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Cancer

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Supplement: Prevention and Early Diagnosis of Lung Cancer

1 December 2000

Volume 89, Issue S11

Pages 2327–2514

  1. Introduction

    1. Top of page
    2. Introduction
    3. Conference Statement
    4. Keynote Address
    5. Original Article
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      Early lung cancer detection : Current and ongoing challenges (pages 2327–2328)

      Robert A. Smith and Thomas J. Glynn

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2327::AID-CNCR1>3.0.CO;2-R

  2. Conference Statement

    1. Top of page
    2. Introduction
    3. Conference Statement
    4. Keynote Address
    5. Original Article
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      Consensus statement : International Conference on Prevention and Early Diagnosis of Lung Cancer (pages 2329–2330)

      Lorenzo Dominioni and Gary M. Strauss

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2329::AID-CNCR2>3.0.CO;2-M

  3. Keynote Address

    1. Top of page
    2. Introduction
    3. Conference Statement
    4. Keynote Address
    5. Original Article
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      The International Association for the Study of Lung Cancer (IASLC) Worldwide Educational Program on Lung Cancer : A keynote address presented by the President of the IASLC (pages 2331–2333)

      Giovanni Motta

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2331::AID-CNCR3>3.0.CO;2-O

      Keynote address. From its foundation in 1974, the International Association for the Study of Lung Cancer (IASLC) has been devoted to promoting education and international cooperation in the field of lung carcinoma knowledge, from basic research to advanced strategies in treatment.

  4. Original Article

    1. Top of page
    2. Introduction
    3. Conference Statement
    4. Keynote Address
    5. Original Article
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      Stage I nonsmall cell lung carcinoma : Analysis of survival and implications for screening (pages 2334–2344)

      Lorenzo Dominioni, Andrea Imperatori, Francesca Rovera, Alberto Ochetti, Grazia Torrigiotti and Massimo Paolucci

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2334::AID-CNCR4>3.0.CO;2-I

      The high survival rate of resected Stage I nonsmall cell lung carcinoma (NSCLC; 60–80% at 5 years) is discussed, as related to the potential benefit of screening for lung cancer. Chest X-ray screening identifies approximately 50% of cancers in Stage I. Screening by helical low dose computed tomography scan, detects greater than 80% of lung carcinomas in Stage I. The asymptomatic screen-diagnosed Stage I carcinomas have longer doubling time than the more advanced cancers; nevertheless, they are not “overdiagnosed tumors.” Indeed, screen-diagnosed Stage I lung carcinomas are truly malignant, because they metastasize and cause fatal outcome if they are not radically resected. The documented improvement of long term survival rate of NSCLC, which can be achieved by early diagnosis and radical resection, strongly indicates that the current dogma against lung cancer screening is untrue. Every effort should be made to detect the disease when it is in Stage I, by implementing screening in at risk smokers and former smokers.

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      Lung cancer screening in cigarette smokers in the province of Varese, Italy (pages 2345–2348)

      Lorenzo Dominioni, Andrea Imperatori, Francesca Rovera, Alberto Ochetti, Massimo Paolucci and Gianlorenzo Dionigi

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2345::AID-CNCR5>3.0.CO;2-B

      From June 1997 to August 1999, 2444 heavy smokers and recent former smokers were enrolled in the PRE.DI.CA project of annual chest X-ray (CXR) screening for lung cancer in the province of Varese, Italy (PRE.DI.CA is an acronym for “early diagnosis of cancer”). 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 found 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.

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      Overview of the NCI Cooperative Early Lung Cancer Detection Program (pages 2349–2351)

      Nathaniel I. Berlin

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2349::AID-CNCR6>3.0.CO;2-4

      This overview reviews the personal and scientific origins, the structure, operations, results, and achievements of the National Cancer Institute Cooperative Early Lung Cancer Detection Program.

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      The Mayo Lung Project : A perspective (pages 2352–2355)

      Robert S. Fontana

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2352::AID-CNCR7>3.0.CO;2-5

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      The Mayo Lung Project was a randomized, controlled trial of screening for lung carcinoma by chest X-rays and sputum cytology tests every 4 months. Compared with control subjects advised to undergo annual screening, study subjects experienced an increased incidence rate of lung carcinoma, resectability, and survival but no decrease in the lung carcinoma mortality rate.

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      Lung cancer screening results in the National Cancer Institute New York Study (pages 2356–2362)

      Myron R. Melamed

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2356::AID-CNCR8>3.0.CO;2-Z

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      Approximately 40% of all lung carcinomas that developed over a 5–8 year period in a population of 10,040 cigarette smoking men in the New York metropolitan area were detected in Stage I by chest X-ray and sputum cytology screening; two-thirds of them were treated successfully and survived their disease. Overall survival of all the men with lung carcinoma who enrolled in this cancer detection program, whether their carcinomas were detected by screening or not, was 35%, compared with 13% for the Surveillance, Epidemiology, and End Results program data on lung carcinoma survival in the United States during this period.

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      Czech study on lung cancer screening : Post-trial follow-up of lung cancer deaths up to year 15 since enrollment (pages 2363–2368)

      Antonín K. Kubík, D. Maxwell Parkin and Petr Zatloukal

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2363::AID-CNCR9>3.0.CO;2-W

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      A population of 6364 males who were heavy cigarette smokers, aged 40–64 years, was randomized into an intervention group screened by 6 monthly chest X-rays and sputum cytology and a control group that was investigated only if symptoms appeared. No benefit in terms of reduction in mortality rate from lung cancer in favor of subjects with semiannual screening was found in the initial 3-year study period, or during follow-up extended up to Year 15 since enrollment.

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      Lung cancer screening : Improved survival but no reduction in deaths—The role of “overdiagnosis” (pages 2369–2376)

      D. Maxwell Parkin and Sue M. Moss

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2369::AID-CNCR10>3.0.CO;2-A

      Randomized controlled trials (RCTs) of lung carcinoma screening consistently show increased diagnoses of cases in screened versus unscreened groups, but no difference in mortality between the two. Evidence, including analogous findings from other cancer screening RCTs, suggests that “overdiagnosis” of lung carcinoma resulting from the screening process may partially explain these observations.

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      Lung cancer : Building hope through comprehensive prevention (pages 2377–2386)

      Tina M. St. John and Fritz D. Robinett

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2377::AID-CNCR11>3.0.CO;2-C

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      Lung carcinoma is a complex, progressive, multiphasic process. The historical approach to controlling this disease has been limited to primary prevention through smoking avoidance and cessation programs. However, this approach has failed to impact significantly either the morbidity or mortality associated with lung carcinoma. In the current study the authors propose a comprehensive approach employing primary, secondary, and tertiary prevention efforts to address the overwhelming magnitude of suffering and death associated with this disease.

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      Does the early detection of lung carcinoma improve prognosis? : The Turku study (pages 2387–2391)

      Eija-Riitta M. Salomaa

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2387::AID-CNCR12>3.0.CO;2-8

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      Lung carcinoma detected through a single chest X-ray was more limited and more often was treated by radical surgery and had a better prognosis compared with tumors found during the course of ordinary health care. However, these results are subject to factors that were only partly controlled, and should be interpreted cautiously.

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      A case–control study for evaluating lung cancer screening in Japan (pages 2392–2396)

      Tomotaka Sobue

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2392::AID-CNCR13>3.0.CO;2-J

      Accumulated data indicate that the efficacy of lung cancer screening by chest X-ray in terms of mortality reduction is none or small (<30%), if any. Because it is difficult to draw definite conclusions whether lung cancer screening has a small effect or has no effect at all, discussion is needed to determine the resources that should be allocated to this issue.

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      The classic approach (pages 2397–2398)

      Jack Cuzick

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2397::AID-CNCR14>3.0.CO;2-1

      A randomized trial is the traditional method by which new medical interventions are evaluated. Endpoints for the trial depend on the context, but mortality reduction usually is the ultimate goal. In many cases good surrogate endpoints also are of primary interest, such as disease recurrence in patients who already have the disease or incidence rate when the goal is to prevent the development of disease in a healthy population.

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      Randomized population trials and screening for lung cancer : Breaking the cure barrier (pages 2399–2421)

      Gary M. Strauss

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2399::AID-CNCR15>3.0.CO;2-T

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      Screening for lung carcinoma is not recommended because no randomized population trial (RPT) to date has demonstrated a significant reduction in lung carcinoma mortality as a result of screening. However, systematic analysis of data from all existing trials supports the conclusion that an improvement in cure rate, rather than a reduction is cause specific mortality, is the proper measure of screening effectiveness in the RPT setting. Chest X-ray screening improves lung carcinoma cure rates and can substantially reduce the global burden of lung cancer mortality.

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      Perception, paradox, paradigm : Alice in the wonderland of lung cancer prevention and early detection (pages 2422–2431)

      Gary M. Strauss and Lorenzo Dominioni

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2422::AID-CNCR16>3.0.CO;2-E

      In less than a century, lung cancer has gone from a medical curiosity to the most deadly of all malignant diseases. Although prevention is the most effective method of reducing future lung cancer mortality rates among children, adolescents, and young adults, smoking cessation has limited effectiveness as a lung cancer prevention strategy among long term smokers. Early detection is the key to reducing the rate of lung cancer mortality among individuals who are at high risk for lung cancer.

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      Extent of surgery and survival in early lung carcinoma : Implications for overdiagnosis in Stage IA nonsmall cell lung carcinoma (pages 2432–2437)

      David J. Sugarbaker and Gary M. Strauss

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2432::AID-CNCR17>3.0.CO;2-A

      The results of three independent series comparing the efficacy of limited resection and lobectomy in Stage IA nonsmall cell lung carcinoma (NSCLC) show that limited resection is inferior to lobectomy with respect to the chance of achieving a curative outcome. Indeed, one study shows that prognosis of patients with Stage IA NSCLC undergoing limited resection is less favorable that the prognosis of those with Stage IB disease undergoing lobectomy. If extent of surgical resection is the major determinant of survival in Stage IA NSCLC, then these lesions must be clinically important. Accordingly, these results support the conclusion that screening does not lead to significant overdiagnosis of Stage IA NSCLC.

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      Surgical management of early stage central (hilar) and peripheral nonsmall cell lung carcinoma (pages 2438–2444)

      Yoh Watanabe, Shinya Murakami, Makoto Oda, Yasuhiko Ohta, Shun-ichi Watanabe, Zensei Nozaki, Ryoichi Kamimura, Takeshi Kobayashi, Akitaka Nonomura and Hiroshi Minato

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2438::AID-CNCR18>3.0.CO;2-Q

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      The subjects were 43 patients with early hilar carcinoma, 14 of whom underwent standard lobectomy, 17 who underwent sleeve lobectomy, 3 who underwent segmentectomy, and 9 who underwent limited bronchial resection. Their 5-year and 10-year survival rates were 100% and 96.9%, respectively. In addition, 174 patients with early peripheral carcinoma were examined. The 5-year survival rate of 142 patients with adenocarcinoma was 89.6%, whereas that of 32 patients with other cell types was 71.8%, showing a poorer prognosis.

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      A therapeutic approach to roentgenographically occult squamous cell carcinoma of the lung (pages 2445–2448)

      S. Fujimura, A. Sakurada, M. Sagawa, Y. Saito, H. Takahashi, T. Tanita, S. Ono, S. Matsumura, T. Kondo and M. Sato

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2445::AID-CNCR19>3.0.CO;2-V

      When a roentgenographically occult bronchogenic squamous cell carcinoma is limited within bronchoscopic visibility and is <10 mm in longitudinal extension, the depth of invasion of the tumor is regarded as within bronchial cartilage, and the patient is a good candidate for photodynamic therapy. Patients with tumors that invade beyond the bronchial cartilage and/or have lymph node involvement should undergo standard surgery.

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      Screening for lung cancer : Do we need randomized trials? (pages 2449–2452)

      Olli S. Miettinen

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2449::AID-CNCR20>3.0.CO;2-8

      The efficacy of screening for lung cancer is determined by its curability rates conditional on disease stage and stage-conditional tumor size, together with the distributions of the latter two at screening-associated diagnosis. These are best studied by the use of a noncomparative approach that inherently is nonrandomized.

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      Sensitivity and specificity of chest x-ray screening for lung cancer : Review article (pages 2453–2456)

      Giampaolo Gavelli and Emanuela Giampalma

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2453::AID-CNCR21>3.0.CO;2-M

      Although, at the present time, lung carcinoma is the most significant cause of cancer-related deaths in many countries, it is widely accepted that screening for the early detection of lung carcinoma is not indicated. This position is supported by the lack of a reduction in lung carcinoma specific mortality rates in all of the randomized, controlled trials regarding chest X-ray screening. However, the same randomized, controlled trials have demonstrated a significant improvement in distribution by disease stage, tumor resectability, and patient survival in the screened population. These controversial results stimulate discussion regarding the role of chest X-ray screening in the early detection of lung carcinoma, because it is necessary to find an effective strategy for the secondary prevention of lung carcinoma.

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      Radiation exposure associated with imaging of the chest : Comparison of different radiographic and computed tomography techniques (pages 2457–2460)

      Stefan Diederich and Horst Lenzen

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2457::AID-CNCR22>3.0.CO;2-7

      Radiation exposure of patients is 0.06–0.25 millisieverts (mSv) with chest radiography in 2 scans and 3–27 mSv with computed tomography (CT) scan using conventional examination parameters, and it may be reduced to 0.3–0.55 mSv using low dose CT scan settings. It can be expected that radiation exposure from an effective dose equivalent of 1 mSv would lead to 5 additional malignancies in 100,000 individuals exposed.

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      The early identification of lung carcinoma by sputum cytology (pages 2461–2464)

      Thomas L. Petty

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2461::AID-CNCR23>3.0.CO;2-L

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      Sputum cytology can help identify roentgenographically occult lung carcinoma and is most useful for central airway lesions, which are often squamous cell carcinoma. Sputum cytology should be done in heavy smokers with airflow obstruction.

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      Considerations in developing successful, population-based molecular screening and prevention of lung cancer (pages 2465–2467)

      James L. Mulshine, Luigi M. De Luca, Robert L. Dedrick, Melvyn S. Tockman, Robert Webster and Michael E. Placke

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2465::AID-CNCR24>3.0.CO;2-6

      With the high mortality rates for patients with symptomatic lung carcinoma, research efforts to routinely detect lung carcinoma prior to the development of symptoms are a major priority. New tools are required to enable such an approach, and, because this is such a large public health problem, critical analysis of the design considerations is essential to ensure that optimal benefits are achieved.

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      Detection and localization of early lung cancer by fluorescence bronchoscopy (pages 2468–2473)

      Stephen Lam, Calum MacAulay, Jean C. leRiche and Branko Palcic

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2468::AID-CNCR25>3.0.CO;2-V

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      Preinvasive bronchial carcinomas are difficult to detect and localize. The worldwide experience with the lung imaging fluorescence endoscope-lung device has shown that fluorescence bronchoscopy can improve the detection rate of these lesions.

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      Early lung cancer action project : Overall design and findings from baseline screening (pages 2474–2482)

      Claudia I. Henschke

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2474::AID-CNCR26>3.0.CO;2-2

      The Early Lung Cancer Action Project was designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography in individuals who are considered to be at high risk for lung cancer. In the current study, the author reports a baseline screening experience in which the estimated 5-year survival rate was between 60–80% for malignancies detected by computed tomography, which is a marked improvement over the currently reported rate of 15%.

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      Screening for asymptomatic early bronchogenic carcinoma with low dose CT of the chest (pages 2483–2484)

      Stefan Diederich, Dag Wormanns, Horst Lenzen M.S., Michael Semik, Michael Thomas and Peter E. Peters

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2483::AID-CNCR27>3.0.CO;2-1

      Low dose screening computed tomography of the chest in more than 700 heavy smokers identified 8 bronchogenic carcinomas larger than 10 mm, all of which were resectable. In addition, pulmonary nodules smaller than or equal to 10 mm were identified in approximately 40% of individuals screened, the significance of which is uncertain.

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      Computed tomography screening for lung carcinoma in Japan (pages 2485–2488)

      Masahiro Kaneko, Masahiko Kusumoto, Toshiaki Kobayashi, Noriyuki Moriyama, Tsuguo Naruke, Hironobu Ohmatsu, Ryutaro Kakinuma, Kenji Eguchi, Hiroyuki Nishiyama and Eisuke Matsui

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2485::AID-CNCR28>3.0.CO;2-T

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      Low dose helical (spiral) computed tomography scanning can effect a three-fold increase in the detection of peripheral lung carcinoma over chest X-rays. However, at present, several issues need to be resolved. These include the establishment of diagnostic standards, the development of diagnostic support systems, and the establishment of methods for definite diagnosis.

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      Cost-effectiveness of lung cancer screening in Japan (pages 2489–2493)

      Naoyuki Okamoto

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2489::AID-CNCR29>3.0.CO;2-E

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      Lung cancer screening in Japan was evaluated according to its cost-effectiveness. The present screening method is cheaper that that used previously, although its effectiveness also is low, and, although the cost of screening by computed tomography scanning is higher than the cost of the present screening method, it is much more effective.

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      Cost-effectiveness of a proposed feasibility study on the detection of early lung carcinoma in Germany (pages 2494–2496)

      John A. Nakhosteen

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2494::AID-CNCR30>3.0.CO;2-H

      A randomized, controlled study combining new technologies with more conventional methods for the detection of early lung carcinoma is planned for 6000 high risk patients. A cost-benefit analysis has shown a projected doubling of the 5-year survival rate with an approximate 20% increase in total (screening and treatment) costs in the screened group compared with the control group.

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      Costs of videothoracoscopic surgery versus open resection for patients with of lung carcinoma (pages 2497–2501)

      Jun Nakajima, Shinichi Takamoto, Tadasu Kohno and Toshiya Ohtsuka

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2497::AID-CNCR31>3.0.CO;2-5

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      Hospital charges for patients undergoing videothoracoscopic surgery for lung carcinoma were lower than hospital charges for patients undergoing open thoracotomy at the authors' hospital. The lower cost was attributable mainly to the fact that thoracoscopic surgical procedures are less invasive, which also may be beneficial in decreasing the risk of postsurgical complications in patients who are in relatively poor health.

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      Could chest X-ray screening for lung cancer be cost-effective? (pages 2502–2505)

      J. Jaime Caro, Wendy S. Klittich and Gary Strauss

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2502::AID-CNCR32>3.0.CO;2-N

      Annual chest X-ray screening for lung cancer would be cost-effective if at least a 6% reduction in mortality can be demonstrated. Further research to properly quantify the effectiveness of screening for lung cancer should be contemplated.

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      Primary prevention, smoking, and smoking cessation : Implications for future trends in lung cancer prevention (pages 2506–2509)

      David M. Burns

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2506::AID-CNCR33>3.0.CO;2-8

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      Historically, lung cancer has been a disease of current cigarette smokers and recent quitters, with only a small portion of lung cancer occurring in former smokers. As a larger fraction of those who have ever smoked quit smoking, a larger fraction of lung cancer cases will occur among former smokers, necessitating early detection and chemoprevention approaches to reduce lung cancer deaths for this group.

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      An advocacy perspective on screening and early diagnosis of lung cancer (pages 2510–2514)

      Peggy M. McCarthy and Nadine C. Jelsing

      Version of Record online: 7 DEC 2000 | DOI: 10.1002/1097-0142(20001201)89:11+<2510::AID-CNCR34>3.0.CO;2-M

      Lung cancer is the leading cause of death by cancer throughout the world, and it is clear that smoking prevention and cessation programs in and of themselves cannot stop or even slow down this lung cancer “epidemic.” The only hope for reducing the number of lives lost to lung cancer lies in creating and implementing broad-range approaches for screening people who are at risk for lung cancer and for diagnosing the disease in its early stages when a cure is possible.

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