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Deaths among Patients with Screen-Detected Lung Cancer

Medical University of South Carolina, Charleston, South Carolina

To the Editor: I write to seek clarification on information presented by Henschke (1) in her recent editorial specifically with regard to one of the findings in a recent case series published from the International Early Lung Cancer Action Project (2). In her editorial, Henschke reports that "all [the] patients [in the study] with clinical stage I NSCLC who were not treated died within 5 years of their lung cancer." This comment echoed that provided by Henschke (3) in another recently published editorial, in which she reported that "We had only 8 such patients, and all died of lung cancer within 5 years of diagnosis". In the original report, however, which was published in 2006 in the New England Journal of Medicine, the investigators did not report that these eight subjects died of lung cancer but instead reported only that the subjects had died, without specifying the cause of death (2). Yee and Lynch (4) pursued the cause of death question in a letter to the editor of that journal asking for clarification on this matter but Henschke et al. (5) did not address Yee and Lynch's question in their response. As Aisner (6) recently noted, whether these subjects died of lung cancer or another cause is a matter of critical importance to the interpretation of the International Early Lung Cancer Action Project findings. Now that Henschke has reported that all eight died of lung cancer, I am writing to ask for some further information about the eight subjects. How was the cause of death ascertained in these subjects? How many of these eight subjects had metastatic or locally advanced disease at the time of their death, and what was the timing of their development of disease progression, relative to the timing of their diagnosis and death? Additionally, did these patients have other competing comorbidities (such as chronic obstructive pulmonary disease) that may have precluded them from undergoing curative surgery at the time of diagnosis?

References

1. Henschke CI. Survival of patients with clinical stage I lung cancer diagnosed by computed tomography screening for lung cancer. Clin Cancer Res 2007;13:4949–50.[Free Full Text]
2. Henschke CI, Yankelevitz DF, Libby DM, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763–71.[Abstract/Free Full Text]
3. Henschke CI. CT screening for lung cancer is justified. Nat Clin Pract 2007;4:440–1.[CrossRef]
4. Yee AJ, Lynch TJ. CT screening for lung cancer. N Engl J Med 2007;356:744–5; author reply 6–7.[Medline]
5. Henschke C, Smith JP, Miettinen OS. CT screening for lung cancer. N Engl J Med 2007;356:746–7.
6. Aisner J. CT screening for lung cancer: are we ready for wide-scale application? Clin Cancer Res 2007;13:4951–3.[Free Full Text]

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