Dominioni L, Imperatori A, Rovera F, Ochetti A, Paolucci M, Dionigi G
Center for Thoracic Surgery, University of Insubria and Azienda Ospedale di Cirolo di Varese, Italy.
Cancer. 2000 Dec 1;89(11 Suppl):2345-8. doi: 10.1002/1097-0142(20001201)89:11+<2345::aid-cncr5>3.3.co;2-2.
For heavy cigarette smokers and recent former smokers who have accumulated a high risk of lung carcinoma, a primary objective is the early detection of that disease; this goal can be achieved by annual screening with one of the radiologic imaging methods available. While awaiting for the implementation of computed tomography or of other, more sensitive methods, it is quite reasonable to screen those who are at risk with annual chest X-ray (CXR), an examination that is readily available at low cost. Indeed, with the annual CXR screening of heavy smokers, it is possible to detect about 50% of lung carcinomas in TNM Stage I. The 5-year survival rate of patients with asymptomatic, screen-detected Stage I disease after radical surgery is significantly greater than the survival rate of patients with symptomatic disease.
At the Center for Thoracic Surgery of the University of Insubria Medical School in Varese we developed a project, called "PRE.DI.CA" (an acronym for "early diagnosis of cancer"), of annual CXR screening for the early diagnosis of asymptomatic lung carcinoma in the high risk population of heavy cigarette smokers and recent former smokers in the province of Varese, Italy. From June 1997 to August 1999, 2444 heavy smokers were enrolled in the PRE.DI.CA project.
About 75% of participants complied with the annual screening protocol. Overall, 23 patients (all males) with asymptomatic lung carcinoma were detected by CXR screening; moreover, 1 patient developed symptoms of lung carcinoma 6 months after his initially negative CXR and was diagnosed with interval carcinoma (Stage IIIA). In the initial (prevalence) screening, the authors detected 16 patients with lung carcinoma in 2444 screened participants (0.65%). In the subsequent incidence screening, the authors detected 7 patients with lung carcinoma in 1361 screened participants (0.51%); it is noteworthy that 5 of 7 patients (71%) with lung carcinoma that was detected by incidence CXR screening had Stage I disease.
In the province of Varese, Italy, it is possible to make an early diagnosis of lung carcinoma with CXR annual screening in asymptomatic, high risk smokers. Incidence screening in 1361 participants detected 7 patients with asymptomatic lung carcinoma; 5 of 7 patients (71%) with such screen-detected lung carcinoma had Stage I disease.
对于重度吸烟者以及近期戒烟者，他们患肺癌的风险较高，首要目标是早期发现该疾病；这一目标可通过采用现有的放射成像方法进行年度筛查来实现。在等待计算机断层扫描或其他更敏感方法实施的过程中，对有风险人群进行年度胸部X线（CXR）筛查是相当合理的，这种检查成本低且容易获得。事实上，通过对重度吸烟者进行年度CXR筛查，有可能检测出约50%的TNM I期肺癌。无症状、经筛查发现的I期疾病患者在根治性手术后的5年生存率显著高于有症状疾病患者的生存率。
在意大利瓦雷泽省因苏布里亚大学医学院胸外科中心，我们开展了一个名为“PRE.DI.CA”（“癌症早期诊断”的首字母缩写）的项目，对意大利瓦雷泽省重度吸烟者和近期戒烟者这一高风险人群进行年度CXR筛查，以早期诊断无症状肺癌。从1997年6月至1999年8月，2444名重度吸烟者参与了PRE.DI.CA项目。
约75%的参与者遵守了年度筛查方案。总体而言，通过CXR筛查发现了23例（均为男性）无症状肺癌患者；此外，1例患者在最初CXR检查呈阴性6个月后出现肺癌症状，被诊断为间隔期癌（IIIA期）。在初始（患病率）筛查中，作者在2444名接受筛查的参与者中检测出16例肺癌患者（0.65%）。在随后的发病率筛查中，作者在1361名接受筛查的参与者中检测出7例肺癌患者（0.51%）；值得注意的是，通过发病率CXR筛查检测出的7例肺癌患者中有5例（71%）为I期疾病。
在意大利瓦雷泽省，对无症状的高风险吸烟者进行年度CXR筛查有可能早期诊断肺癌。对1361名参与者进行的发病率筛查发现了7例无症状肺癌患者；7例经筛查发现的肺癌患者中有5例（71%）为I期疾病。
