Elsevier

Lung Cancer

Volume 35, Issue 2, February 2002, Pages 143-148
Lung Cancer

Screening for lung cancer: the early lung cancer action approach

https://doi.org/10.1016/S0169-5002(01)00416-0Get rights and content

Introduction

Suddenly, screening for lung cancer has become a hot topic. Researchers are initiating projects to study it; the public is demanding it; and medical institutions are offering it. The sudden activity is also prompting reconsideration of the still-nihilistic North American public policies on lung-cancer screening.

Out of the Fourth International Conference on Screening for Lung Cancer, held in February 2001 and only 16 months after the first one, arose a unanimous recommendation to quickly publish the current protocol of the International Early Lung Cancer Action Program (I-ELCAP) initiated by a resolution of the third Conference. The purpose here is to do just that, though only upon first outlining the origins of this initiative and also specifying its aims and broadest principles.

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Origins

In 1992, a group of chest radiologists (CIH, DFY), pulmonologists (including DML, JPS), oncologists and a thoracic surgeon (NKA) from Cornell University Medical Center, now Weill Medical College of Cornell University, together with a statistician (M. Kimmel) from Rice University, convened in a ski resort to outline to each other their respective research interests with a view to finding a common ground; and they invited an epidemiologist (OSM) from McGill University to assist in this search.

Aims

At any given time, the I-ELCAP focuses on the then-most-promising regimen of early (pre-symptomatic) diagnosis of lung cancer; and in respect to any such regimen, the first-order aim is to determine how early the diagnoses are achieved [4], [5], [6]. This is a matter of determining the distribution of the diagnosed cases according to indicators such as stage and size, and status as to symptoms and signs, jointly considered. The diagnostic distribution is considered separately for baseline and

Principles

Some of the principles of the I-ELCAP were already set forth in the two preceding sections. Added in this section are the admissibility criteria for contributing membership in this program, pertaining to research groups and their institutions. They are to:

  • 1

    Implement the regimen of early diagnosis specified below (subject risk profiles and intervention policies may vary; cf. below). Commitment to at least one repeat screen on each subject is required.

  • 2

    Submit to the Coordinating Center the

Subject admissibility

The participating investigator groups are free to set their own criteria for both entry into the screening and termination of this. Insofar as they wish to maximize the screening's presumptive benefit to the screenees, they are advised to accent screening in the fifth and sixth decades of age [3] and, of course, on persons with the highest levels of risk. On the other hand, study tends to be more efficient when accenting higher ages.

There is flexibility in the admissibility criteria because,

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1

ELCAP Group: Claudia I. Henschke, PhD, MD, radiologist, principal investigator; Nasser K. Altorki, MD, thoracic surgeon; Daniel M. Libby, MD, pulmonologist; Dorothy I. MacCauley, MD, radiologist; Olli S. Miettinen, MD, PhD, epidemiologist; Mark W. Pasmantier, MD, oncologist; James P. Smith, MD, pulmonologist; David F. Yankelevitz, MD, radiologist.

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