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The First International Conference on Screening for Lung Cancer

Location: Weill Medical College of Cornell University

1300 York Avenue, New York NY 10021

Workshop 1 - Are the institutional recommendations of the 1980's on lung cancer screening still justifiable?

Mission:To produce a succinct answer to that question and a brief statement of the rationale justifying that answer.
Chair:Michael Unger
Members:Masahiro Kaneko, Margaret McCarthy, James Jett, Melvyn Tockman, Olli Miettinen
Topics Along the Way:
  1. What exactly were the recommendations of the ACS, NIH, and AMA in the 1980's. Did they actually recommend against screening, as distinct from not recommending for it?
  2. What was the basis of the recommendations? a) Solely the RCT results or b) these in conjunction with apriori ideas about i) attainable shift in the stage distribution, and ii) curability as it depends on stage?
  3. Were the RCT results interpreted as a) conclusively indicating no gain or b) merely not indicating any gain from screening?
  4. Were the recommendations justifiable at the time?
  5. How promising, or compelling, are the developments subsequent to those recommendations?
  6. Have those recommendations been appreciably revised?
  7. Are the existing recommendations tenable?

Summary

The American Cancer Society (ACS), the National Institutes of Health (NIH), and the American Medical Association (AMA) have stated they do not recommend screening for lung cancer. The consensus statement of the International Conference in Varese and the participants in this International Conference reached several points of agreement. The scientific basis of those recommendations was the failure of randomized controlled trials (RCTs) to demonstrate reduction in mortality, not consideration of shift in stage distribution nor stage-dependent curability. Subsequent to these recommendations, new techniques have become available which provide for substantially earlier detection of lung cancer. Also, compelling evidence has emerged that resection of early lesions has a major bearing on survival. It follows that screening for lung cancer is likely to save lives. Considering the magnitude of the mortality from lung cancer, the urgent challenges are to evaluate the effectiveness of screening with these new techniques, to quantify this effect, and to guide public policy recommendations.

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