diagnostic bronchoscopy for CELC. CELCs less than 1 cm in diameter showed a favorable cure rate by PDT, thus this is a good indication for PDT. The relatively newer photosensitizer NPe6, which has a stronger antitumor effect than Photofrin, showed similar treatment outcome even for large tumors >1.0 cm in diameter. Furthermore, comprehensive management including photodynamic diagnosis before and after PDT should be effective to minimize the possibility of local recurrence after PDT. CONCLUSION The present guidelines of PDT for CELC were established based on the data obtained from studies in the 1980's. We postulate that comprehensive diagnosis and the new generation of photosensitizers may increase the CR rate and expand the indications of PDT for larger tumors.
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Affiliation(s)
- Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan.
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Yoshida M, Kondo K, Nakanishi C, Tada T. Interventional study for improvement of lung cancer screening rate. THE JOURNAL OF MEDICAL INVESTIGATION 2012; 59:127-35. [PMID: 22450001 DOI: 10.2152/jmi.59.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aim of this study is to evaluate whether leaflet distribution affects lung screening rate, and what factor affects the motivation of consultation. Men and women aged 40 to 59 were targeted to improve screening rate of ages for cancer screening, especially in their prime. Each 1,000 subject, a total of 2,000 were selected and divided into 8 groups in consideration of age group by random sampling method. This group was further divided into two groups, an intervention group including subjects distributed a leaflet and a non-intervention (control) group. A survey was conducted by postal self-administered survey forms. Collection rate was 21.6% for the intervention and 17.6% for the control group. The numbers of respondents who answered that this leaflet was effective for motivation of consulting lung cancer screening and the leaflet was ineffective, were 120 (60.0%) and 80 (40.0%), respectively. This indicated that the leaflet was clearly effective (p<0.01). Actual cancer screening rate was 38.8% for the intervention group and 37.7% for the control group. It was shown that distribution by mail of even a single leaflet made by National Cancer Center was effective for motivation of consultation of lung cancer screening.
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Affiliation(s)
- Midori Yoshida
- Graduate School of Health Sciences, the University of Tokushima, Tokushima, Japan
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Abstract
Lung cancer is a global health burden and is among the most common and deadly of all malignancies worldwide. Early detection of resectable and potentially curable disease may reduce the overall death rate from lung cancer. However, at the present time, screening for lung cancer is not recommended by most clinical societies and health care agencies in the United States. This article discusses the history of, and rationale for, lung cancer screening, addresses optimization of screening protocols, and describes our current approach for the evaluation of small pulmonary nodules referred for surgical management.
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Efficacy of CT screening for lung cancer in never-smokers: Analysis of Japanese cases detected using a low-dose CT screen. Lung Cancer 2011; 74:426-32. [DOI: 10.1016/j.lungcan.2011.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/20/2011] [Accepted: 05/01/2011] [Indexed: 11/21/2022]
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Kondo R, Yoshida K, Kawakami S, Shiina T, Kurai M, Takasuna K, Yamamoto H, Koizumi T, Honda T, Kubo K. Different efficacy of CT screening for lung cancer according to histological type: analysis of Japanese-smoker cases detected using a low-dose CT screen. Lung Cancer 2011; 74:433-40. [PMID: 21663995 DOI: 10.1016/j.lungcan.2011.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/20/2011] [Accepted: 05/01/2011] [Indexed: 12/21/2022]
Abstract
The efficacy of CT screening for lung cancers is still a controversial issue, although one of the recently publicized large randomized controlled trials of this methodology, the National Lung Screening Trial (NLST), reported a decrease in the lung cancer-specific mortality for heavy smokers. We here performed case-matched comparative analyses, as a retrospective study, of three lung cancer arms detected by CT screen, X-ray screen, and by individual analysis of the clinicopathological features and outcomes in smokers from a symptomatic-prompted group of patients. We also considered the impacts of various potential biases in this cohort. The total study cohort comprised 136 patients in the CT screen group, 263 in the X-ray screen group and 254 in the symptomatic-prompted group. The ratio of stage IA cancers in the CT screen group was 67.7% and the ratio of advanced cases (i.e. stages IIIB+IV) was 12.5%. The percentage of bronchioloalveolar carcinoma (BAC) was 28.7% in the CT screen group. The 5-year survival rates were 82.4% in the CT screen group, 38.0% in the X-ray screen group and 17.8% in the symptomatic-prompted group. CT screening was found to be an independent prognostic factor for lung cancer even when BAC cases were eliminated (HR 0.35, P<0.01). Based on our sub-analysis by individual histological sub-type, CT screen lung cancer cases had a better survival rate than non-screened patients, which included adenocarcinoma, squamous cell carcinoma and large/small cell carcinoma. However, by multi-variant analysis a CT scan would not be expected to reduce the risk of lung cancer mortality in patients with large/small cell carcinoma, although would be expected to reduce the risk of lung cancer death by 80% in cases of both adenocarcinoma and squamous cell carcinoma. In conclusion, our current findings indicate that CT screening for lung cancer is an effective strategy for smokers and that patients with adenocarcinoma and squamous cell carcinoma of all variant histological types may benefit from this test. In this regard, early stage large/small cell carcinomas are insufficiently detected by the existing annual screening system.
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Self-Selection Effects in Smokers Attending Lung Cancer Screening: A 9.5-Year Population-Based Cohort Study in Varese, Italy. J Thorac Oncol 2010; 5:428-35. [DOI: 10.1097/jto.0b013e3181d2efc7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sagawa M, Usuda K, Aikawa H, Machida Y, Tanaka M, Ueno M, Sakuma T. Lung cancer screening and its efficacy. Gen Thorac Cardiovasc Surg 2009; 57:519-27. [PMID: 19830514 DOI: 10.1007/s11748-009-0448-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 04/06/2009] [Indexed: 11/24/2022]
Abstract
The efficacy of lung cancer screening should not be evaluated by the survival rate of lung cancer patients but by lung cancer mortality in a certain population because the survival rate can be greatly affected by several types of bias. Randomized controlled trials that were conducted during the 1970s and 1980s in Europe and the United States failed to prove the efficacy of lung cancer screening in decreasing the mortality rate; but recently the results of case-control studies in Japan have revealed that undergoing currently available screening decreases the risk of lung cancer deaths by 30%-60%. A system is now being created in Japan whereby the guidelines regarding cancer screening will continue to be updated. The preliminary reports concerning lung cancer screening using thoracic computed tomography revealed that not only the detection rate of lung cancer but also the survival rate of detected lung cancer patients were surprisingly high. However, the presence of some potential bias in these studies cannot be ignored; therefore, it is still unknown whether there is actual efficacy. Several randomized controlled trials are presently in progress overseas, but the interim results were not favorable. A randomized controlled trial should therefore immediately be started in Japan as well.
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Affiliation(s)
- Motoyasu Sagawa
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan.
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17
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Endo C, Miyamoto A, Sakurada A, Aikawa H, Sagawa M, Sato M, Saito Y, Kondo T. Results of long-term follow-up of photodynamic therapy for roentgenographically occult bronchogenic squamous cell carcinoma. Chest 2009; 136:369-375. [PMID: 19318660 DOI: 10.1378/chest.08-2237] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Photodynamic therapy (PDT) is considered a useful and minimally invasive modality for treating centrally located early lung cancer. To date, there has been limited information on the long-term outcome of patients treated with PDT, especially those who are medically operable. METHODS Beginning in 1994, patients with roentgenographically occult bronchogenic squamous cell carcinoma (ROSCC) who met our criteria underwent PDT at Tohoku University Hospital and were followed up through 2006. Our criteria were as follows: (1) ROSCC without distant metastasis; (2) medically operable by means of lobectomy or further resection; (3) longitudinal tumor length of <or= 10 mm; and (4) superficial bronchoscopic tumor findings. RESULTS A total of 48 patients with ROSCC underwent PDT. The complete response (CR) rate was 94% (45 of 48 of patients). Nine patients (20%) had local recurrence after CR. A total of 11 deaths was observed, with 6 resulting from multiple primary lung cancer and only 1 from the original ROSCC. The 5-year and 10-year overall survival rates for all 48 patients were 81% and 71%, respectively. The Cox proportional hazard model showed that only metachronous multiple primary lung cancer was an independent poor prognostic factor. CONCLUSIONS PDT is thought to be a first-line modality for patients who have ROSCC with a tumor length of <or= 10 mm, even if the tumor is medically operable. Most local recurrence can be cured by active therapy such as surgery, radiotherapy, or PDT. Multiple primary lung cancer subsequent to PDT is an important issue from the viewpoint of survival.
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Affiliation(s)
- Chiaki Endo
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, Sendai, Japan.
| | - Akira Miyamoto
- Department of Thoracic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Akira Sakurada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Hirokazu Aikawa
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Motoyasu Sagawa
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Masamai Sato
- Department of Thoracic Surgery, Miyagi Cancer Center, Natori, Japan
| | - Yasuki Saito
- Department of Thoracic Surgery, Sendai Medical Center, Sendai, Japan
| | - Takashi Kondo
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, Sendai, Japan
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18
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Sumitani M, Takifuji N, Nanjyo S, Imahashi Y, Kiyota H, Takeda K, Yamamoto R, Tada H. Clinical relevance of sputum cytology and chest X-ray in patients with suspected lung tumors. Intern Med 2008; 47:1199-205. [PMID: 18591840 DOI: 10.2169/internalmedicine.47.0777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To review diagnostic procedures, therapeutic modalities, and follow-up methods in patients with suspected lung tumors. METHODS We retrospectively examined 70 patients who underwent a complete medical checkup because they had been positive for sputum cytology and had presented no chest X-ray findings for the 10-year period between 1994 and 2004. To make a diagnosis, we conducted the first complete medical checkup that included chest X-ray, sputum cytology, chest computed tomography (CT), and bronchoscopy. In the case that no diagnosis could be made, we repeated the chest X-ray and sputum cytology every 3 to 6 months and additionally conducted chest CT and bronchoscopy according to abnormal findings. RESULTS Among 70 patients, there were 36 and 13 who were diagnosed during the first complete medical checkup and follow-up, respectively, 13 who remained undiagnosed, and eight for whom follow-up was discontinued. Among the 49 diagnosed patients, 40, 8, and 1 patient had lung cancer, upper respiratory tract carcinoma (URTC), and esophageal carcinoma (EC), respectively. Among the 40 patients with lung cancer, 34 had a stage 0 or I tumor and 15 were radically treatable by photodynamic therapy and endobronchial irradiation. Nine among 11 patients whose lung cancer was detected during follow-up had a stage 0 or IA tumor. CONCLUSION Not only lung cancer but also URTC and EC were successfully detected in patients who were positive for sputum cytology and presented negative chest X-ray. Radical treatment was possible in 38 (76%) of 50 diagnosed patients, thus indicating the importance of follow-up through these procedures.
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Affiliation(s)
- Mitsuhiro Sumitani
- Department of Respiratory Medicine, Osaka City General Hospital, Osaka, Japan.
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19
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Córdoba García R, Coscollar Santaliestra C. El cribado de los fumadores llevado a su extremo. A propósito del cáncer de pulmón. Aten Primaria 2007; 39:521-3. [DOI: 10.1157/13110728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Hanagiri T, Sugio K, Mizukami M, Ichiki Y, Sugaya M, Ono K, Yasuda M, Nozoe T, Takenoyama M, Yasumoto K. Postoperative Prognosis in Patients with Non-small Cell Lung Cancer According to the Method of Initial Detection. J Thorac Oncol 2007; 2:907-11. [PMID: 17909352 DOI: 10.1097/jto.0b013e318156079c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In this study, we investigated the difference in the surgical results of non-small cell lung cancer according to the method of initial detection. METHODS We reviewed the medical records of 796 patients who underwent pulmonary resection for non-small cell lung cancer between 1994 and 2005. The subjects consisted of 171 patients whose cancer was detected by a medical checkup or mass health screening (group I), 316 patients who were under evaluation for other diseases or with symptoms related to other diseases (group II), and 309 patients with lung cancer-related symptoms (group III). The mean ages of the three groups were 63.2, 69.7, and 68.2 years old, respectively, with group I being significantly younger than the other groups. The proportion of women in the symptomatic group was significantly lower than that of men. RESULTS Pathologic stage I lung cancer was found in 112 (65.5%), 209 (65.2%), and 110 (35.6%) patients in groups I, II, and III, respectively. In comparison with stage II-IV cancer, stage I cancer was diagnosed more frequently in group I. According to the histologic type, adenocarcinoma was found in 132 patients (77.2%) in group I. However, squamous cell carcinoma was detected in only 27 patients (15.8%) in group I. The overall 5-year survival rates were 71.9%, 60.2%, and 48.0% in groups I, II, and III, respectively. Groups I and II had significantly better prognoses than group III. CONCLUSION Groups I and II had favorable prognoses, and the presence of symptoms related to lung cancer was a significantly unfavorable prognostic factor independent of all other factors.
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Affiliation(s)
- Takeshi Hanagiri
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
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21
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Abstract
The result of a lung cancer screening program should be fewer lung cancer-specific deaths in the screened population. Studies evaluating chest imaging as a screening tool for lung cancer have not shown a reduction in lung cancer-specific mortality to date. The ability of institutions using chest imaging to meet the criteria for successful screening programs has also been debated. Contentious issues include the presence of an overdiagnosis bias, the ability to find preclinical disease at a curable point in time, the amount of pseudodisease identified, and the cost-effectiveness of screening programs. Current guidelines remain vague as randomized trials are being completed and technologic advances are occurring. The ultimate face of a successful lung cancer screening program is yet to be defined.
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Affiliation(s)
- Peter J Mazzone
- Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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22
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Patz EF, Swensen SJ, Herndon JE. Estimate of lung cancer mortality from low-dose spiral computed tomography screening trials: implications for current mass screening recommendations. J Clin Oncol 2004; 22:2202-6. [PMID: 15169809 DOI: 10.1200/jco.2004.12.046] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Low-dose computed tomography (CT) has been suggested for lung cancer screening. Several observational trials have published their preliminary results, and some investigators suggest that this technique will save lives. There are no mortality statistics, however, and the current study used published data from these trials to estimate the disease-specific mortality in this high-risk population. PATIENTS AND METHODS Two nonrandomized CT screening trials were selected from the literature for analysis. The number of trial participants, the number of lung cancers diagnosed per year, and stage distribution of the cancers was recorded. Previously published 5-year survival data were used to calculate the number of predicted lung cancer deaths and estimate the overall lung cancer mortality per 1,000 person-years among participants screened. These statistics were then compared to the previous Mayo Lung Project, which used chest radiographs and sputum cytology for screening high-risk individuals. RESULTS This study estimates the lung cancer mortality is 4.1 deaths per 1,000 person-years in the Mayo Clinic CT screening trial, and is 5.5 deaths per 1,000 person-years in the Early Lung Cancer Action Program trial. These data are similar to the lung cancer mortality of 4.4 deaths per 1,000 person-years in the interventional arm, and 3.9 deaths per 1,000 person-years in the usual-care arm of the previous Mayo Lung Project. CONCLUSION These data suggest that CT screening could produce similar outcomes to prior chest radiographic trials in this high-risk group. Results from randomized trials are required, however, before the true utility of mass screening with CT for lung cancer can be determined.
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Affiliation(s)
- Edward F Patz
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
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Abstract
PURPOSE OF REVIEW With the development of newer forms of technology such as low-dose spiral computed tomography, there has been a resurgent interest in screening for lung cancer. The purpose of this review is to highlight recent advances in screening for lung cancer. Articles published since September 2002 are reviewed here. RECENT FINDINGS More frequent screenings (every 4 or 6 months) showed increased mortality from lung cancer, compared with annual screening. A mass screening conducted in 1990 was effective in a case-control study. The results of lung cancer screening by low-dose spiral computed tomography were reported from the Milan group and the Mayo Clinic. Computed tomography depicted peripheral early lung cancer, especially adenocarcinoma. These results are consistent with previous reports from other groups. Screening with imaging becomes more sensitive with automated computerized methods. SUMMARY A high percentage of stage IA lung cancers were detected by screening with low-dose helical computed tomography. The characteristics of the nodules detected by low-dose spiral computed tomography have been clarified. There have been many controversial discussions about cost effectiveness and overdiagnosis. There is still no evidence that screening tests reduce the rate of cancer-specific mortality. Several studies of screening for lung cancer are under way.
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Affiliation(s)
- Masaaki Kawahara
- Department of Internal Medicine, National Kinki Central Hospital for Chest Diseases, 1180 Nagasone, Sakai, Osaka 591-8555, Japan.
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Sagawa M, Nakayama T, Tsukada H, Nishii K, Baba T, Kurita Y, Saito Y, Kaneko M, Sakuma T, Suzuki T, Fujimura S. The efficacy of lung cancer screening conducted in 1990s: four case-control studies in Japan. Lung Cancer 2003; 41:29-36. [PMID: 12826309 DOI: 10.1016/s0169-5002(03)00197-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The efficacy of lung cancer screening is still controversial. In order to evaluate efficacy of mass screening for lung cancer in 1990s, the Japanese Ministry of Health and Welfare planned to conduct four independent case-control studies in four different regions; Miyagi, Gunma, Niigata, and Okayama Prefecture. The study design of all the four studies was a matched case-control study in which the decedents from lung cancer were defined as cases. In Gunma Prefecture, a screening examination is annual miniature chest X-ray only, whereas sputum cytology is added for high-risk screenees in others. Matching conditions were gender, year of birth, smoking histories (except Okayama), and municipality. Smoking adjusted odds ratio (OR) of dying from lung cancer for those screened within 12 months before case diagnosis compared with those not screened ranged 0.40-0.68. Three of four studies revealed statistically significant reduction of the risk for lung cancer death. OR of pooled analysis, where all sets were combined and analyzed, was 0.56 (95% confidence interval: 0.48-0.65). Recent mass screening program for lung cancer in Japan could reduce the risk for lung cancer death. However, the possibility exists that some confounding factors affected the results. In order to elucidate whether the results can be applied to Western countries, further studies will be required.
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Affiliation(s)
- Motoyasu Sagawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan.
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25
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Marcus PM. Conflicting evidence in lung cancer screening: randomized controlled trials versus case-control studies. Lung Cancer 2003; 41:37-9. [PMID: 12826310 DOI: 10.1016/s0169-5002(03)00200-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Minami Y, Tateno H. Associations between cigarette smoking and the risk of four leading cancers in Miyagi Prefecture, Japan: a multi-site case-control study. Cancer Sci 2003; 94:540-7. [PMID: 14529588 PMCID: PMC11160141 DOI: 10.1111/j.1349-7006.2003.tb01480.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2003] [Revised: 03/20/2003] [Accepted: 03/24/2003] [Indexed: 01/11/2023] Open
Abstract
Although cigarette smoking is a well-known risk factor of lung cancer, associations of cigarette smoking with the risk of other sites have not been fully elucidated in Japan. To simultaneously evaluate the associations of cigarette smoking with the risks of cancers of the stomach, lung, colon, and rectum, which have been the leading cancer sites in recent years in Miyagi Prefecture, Japan, we conducted a hospital-based case-control study. Study subjects consisted of 614 stomach, 515 lung, 324 colon, and 164 rectal cancer cases and 2444 hospital controls admitted to a single hospital in Miyagi Prefecture from 1997 to 2001. Information on smoking habit and other lifestyle factors was collected using a self-administered questionnaire. Distributions of referral base among cases and controls were also investigated. For each site, odds ratios (ORs) and 95% confidence intervals (95% CIs) for smoking habit were estimated with adjustment for age, year of survey, history of alcohol drinking, family history of index cancer, and occupational history, respectively, using an unconditional logistic regression model. Cigarette smoking (ever vs. never) was associated with an increased risk of stomach (OR = 1.62; 95% CI 1.20-2.19) and lung (OR = 3.82; 95% CI 2.49-5.86) cancer among males and lung cancer among females (OR = 2.02; 95% CI 1.28-3.18). For female stomach cancer, the association with cigarette smoking was uncertain (OR = 0.65, P = 0.1533). For rectal cancer, a significant increased risk was observed in both-sex-combined analysis. There was no association between cigarette smoking and the risk of colon cancer. Detailed analysis showed that the association of cigarette smoking with cancer risk might be modified by the patient referral pattern, i.e., screened or not screened. The present results indicate that the association of cigarette smoking with cancer risk may differ among sites and sexes. In terms of the population attributable risk, a large proportion of leading cancers in males appears to be related to cigarette smoking.
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Affiliation(s)
- Yuko Minami
- Division of Epidemiology, Miyagi Cancer Center Research Institute, Medeshima-Shiode, Natori 981-1293, Japan.
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Swensen SJ, Jett JR, Sloan JA, Midthun DE, Hartman TE, Sykes AM, Aughenbaugh GL, Zink FE, Hillman SL, Noetzel GR, Marks RS, Clayton AC, Pairolero PC. Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med 2002; 165:508-13. [PMID: 11850344 DOI: 10.1164/ajrccm.165.4.2107006] [Citation(s) in RCA: 459] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Studies suggest that screening with spiral computed tomography can detect lung cancers at a smaller size and earlier stage than chest radiography can. To evaluate low-radiation-dose spiral computed tomography and sputum cytology in screening for lung cancer, we enrolled 1,520 individuals aged 50 yr or older who had smoked 20 pack-years or more in a prospective cohort study. One year after baseline scanning, 2,244 uncalcified lung nodules were identified in 1,000 participants (66%). Twenty-five cases of lung cancer were diagnosed (22 prevalence, 3 incidence). Computed tomography alone detected 23 cases; sputum cytology alone detected 2 cases. Cell types were: squamous cell, 6; adenocarcinoma or bronchioalveolar, 15; large cell, 1; small cell, 3. Twenty-two patients underwent curative surgical resection. Seven benign nodules were resected. The mean size of the non-small cell cancers detected by computed tomography was 17 mm (median, 13 mm). The postsurgical stage was IA, 13; IB, 1; IIA, 5; IIB, 1; IIIA, 2; limited, 3. Twelve (57%) of the 21 non-small cell cancers detected by computed tomography were stage IA at diagnosis. Computed tomography can detect early-stage lung cancers. The rate of benign nodule detection is high.
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Affiliation(s)
- Stephen J Swensen
- Department of Radiology, the Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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