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U.S. Announces Largest-Ever Lung Screening Trial DHMC is Site for Northern New England

Lebanon, NH -- The President today announced plans for a major lung screening trial, to be conducted by the National Cancer Institute at 30 sites across the country and enroll an estimated 50,000 current and former smokers. The trial, which will begin immediately and continue through 2009, is designed to determine if screening people with either spiral computerized tomography CT or chest X-ray, prior to evidence of symptoms, can reduce deaths from lung cancer.

President George Bush, accompanied by four-time Tour de France winner Lance Armstrong, made the announcement at a White House event highlighting efforts at cancer prevention, detection, and treatment.

The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center (DHMC) will serve as the primary screening site for Northern New England. William Black, MD, radiologist at DHMC and professor of radiology and of community and family medicine at Dartmouth Medical School, is one of five co-chairs in the national study and was involved in developing the protocols for the massive trial.

The National Lung Screening Trial (NLST) will be a randomized, controlled study-the "gold standard" of research studies. Study participants will be randomly assigned-designated by chance-to receive either a chest X-ray or a spiral CT once a year for three years. Researchers will continue to contact participants annually to monitor their health until 2009.

DHMC is the only site in Northern New England participating in the study and expects to enroll participants from Maine, New Hampshire, and Vermont. Beth Israel Deaconess Medical Center and Brigham and Women's Hospital in Boston are the other New England participating sites.

"Lung cancer kills more people than cancers of the breast, prostate, colon and pancreas combined and will claim nearly 155,000 lives this year," said Black. "Our hope is that this study will lead to saving lives,"

In New Hampshire, current estimates are that 800 people will be diagnosed with lung cancer this year. Of those, 700 are expected to die from the disease. In Vermont, the American Cancer Society (ACS) predicts 400 new cases of lung cancer this year and 400 deaths from the disease. In Maine, 1,000 new lung cancer cases will be diagnosed this year and 900 people will die from lung cancer, according to ACS estimates.

Lung cancer rates in Northern New England have traditionally been above average for the nation. Statistics compiled by the National Cancer Institute (NCI) show that through 1994 (the last year for which national statistics are available) Maine, New Hampshire, and Vermont were in the top half of states for lung cancer deaths per 100,000 population. During the years 1990-1994, Maine was 8th highest for lung cancer deaths among Caucasian women and 15th highest for lung cancer deaths among Caucasian men. New Hampshire ranked 13th and 22nd, respectively for those population groups in that time period, and Vermont ranked 20th and 24th.

To carry out the trial, NCI is using two research networks funded by the Institute: one network has been conducting the lung screening study called the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, and the other is the American College of Radiology Imaging Network (ACRIN), a network of researchers who conduct imaging studies. In addition, NCI is collaborating with the American Cancer Society to organize grassroots recruitment efforts at NLST sites.

"NLST is important because there are more than 90 million current and former smokers in the United States at high risk for lung cancer, and death rates for this disease, unlike many other cancers, have not declined," said NLST co-director John Gohagan, PhD., of NCI's Division of Cancer Prevention. "Cigarette smoking is by far the most important risk factor in the development of lung cancer."

When detected, lung cancer has usually spread outside the lung in 15 percent to 30 percent of cases. Spiral CT, a technology introduced in the 1990s, can pick up tumors well under 1 centimeter (cm) in size, while chest X-rays detect tumors about 1 to 2 cm in size.

"Conventional wisdom suggests that the smaller the tumor when it is found, the more likely the chance of survival-but that remains to be proven," said ACRIN researcher and NLST co-director Denise Aberle, MD, from the University of California Los Angeles. "Because of the number of individuals participating and because it is a randomized, controlled trial, NLST will be able to provide the evidence needed to determine whether spiral CT scans are better than chest X-rays at reducing a person's chances of dying from lung cancer."

Spiral CT uses X-rays to scan the entire chest in about 15 to 25 seconds, during a single breath hold. A computer creates images from the scan, assembling them into a 3-dimensional model of the lungs. More than half of the hospitals in the United States own a spiral CT machine and routinely use them for staging lung and other cancers-that is, determining how advanced the cancer is after diagnosis. Recently some hospitals have begun performing spiral CT scans as a new way to find early lung cancer in smokers and former smokers. However, no scientific evidence to date has shown that screening or early detection of lung cancer with either spiral CT or chest X-rays actually saves lives.

Participants in NLST will receive lung cancer screenings free of charge. In addition, some NLST centers will collect blood, urine and sputum. These samples will be used for future research to test for biomarkers that may someday help doctors better diagnose lung cancer. Men and women can participate in NLST if they meet the following requirements:

• Are current or former smokers ages 55 to 74
• Have never had lung cancer and have not had any cancer within the last five years (except some skin cancers or in situ cancers)
• Are not currently enrolled in any other cancer screening or cancer prevention trial
• Have not had a CT scan of the chest or lungs within the last 18 months.

Each of the 30 sites chosen to participate in the study is an NCI-designated Comprehensive Cancer Center. Norris Cotton Cancer Center at Dartmouth is recognized as a premier cancer research, education and treatment facility, and has recently been ranked as one of the top 50 cancer centers in the U.S.

For more information, contact Deborah Kimbell at 603-653-1913 or Deborah.Kimbell@dartmouth.edu.

Persons interested in enrolling in the study or receiving more information can call the study office at DHMC at 603-650-8747 or toll-free, 800-221-9994. Information is also available by calling NCI's Cancer Information Service toll-free, Monday through Friday, 9 a.m. to 4:30 p.m., at 1-800-4-CANCER. The number for callers with TTY equipment is 1-800-332-8615. On the web, log on to http://www.cancer.gov/NLST.

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