Outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor

doi:10.1016/S0169-5002(02)00505-6

Lung Cancer

Volume 40, Issue 1, April 2003, Pages 67-72

https://doi.org/10.1016/S0169-5002(02)00505-6 Get rights and content

Abstract

Goals of the study: To evaluate the outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor. Patients and Methods: This study enrolled 198 asymptomatic patients with lung cancer found by lung cancer mass screening during the 9-year period. Five-year survival rates in patients who did not consult a doctor or who stopped consulting a doctor in spite of abnormal shadows detected on last mass screening chest roentgenograms (n=45, delayed consultation group) and in patients who subsequently consulted a doctor when abnormal shadows were detected (n=153, control group) were evaluated by the method of Kaplan and Meier and clinical variables were examined as possible predictors of survival time by the Cox proportional-hazards model. Results: There was a significant difference between the 5-year survival rates in the delayed consultation group and in the control group (21 vs. 51%, log rank: P=0.0003, Wilcoxon: P=0.0009). The risk of death increased 115.0% for the 1-year delay in consultation (hazard ratio: 2.150, 95% CI: 1.203–3.842, P=0.0097). With regard to the reason why they did not consult a doctor, many of them answered that they did not have any respiratory symptoms. Conclusion: The 1-year delay in consultation had a great significance in that these patients did not receive any treatment for lung cancer for 1 year, and the 1-year delay in treatment itself affected the outcome.

Introduction

We have occasionally encountered lung cancer patients who were found retrospectively to have had evidence of disease on past mass screening chest roentgenograms. With regard to delayed detection of lung cancer, we previously reported that, although it may be difficult to find tumors less than 10 mm in greatest dimension on chest roentgenograms on mass screening, 1-year delayed detection of lung cancer less than or equal to 20 mm dose not affect the prognosis [1]. In our previous study, we found that there were some patients who did not subsequently consult a doctor or who stopped consulting a doctor in spite of the detection of a malignant disease on mass screening. As it has been reported that the survival of patients with resected lung cancer found by lung cancer mass screening is better than that patients with of resected lung cancer found by other methods [2], [3], [4], [5], [6], [7], [8], delayed consultation as well as delayed detection may affect the outcome. The purpose of this study is to evaluate the difference in outcomes in patients with a 1-year delay in consultation for lung cancer on mass screening and patients without the 1-year delay in consultation.

Section snippets

Patients and methods

This study enrolled 198 asymptomatic patients (130 men: 70.3±9.2 years, 68 women: 69.3±10.0 years) with lung cancer found by lung cancer mass screening during the 9 year period from January 1, 1993 to December 31, 2001 who had undergone mass screening chest roentgenograms 1 year before the disease was found. Of those, 143 patients with lung cancer enrolled in the period from 1993 through 2000, were included in previously published data [1]. The mass-screening program consists of an annual chest

Reasons why subjects did not consult a doctor or stopped consulting a doctor for 1 year

Medical Health Care Center staff advised patients to consult a doctor immediately if they had not done so 3 months after mass screening. Patients did not consult a doctor for 1 year for the following reasons: because they did not have any respiratory symptoms (n=23), because they had old inflammatory shadows that had been frequently checked on mass screening chest roentgenograms (n=4), because they had no time to consult a doctor (n=3) and because they were afraid of the presence of lung cancer

Discussion

We found that survival times in lung cancer patients who did not consult a doctor in spite of abnormal shadows of the lung detected on mass screening, were worse than those in lung cancer patients who subsequently consulted a doctor when abnormal shadows were detected on mass screening.

It has been reported that chest roentgenogram mass screening increases earlier detection, resectability and survival in lung cancer patients, although no randomized controlled trial has ever succeeded in

Acknowledgements

The authors are indebted to Assistant Prof. Raoul Breugelmans and Prof. J. Patrick Barron of the International Medical Communications Center of Tokyo Medical University for his review of this manuscript.

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Outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor

Abstract

Introduction

Section snippets

Patients and methods

Reasons why subjects did not consult a doctor or stopped consulting a doctor for 1 year

Discussion

Acknowledgements

Lung Cancer

Lung Cancer

Ann. Thorac. Surg.

J. Thorac. Cardiovasc. Surg.

J. Thorac. Cardiovasc. Surg.

Screening for lung cancer. A critique of the Mayo Lung Projects

Cancer

Comparative study of survival of screen-detected compared with symptom-detected lung cancer cases. Japanese Lung Cancer Screening Reseach Group

Semin. Surg. Oncol.