This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200301-144OCv1 168/10/1167    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McWilliams, A. Articles by Lam, S. Search for Related Content PubMed PubMed Citation Articles by McWilliams, A. Articles by Lam, S.

Lung Cancer Screening

A Different Paradigm

British Columbia Cancer Agency; Radiology Department, Vancouver General Hospital, Vancouver, British Columbia, Canada; and NCI/DCP/Lung and Upper Aerodigestive Cancer Research Group, Bethesda, Maryland

Correspondence and requests for reprints should be addressed to Annette McWilliams, M.B.B.S., F.R.A.C.P., British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada. E-mail: amcwilli{at}bccancer.bc.ca

Thoracic computed tomography (CT) is a sensitive method for detecting early lung cancer but has a high false-positive rate and is not sensitive for detecting central preinvasive and microinvasive cancer. Our hypothesis was that automated quantitative image cytometry (AQC) of sputum cells as the first screening method may improve detection rate by identifying individuals at highest risk for lung cancer. A total of 561 volunteer current or former smokers 50 years of age or older, with a smoking history of more than or equal to 30 pack/years, were studied. Among these, 423 were found to have sputum atypia defined as five cells or more with abnormal DNA content using AQC. Noncalcified pulmonary nodules were found in 46% (259/561). Of the 14 detected cancers, 13 were detected in subjects with sputum atypia—nine by CT and four carcinoma in situ/microinvasive cancers by autofluorescence bronchoscopy. One cancer was detected by CT alone. AQC of sputum cells improved the detection rate of lung cancer from 1.8 to 3.1%. CT scan alone would have missed 29% of the cancers. This screening paradigm shift has the additional potential of reducing the number of initial CT scans by at least 25% with further savings in follow-up investigations and treatment.

Key Words: lung neoplasms • tomography, X-ray computed • bronchoscopy • diagnostic imaging • cytology

This article has been cited by other articles:

				A. McWilliams and J. Mayo Computed Tomography-detected Noncalcified Pulmonary Nodules: A Review of Evidence for Significance and Management Proceedings of the ATS, December 15, 2008; 5(9): 900 - 904. [Abstract] [Full Text] [PDF]

				J. R. Jett and D. E. Midthun Commentary: CT Screening for Lung Cancer--Caveat Emptor Oncologist, April 1, 2008; 13(4): 439 - 444. [Full Text] [PDF]

				C. J.A. Haasbeek, S. Senan, E. F. Smit, M. A. Paul, B. J. Slotman, and F. J. Lagerwaard Critical Review of Nonsurgical Treatment Options for Stage I Non-Small Cell Lung Cancer Oncologist, March 1, 2008; 13(3): 309 - 319. [Abstract] [Full Text] [PDF]

				P. B. Bach, G. A. Silvestri, M. Hanger, and J. R. Jett Screening for Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 69S - 77S. [Abstract] [Full Text] [PDF]

				M. K. Gould, J. Fletcher, M. D. Iannettoni, W. R. Lynch, D. E. Midthun, D. P. Naidich, and D. E. Ost Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 108S - 130S. [Abstract] [Full Text] [PDF]

				T. C. Kennedy, A. McWilliams, E. Edell, T. Sutedja, G. Downie, R. Yung, A. Gazdar, and P. N. Mathur Bronchial Intraepithelial Neoplasia/Early Central Airways Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 221S - 233S. [Abstract] [Full Text] [PDF]

				R. Yuan, J. R. Mayo, J. C. Hogg, P. D. Pare, A. M. McWilliams, S. Lam, and H. O. Coxson The Effects of Radiation Dose and CT Manufacturer on Measurements of Lung Densitometry Chest, August 1, 2007; 132(2): 617 - 623. [Abstract] [Full Text] [PDF]

				S. B. Markowitz, A. Miller, J. Miller, A. Manowitz, S. Kieding, L. Sider, and A. Morabia Ability of Low-Dose Helical CT To Distinguish Between Benign and Malignant Noncalcified Lung Nodules Chest, April 1, 2007; 131(4): 1028 - 1034. [Abstract] [Full Text] [PDF]

				G. Loewen, N. Natarajan, D. Tan, E. Nava, D. Klippenstein, M. Mahoney, M. Cummings, and M. Reid Autofluorescence bronchoscopy for lung cancer surveillance based on risk assessment Thorax, April 1, 2007; 62(4): 335 - 340. [Abstract] [Full Text] [PDF]

				R. Li, N. W. Todd, Q. Qiu, T. Fan, R. Y. Zhao, W. H. Rodgers, H.-B. Fang, R. L. Katz, S. A. Stass, and F. Jiang Genetic Deletions in Sputum as Diagnostic Markers for Early Detection of Stage I Non-Small Cell Lung Cancer Clin. Cancer Res., January 15, 2007; 13(2): 482 - 487. [Abstract] [Full Text] [PDF]

				G. J. Kelloff, S. M. Lippman, A. J. Dannenberg, C. C. Sigman, H. L. Pearce, B. J. Reid, E. Szabo, V. C. Jordan, M. R. Spitz, G. B. Mills, et al. Progress in Chemoprevention Drug Development: The Promise of Molecular Biomarkers for Prevention of Intraepithelial Neoplasia and Cancer--A Plan to Move Forward Clin. Cancer Res., June 15, 2006; 12(12): 3661 - 3697. [Abstract] [Full Text] [PDF]

				F V Gleeson Is screening for lung cancer using low dose spiral CT scanning worthwhile? Thorax, January 1, 2006; 61(1): 5 - 7. [Full Text] [PDF]

				J. R. Jett Limitations of Screening for Lung Cancer with Low-Dose Spiral Computed Tomography Clin. Cancer Res., July 1, 2005; 11(13): 4988s - 4992s. [Abstract] [Full Text] [PDF]

				S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, S. J. Mandrekar, S. L. Hillman, A.-M. Sykes, G. L. Aughenbaugh, A. O. Bungum, and K. L. Allen CT Screening for Lung Cancer: Five-year Prospective Experience Radiology, April 1, 2005; 235(1): 259 - 265. [Abstract] [Full Text] [PDF]

				S. Lam, J. C. leRiche, A. McWilliams, C. MacAulay, Y. Dyachkova, E. Szabo, J. Mayo, R. Schellenberg, A. Coldman, E. Hawk, et al. A Randomized Phase IIb Trial of Pulmicort Turbuhaler (Budesonide) in People with Dysplasia of the Bronchial Epithelium Clin. Cancer Res., October 1, 2004; 10(19): 6502 - 6511. [Abstract] [Full Text] [PDF]

				G. J. Kelloff, R. C. Bast Jr., D. S. Coffey, A. V. D'Amico, R. S. Kerbel, J. W. Park, R. W. Ruddon, G. J. S. Rustin, R. L. Schilsky, C. C. Sigman, et al. Biomarkers, Surrogate End Points, and the Acceleration of Drug Development for Cancer Prevention and Treatment: An Update Prologue Clin. Cancer Res., June 1, 2004; 10(11): 3881 - 3884. [Full Text] [PDF]

				M. J. Tobin Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 301 - 313. [Full Text] [PDF]

				C. I. Henschke Medicine on Lung Cancer Screening: A Different Paradigm Am. J. Respir. Crit. Care Med., November 15, 2003; 168(10): 1143 - 1144. [Full Text] [PDF]