M. D. Anderson Opens Lung Cancer Screening Study
M. D. Anderson Opens Lung Cancer Screening Study
Joins 30 Centers to Screen 50,000 Current and Former Smokers
M. D. Anderson News Release 09/18/02
The University of Texas M. D. Anderson Cancer Center announced today that it is recruiting current and former smokers for the largest lung cancer screening study ever conducted.
M. D. Anderson is among 30 sites across the United States participating in the National Lung Screening Trial, known as NLST. Coordinated at M. D. Anderson by the American College of Radiology Imaging Network and funded by the National Cancer Institute (NCI), the screening study plans to enroll 50,000 current and former smokers in the next two years. M. D. Anderson is the only participating site in Texas and in the entire southwest United States and intends to recruit 1,000 current and former smokers into the project.
The eight-year, $200 million trial will compare methods of detecting lung cancer:
- spiral computed tomography (spiral CT) versus
- standard chest X-ray
The risks and benefits of the two techniques will be compared.
Dr. Reginald Munden, associate professor in M. D. Anderson's Department of Diagnostic Radiology –– Patient Care, is M. D. Anderson’s principal investigator of NLST. Dr. Therese Bevers, assistant professor in the institution’s Department of Clinical Cancer Prevention, serves as the trial’s co-principal investigator.
"This historic trial follows M. D. Anderson’s success with other large NCI-sponsored trials –– such as STAR and SELECT –– that have advanced our understanding of cancer prevention strategies," says Dr. Bevers, who is also the director of the institution’s Cancer Prevention Center. “With NLST, we are given the unique opportunity to determine if there is a detection mechanism that reduces a person’s chance of dying from lung cancer in a group of individuals at increased risk for the disease. Each year, lung cancer kills more people than cancers of the breast, prostate, colon and pancreas combined because the cancer is often found after it has spread."
Lung cancer, which is most frequently caused by smoking, is the leading cause of cancer-related deaths in the United States. According to the American Cancer Society, the disease will claim 155,000 lives in 2002.
Currently, guidelines for lung cancer screening do not exist, as no technology –– including chest X-ray and spiral CT –– has proven effective in reducing a person’s chance of dying from the disease.
“There is a tremendous need to establish an early detection mechanism for lung cancer that can extend peoples’ lives as well as reduce the overall mortality rate from this disease,” says Dr. Munden. “However, spiral CT has been shown to be better at detecting tumors than conventional chest X-rays, especially cancers smaller than one centimeter.
“Conventional wisdom suggests that the smaller the tumor, the more likely the chance of survival but, to date, no scientific evidence has shown that screening or early detection of lung cancer actually saves lives,” he continues. “With the size and scope of NLST, we will be able to provide the evidence needed to determine whether spiral CT scans are better than chest X-rays at reducing a person’s chances of dying from the disease.”
Spiral CT, also known as helical CT, utilizes X-rays to scan the entire chest in about 15 to 25 seconds during a single, large-breath hold. During the procedure, the participant lies still on a table; the table and patient pass through the CT scanner, which is shaped like a donut. The scanner rotates around the participant and a computer creates images from the scan, assembling them into a three-dimensional model of the lungs. Introduced for clinical usage in the early 1990s, spiral CT was first used as a lung cancer screening technique in Japan, says Dr. Munden. Since then, a number of independent trials have been conducted validating the technique.
NCI’s first look into CT as a lung cancer screening method began in late 2000 with the launch of an initial trial comparing CT to chest X-ray. Much smaller than NLST, the study enrolled 3,000 current and former smokers within just two months of the study’s launch. Data from that trial is expected to be released later this year.
“The need for a large, randomized controlled study –– the ‘gold standard’ of research studies –– to confirm the benefits of spiral CT is paramount,” says Dr. Munden. “Before NCI’s first trial, all trials involving CT were non-randomized and uncontrolled. Despite earlier studies suggesting CT works, we really don’t know if CT is any better than chest X-ray at increasing survival. With a comprehensive trial such as NLST, we will learn an answer to the most important public health issue: does spiral CT reduce lung cancer deaths.”
Prospective NLST participants must be healthy men and women who meet the following criteria:
- current or former smokers who have smoked heavily for many years and are between the ages of 55 and 74
- at present, not receiving treatment for any type of cancer other than non-melanoma skin cancer
- have no history of lung cancer
- must not have had a CT scan of the chest or lungs within the last 18 months.
Potential participants will go through a process known as informed consent, during which they learn about the trial in greater detail before deciding whether to participate in NLST.
Once a participant enrolls in the study, he or she will be randomly assigned to receive either a chest X-ray or a CT scan each year for three years. M. D. Anderson radiologists will review M. D. Anderson participants’ spiral CT or chest X-ray. Test results will be mailed to the patient and the patient’s personal physician. Participants also will be contacted periodically so that quality-of-life surveys may be conducted. For those with positive chest X-rays and suspicious CT scans that might be cancer, M. D. Anderson will notify the participants and their primary care physicians and recommend specific follow-up care, Dr. Munden says. The CT and chest X-rays will be provided at no charge for all trial participants. Should lung cancer and/or other abnormalities be found via screening, additional follow-up tests or recommended treatment would not be financially covered by NLST.
Screening for lung cancer does have risks, warns Dr. Munden. According to the NCI, recent studies indicate that upwards of 70% of current and former smokers screening CT scans will show abnormalities. While many of these abnormalities –– such as scars from smoking and areas of inflammation –– are not lung cancer, some of these conditions may mimic lung cancer on scans and thus may require additional evaluation such as further radiology studies, lung biopsy or even surgery.
For more information, call (713) 792-5340. Additional information is available at the National Cancer Institute's website. Prospective participants interested in joining the study can also call the NCI’s Cancer Information Service line at 1-800-4-CANCER. Information is offered in English and Spanish.