Screening for bronchogenic carcinoma: the surgical experience
Baker, R.R.; Tockman, M.S.; Marsh, B.R.; Stitik, F.P.; Ball, W.C.; Eggleston, J.C.; Erozan, Y.S.; Levin, M.L.; Frost, J.K.
Journal of Thoracic and Cardiovascular Surgery 78(6): 876-882
1979
ISSN/ISBN: 0022-5223 PMID: 502570 Document Number: 151157
A screening project consisting of 10,362 men was designed to detect early lung cancer. Half of the subjects had sputum cytologic studies and chest radiographs and the other half had chest radiographs. Seventy cases of bronchogenic carcinoma were detected. Eight patients had malignant cells in their sputum and normal chest radiographs and 62 patients had radiographic evidence of bronchogenic carcinoma. After clinical assessment including bronchoscopy, percutaneous needle biopsy, mediastinoscopy and mediastinotomy in selected cases, 48 of the patients underwent exploratory thoracotomies. Six patients had benign disease. Of the remaining 42 patients 39 had tumors resected for cure, an overall resectability rate of 55%. Staging was accomplished after resection and histologic examination of the operative specimens. Five patients with Stage 0 carcinoma have survived a median of 36 mo. without evidence of recurrence. A total of 26 patients had Stage I disease and 77% have survived a median of 36 mo. without recurrence. Four of these patients have developed 2nd primary tumors. Of the 7 patients with Stage II disease, 3 are alive 40-50 mo. following operation. Seventeen patients had Stage III disease, 2 of whom have survived. Nine patients with oat cell carcinoma were treated by irradiation and chemotherapy; all died. The median survival was 8 mo. The results of this study are encouraging. Long-term follow-up is necessary to demonstrate whether early detection by sputum cytologic studies and chest radiographs and the apparently improved survival of these patients will result in a decreased death rate from bronchogenic carcinoma. The high initial survival rates may be due simply to earlier intervention in the natural history of the disease.