Paul A Kvale1, Christine Cole Johnson2, Martin Tammemägi3, Pamela M Marcus4, Carl J Zylak5, David L Spizarny6, William Hocking7, Martin Oken8, John Commins9, Lawrence Ragard10, Ping Hu11, Christine Berg12, Philip Prorok13. 1. Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI, United States. Electronic address: pkvale1@hfhs.org. 2. Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, United States. Electronic address: cjohnso1@hfhs.org. 3. Department of Community Health Sciences, Brock University, St. Catharines, Ontario, Canada. Electronic address: martin.tammemagi@brocku.ca. 4. National Cancer Institute, Bethesda, MD, United States. Electronic address: marcusp@mail.nih.gov. 5. Department of Radiology, Henry Ford Health System, Detroit, MI, United States. Electronic address: zylak@rad.hfh.edu. 6. Department of Radiology, Henry Ford Health System, Detroit, MI, United States. Electronic address: davidl@rad.hfh.edu. 7. Department of Clinical Oncology, Marshfield Clinic, Marshfield, WI, United States. Electronic address: hocking.william@marshfieldclinic.org. 8. Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States. Electronic address: travelermmo@yahoo.com. 9. Information Management Services, Inc., Rockville, MD, United States. Electronic address: comminsj@imsweb.com. 10. Westat, Inc., Rockville, MD, United States. Electronic address: lawrenceragard@westat.com. 11. National Cancer Institute, Bethesda, MD, United States. Electronic address: pingh@mail.nih.gov. 12. National Cancer Institute, Bethesda, MD, United States. Electronic address: bergc@mail.nih.gov. 13. National Cancer Institute, Bethesda, MD, United States. Electronic address: prorokp@mail.nih.gov.
Abstract
BACKGROUND: The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial provides us an opportunity to describe interval lung cancers not detected by screening chest X-ray (CXR) compared to screen-detected cancers. METHODS:Participants were screened for lung cancer with CXR at baseline and annually for two (never smokers) or three (ever smokers) more years. Screen-detected cancers were those with a positive CXR and diagnosed within 12 months. Putative interval cancers were those with a negative CXR screen but with a diagnosis of lung cancer within 12 months. Potential interval cancers were re-reviewed to determine whether lung cancer was missed and probably present during the initial interpretation or whether the lesion was a "true interval" cancer. RESULTS:77,445 participants were randomized to the intervention arm with 70,633 screened. Of 5227 positive screens from any screening round, 299 resulted in screen-detected lung cancers; 151 had potential interval cancers with 127 CXR available for re-review. Cancer was probably present in 45/127 (35.4%) at time of screening; 82 (64.6%) were "true interval" cancers. Compared to screen-detected cancers, true interval cancers were more common among males, persons with <12 years education and those with a history of smoking. True interval lung cancers were more often small cell, 28.1% vs. 7.4%, and less often adenocarcinoma, 25.6% vs. 56.2% (p<0.001), more advanced stage IV (30.5% vs. 16.6%, p<0.02), and less likely to be in the right upper lobe, 17.1% vs. 36.1% (p<0.02). CONCLUSION:True interval lung cancers differ from CXR-screen-detected cancers with regard to demographic variables, stage, cell type and location. ClinicalTrials.gov number: NCT00002540.
RCT Entities:
BACKGROUND: The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial provides us an opportunity to describe interval lung cancers not detected by screening chest X-ray (CXR) compared to screen-detected cancers. METHODS:Participants were screened for lung cancer with CXR at baseline and annually for two (never smokers) or three (ever smokers) more years. Screen-detected cancers were those with a positive CXR and diagnosed within 12 months. Putative interval cancers were those with a negative CXR screen but with a diagnosis of lung cancer within 12 months. Potential interval cancers were re-reviewed to determine whether lung cancer was missed and probably present during the initial interpretation or whether the lesion was a "true interval" cancer. RESULTS: 77,445 participants were randomized to the intervention arm with 70,633 screened. Of 5227 positive screens from any screening round, 299 resulted in screen-detected lung cancers; 151 had potential interval cancers with 127 CXR available for re-review. Cancer was probably present in 45/127 (35.4%) at time of screening; 82 (64.6%) were "true interval" cancers. Compared to screen-detected cancers, true interval cancers were more common among males, persons with <12 years education and those with a history of smoking. True interval lung cancers were more often small cell, 28.1% vs. 7.4%, and less often adenocarcinoma, 25.6% vs. 56.2% (p<0.001), more advanced stage IV (30.5% vs. 16.6%, p<0.02), and less likely to be in the right upper lobe, 17.1% vs. 36.1% (p<0.02). CONCLUSION:True interval lung cancers differ from CXR-screen-detected cancers with regard to demographic variables, stage, cell type and location. ClinicalTrials.gov number: NCT00002540.
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