International Conference on Prevention and Early Diagnosis of Lung Cancer Varese, Italy, December 9 & 10, 1998
Conference Consensus Statement December 14, 1998
We are in the midst of a global and growing lung cancer epidemic. On a worldwide basis, lung cancer is the most deadly malignancy; it will cause more that one million deaths this year. Because cigarette smoking is the vastly predominant cause, lung cancer is almost entirely preventable. Other sources of risk include environmental exposures and inherited risk.
Accordingly, the only currently effective means of prevention is to refrain from smoking. For children and adolescents the focus should be on not starting smoking, whereas for adults, smoking cessation is an effective method of reducing lung cancer risk, but it is difficult to implement and achieve. It is important to recognize their continuing risk; even after quitting, long term smokers remain at high risk for prolonged periods. There is a pressing need for effective secondary prevention (screening) measures.
The Conference reviewed available evidence relative to early diagnosis of lung cancer. The early pioneering studies have not shown mortality reductions, and have led many organizations to recommend against lung cancer screening. However, there are a number of limitations to these studies, leaving us with an inperfect basis for health policy. Paradoxically, case-finding studies, show favourable outcomes when lung cancer is detected early. Furthermore, over the last twenty years, the pattern of disease has changed; conventional diagnostic techniques have improved and new early detection techniques have emerged.
An important aspect of the Conference was a review of new technology that holds the promise of substantial mortality reduction from lung cancer. These new technologies include low dose spiral CT scan, autofluorescent bronchoscopy and molecular markers in sputum cytology. Rigorous and rapid evaluation of these new technologies is essential in order to ensure confidence in their efficacy, and timely application of their findings.
At this time, only one large trial with chest x-ray screening is ongoing, although newer modalities are being investigated in other studies around the world. The Conference concluded that additional studies are needed. It is especially important that investigation of new early detection technologies receive high scientific and public health priority.
For those who develop lung cancer, outcome is dramatically better when the disease is detected at an early stage and surgically treated. Unfortunately, at this time, the majority of lung cancers are diagnosed when the disease is overtly symptomatic, and in an advanced stage when prognosis is extremely poor. Available clinical data demonstrate that the vast majority of curable lung cancers are currently detected by chest X-rays and CT scan, although there is no proven strategy to assure early detection.
The Conference encourages national governments and public health organizations involved in cancer prevention and control to more aggressively address tobacco control and to urgently consider the issues surrounding the early detection of lung cancer. The Conference recognizes that current and former smokers must be advised of their continuing risk of lung cancer. In order to address these issues, organizations must support research on new diagnostic techniques, chemoprevention and develop recommendations regarding how health care providers and high risk patients can make informed decisions about monitoring for the occurrence of lung cancer.
Gary Strauss, MD Dana-Farber Cancer Institute and University of Massachusetts Medical School Scientific Co-Secretary, 1998 International Conference on Prevention and Early Diagnosis of Lung Cancer (011) 508-793-5759 or (617) 632-5357
Lorenzo Dominioni, MD Center for Thoracic Surgery, University of Varese, Italy Scientific Co-Secretary, 1998 International Conference on Prevention and Early Diagnosis of Lung Cancer (390) 332-264169
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