Lung cancer screening in cigarette smokers in the province of Varese, Italy.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.