Screening for Early Lung Cancer: Results of the Memorial Sloan-Kettering Study in New York

doi:10.1378/chest.86.1.44

Chest

Volume 86, Issue 1, July 1984, Pages 44-53

https://doi.org/10.1378/chest.86.1.44 Get rights and content

The Memorial Sloan-Kettering lung cancer screening program was begun in 1974 to evaluate sputum cytology as a supplement to the annual chest x-ray examination for early detection and diagnosis. The 10,040 adult, male cigarette smokers who enrolled were randomly assigned to receive annual chest x-ray examinations only or a dual screen with annual chest x-ray examination and four monthly sputum cytology evaluation. Over 40 percent of the 288 who developed lung cancer were diagnosed in stage I, and their survival was 76 percent at five years; overall survival was 35 percent. Nearly one third of the lung cancers detected on first examination on the dual screen, and 14 percent of those on subsequent examinations were found by cytologic examination. The same number of cancers developed in the x-ray screen only group, and were diagnosed at a later date. Despite the delay, survival and mortality were the same, suggesting that the squamous carcinomas detected by cytologic examination alone are very slow growing and tend to remain localized until detectable by x-ray examination.

Section snippets

MATERIAL AND METHODS

The study was conducted at a specially designed site in the Strang Clinic-Preventive Medicine Institute building, located convenient to public transportation in mid-town Manhattan. The procedures that we followed were described in detail in a Manual of Procedures published by the Cooperating Institutions.³

A total of 10,040 cigarette-smoking men over 45 years old, considered at high risk of lung cancer, were recruited from the general population of metropolitan New York for this study.⁴ All the

FOLLOW-UP

Enrollment began in 1974 and required more than three years to complete, whereas screening was phased out during the first ten months of 1982. Thus, the participants had an opportunity to be screened for periods varying from five to eight years, depending on the date of enrollment. A vigorous effort was made to encourage compliance with the screening schedule. Compilers were defined as the men who had their last chest x-ray examination in 1982 (the last year of screening), or more than five

RESULTS

The computer generated randomization assigned 5,072 men to the x-ray only group, and 4,968 to the dual screen (x-ray and cytology). The data collected at registration included age distribution, smoking history, residence at enrollment, and reported exposure to chemical carcinogens. Over 3,700 men were recruited through the news media, 3,750 by direct mailing to Group Health, Inc, subscribers and licensed motor vehicle drivers in New York City, 1,150 from the New York City Police Department, and

DISCUSSION

On initial screening, nearly one-third of the lung cancers detected in the population that had dual screening were detected by sputum cytology, and these included half of the localized (stage I) lung cancers. In subsequent examinations, the proportion of cases detected by cytology alone (14 percent) or by cytology including cases with x-ray suspicion (20 percent) was much lower; and nearly four times as many stage I lung cancers were found by x-ray screening as by cytology. Thus, the major

SURVIVAL

Figure 4, Figure 5, Figure 6, Figure 7 represent Kaplan-Meier estimates of survival from lung cancer. Deaths from other causes are treated as losses from follow-up and indicated as diamonds. We have already reported survival of lung cancers detected in this study to be highly correlated with stage.16, 19 This continues to be evident (Fig 4). For stage I disease, the estimate of survival from detection of lung cancer is 76 percent at five years, and the only three deaths from lung cancer that

ACKNOWLEDGEMENT

Gladys Watson provided skilled typing assistance.

REFERENCES (21)

YerushalmyJ
The statistical assessment of roentgenographic pulmonary shadows
Radiol Clin N Am
(1969)
MartiniN et al.
Occult carcinomas of the lung
Ann Thorac Surg
(1980)
SilverbergSG et al.
Locally advanced lung carcinoma with favorable prognosis
J Thorac Cardiovasc Surg
(1967)
The National Cancer Institute Cooperative Early Lung Cancer Detection Program. Results of initial screen (prevalence):...
American Joint Committee on Cancer: Manual for staging of cancer
(1983)
Manual of procedures. National Cancer Institute Cooperative Early Lung Group. 2nd Ed. National Institutes of Health...
MelamedMR et al.
Preliminary report of the lung cancer detection program in New York
Cancer
(1977)
FlehingerBJ et al.
Accuracy of chest films screening by technologists in the New York early lung cancer detection program
Am J Roentgenol
(1978)
TuddenhamWJ
Visual search, image organization and reader error in roentgen diagnosis
Radiology
(1969)
NeelHB et al.
Sputum cytologic diagnosis of upper respiratory tract cancer: second report
Ann Otol Rhinol Laryngol
(1981)

There are more references available in the full text version of this article.

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: Manuscript received July 26; revision accepted January 18.

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Clinical InvestigationsScreening for Early Lung Cancer: Results of the Memorial Sloan-Kettering Study in New York

Section snippets

MATERIAL AND METHODS

FOLLOW-UP

RESULTS

DISCUSSION

SURVIVAL

ACKNOWLEDGEMENT

Radiol Clin N Am

Ann Thorac Surg

J Thorac Cardiovasc Surg

American Joint Committee on Cancer: Manual for staging of cancer

Preliminary report of the lung cancer detection program in New York

Cancer

Accuracy of chest films screening by technologists in the New York early lung cancer detection program

Am J Roentgenol

Visual search, image organization and reader error in roentgen diagnosis

Radiology

Sputum cytologic diagnosis of upper respiratory tract cancer: second report

Ann Otol Rhinol Laryngol

Clinical Investigations
Screening for Early Lung Cancer: Results of the Memorial Sloan-Kettering Study in New York