OUTCOME OF 51 PATIENTS WITH ROENTGENOGRAPHICALLY OCCULT LUNG-CANCER DETECTED BY SPUTUM CYTOLOGIC TESTING - A COMMUNITY-HOSPITAL PROGRAM

Background: Lung cancer is the most common fatal malignant neoplasm of both men and women. It is usually caused by tobacco smoke. However, a t present there is no systematic approach to early diagnosis. The diag nosis of lung cancer is usually made by standard chest roentgenograms and biopsy by bronchoscopy or surgery. Survival rates at 5 years have remained 10% to 15% for the past 30 years with this conventional appro ach to diagnosis. Methods: Fifty-one men and women, aged 46 to 81 year s (mean age, 64.2 years), with roentgenographically occult cancer were identified in one community hospital by means of sputum cytologic tes ting. Cancers were diagnosed by means of one or more standard light fi beroptic bronchoscopic procedures with biopsies. Results: Forty-four s quamous cell carcinomas, three adenocarcinomas, two large-cell carcino mas, and two undifferentiated carcinomas were found. Forty-five (86%) were stage 0 or I, Surgical cure was attempted in 27 patients, and the re were three actuarial cancer deaths at 5 years and a total of nine d eaths. Additionally, 19 patients received attempts at curative radiati on therapy for various reasons, which were usually poor pulmonary or c ardiac function or advanced age. Of both the 27 patients who underwent surgery and the 19 who were treated with radiation therapy (total, 46 ), the actuarial results by the life-table method in eluded nine lung cancer deaths in 5 years and 21 deaths from all causes, giving an actu arial survival, including deaths from all causes, of 55%. Conclusion: Roentgenographically occult lung cancer can be found by sputum cytolog ic testing followed by fiberoptic bronchoscopy and biopsy at a time wh en cure is more likely than when it is diagnosed by conventional roent genographic techniques (ie, 55% survival vs 10% to 15% survival). Sput um cytologic testing should be used as a case-finding tool, particular ly in heavy smokers and those with occupational risks. This diagnostic approach to earlier diagnosis and intervention can be successful in a small community hospital.