Spiral Chest CT Scans Can Increase Lung Cancer Patients’ Chances for Survival, According to ELCAP Study

Studies in the first phase of the Early Lung Cancer Action Project (ELCAP), a joint research study with Weill Cornell Medical Center at New York Presbyterian Hospital and New York University Hospital, show that not only can spiral (“helical”) chest computed tomographic (CT) scans detect four times as many lung cancer tumors as conventional chest x-rays, but also the scans find these tumors when they are significantly smaller. Results of these studies (published in the July 10th issue of the Lancet) show that lung cancer patients have a significantly improved chance for long-term survival if the CT scan (which travels completely around the patient’s torso), is used to detect early-stage tumors.

Beginning in 1993, ELCAP enrolled 1,000 current or former smokers ³ 60 years old with at least a 10 pack/year history (1 pack/day for 10 years). They were screened with chest x-rays and spiral CT scans. Researchers found that 27 people (2.7% of subjects) had lung cancer.

CT Scan Can Detect Tumors < 10 mm in Diameter

 These CT scans picked up 74% more of the small tumors (some just the size of a grain of rice) than chest x-rays. For early-stage tumors, more effective treatment, especially surgery, is possible, giving patients a greater chance of long-term survival. The painless scan takes less than 20 seconds using less radiation than chest x-rays and can detect lesions much smaller than those revealed by x-rays, especially nodules < 10 mm in diameter.

“I think the most important result is that with spiral CT, we are able to find so many lung cancers that are small, even on the first scan,” said principal investigator, Claudia Henschke, MD, PhD, professor of radiology and division chief of chest imaging at New York Weill Cornell Center. “Just as with mammograms and breast cancer, finding a method that lets us intervene early is key to changing outcomes for people with lung cancer. We can save many lives and achieve a 5-year survival rate of around 80%.”

Researchers plan to track ELCAP enrollees with repeat scans for 10 years and to conduct a cost-effectiveness study. Dr. Henschke estimates that only about 5% additional malignant nodules will be detected in current enrollees and that they will be generally small.

Peggy McCarthy, volunteer executive director of the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE), applauds the study. “The ELCAP findings are the most significant breakthroughs for lung cancer diagnosis and treatment options in decades. Conventional use of chest x-ray on people with symptoms allows only 20% of all those detected with lung cancer to have a chance for survival. By offering this type of CT screen for all people at risk, we can very definitely change not only the numbers dying from lung cancer, but also significantly improve cancer statistics in general. Nothing in the history of cancer research has ever given such hope for survival.” (ALCASE is an international, nonprofit organization dedicated to helping people at risk for and living with lung cancer. Programs include a national hot-line and educational and supportiv