Lung cancer screening in cigarette smokers in the Province of Varese, Italy

BACKGROUND, For heavy cigarette smokers and recent former smokers who have accumulated a high risk of lung carcinoma, a primary objective is the early detection of that disease; this goal can be achieved by annual screening w ith one of the radiologic imaging methods available. While awaiting for the implementation of computed tomography or of other, more sensitive methods, it is quite reasonable to screen those who are at risk with annual chest X -ray (CXR), an examination that is readily available at low cost. Indeed, w ith the annual CXR screening of heavy smokers, it is possible to detect abo ut 50% of lung carcinomas in TNM Stage I. The 5-year survival rate of patie nts with asymptomatic, screen-detected Stage I disease after radical surger y is significantly greater than the survival rate of patients with symptoma tic disease. METHODS. At the Center for Thoracic Surgery of the University of Insubria M edical School in Varese we developed a project, called "PRE.DL.CA" (an acro nym for "early diagnosis of cancer"), of annual CXR screening for the early diagnosis of asymptomatic lung carcinoma in the high risk population of he avy cigarette smokers and recent former smokers in the province of Varese, Italy. From June 1997 to August 1999, 2444 heavy smokers were enrolled in t he PRE.DI.CA project. RESULTS. About 75% of participants compiled with the annual screening proto col. Overall, 23 patients tall males) with asymptomatic lung carcinoma were detected by CXR screening; moreover, 1 patient developed symptoms of lung carcinoma 6 months after his initially negative CXR and was diagnosed with interval carcinoma (Stage IIIA. In the initial (prevalence) screening, the authors detected 16 patients with lung carcinoma in 2444 screened participa nts (0.65%). In the subsequent incidence screening, the authors detected 7 patients with lung carcinoma in 1361 screened participants (0.51%); it is n oteworthy that 5 of 7 patients (71%) with lung carcinoma that was detected by incidence CXR screening had Stage I disease. CONCLUSIONS. In the province of Varese, Italy, it is possible to make an ea rly diagnosis of lung carcinoma with CXR annual screening in asymptomatic, high risk smokers. Incidence screening in 1361 participants detected 7 pati ents with asymptomatic lung carcinoma; 5 of 7 patients (71%) with such scre en-detected lung carcinoma had Stage I disease. Cancer 2000;89:2345-8. (C) 2000 American Cancer Society.