German Study Suggests CT Screening For Lung Cancer Has Unresolved Questions

MedicalResearch.com Interview with:
Prof. Dr. Nikolaus Becker

Epidemiologisches Krebsregister Baden-Württemberg
Deutsches Krebsforschungszentrum
Heidelberg Germany

Medical Research: What is the background for this study? What are the main findings?

Prof. Becker: Lung cancer is the leading cause of cancer death in our Western countries as well as worldwide. One reason is that it is clinically diagnosed mostly in an advanced stage with a poor five-year survival of less than 10%. Diagnosed at an early stage, more than 70% would survive 5 years. For low dose-multislice CT (MSCT) indications exist that it is able to detect lung cancers early. As every newly upcoming screening tool, it has to be carefully analyzed whether it is really able to decrease the mortality from lung cancers and at which costs in terms of undesired side effects such as false-positive findings and overdiagnosis. Our results indicate that spontaneous MSCT screening with changing doctors might be ineffective due to many false-positive alarms; if screening then within an organizational framework.

Medical Research: What should clinicians and patients take away from your report?

Prof. Becker: Currently, there are several randomized trials running in Europe and the USA from which interesting results have already been published. It appears nevertheless too early for a decision in favour of lung cancer screening in high risk populations since many important questions remain unresolved. Reduction of lung cancer mortality has been shown from one study (NLST) but not from others. Overdiagnosis is an important issue which can directly only be resolved with studies comparing low dose-multislice CT with no intervention as the European studies are designed. Their results should be waited for until decisions are taken. Clinicians should inform interested patients in detail about the currently existing uncertainties and the risks of self-initiated screening diagnostics.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Becker: The running studies should be continued. It is highly interesting whether the reduction of lung cancer mortality persists in the NLST or is followed by an increase above background incidence indicating to a postponement of lung cancer death by screening. It is important to see the results on lung cancer mortality from the other studies, and what can they contribute to the issue of overdiagnosis. Newly established studies should approach the screening interval which has only addressed so far by NELSON (the Netherlands and Belgium) and MILD (Italy). Even appropriate and efficient structures for an organized screening should be investigated in advance of a broad roll-out.

Citation:

Randomised study on early detection of lung cancer with MSCT in Germany: results of the first 3 years of follow-up after randomisation.

Becker N1, Motsch E, Gross ML, Eigentopf A, Heussel CP, Dienemann H, Schnabel PA, Eichinger M, Optazaite DE, Puderbach M, Wielpütz M, Kauczor HU, Tremper J, Delorme S.

J Thorac Oncol. 2015 Mar 16. [Epub ahead of print]

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MedicalResearch.com Interview with: Prof. Dr. Nikolaus Becker (2015). German Study Suggests CT Screening For Lung Cancer Has Unresolved Questions MedicalResearch.com