Early Detection of Lung Cancer in a High-Risk Population Defined by PFT, Biomarkers, and CT Scanning

Lung cancer is the number one cancer killer in Kentucky and has a very high incidence within
the 5th Congressional District of Kentucky (110.8 cases per 100,000 in period 1996-2000).
Surgical removal provides the best chance for cure. Unfortunately, the majority of lung
cancer cases are detected in an advanced stage, when surgical resection is impossible. This
leads to shorter survival rates and increased mortality rates for lung cancer, increased
patient suffering, and greater cost to the healthcare system. Methods that favor earlier
detection are therefore crucial for successful treatment. One such method, low-dose spiral
computed tomography (CT) is being studied to determine whether its use as a screening method
will lead to earlier detection and earlier intervention, perhaps impacting survival and
mortality in lung cancer. This method has a modest sensitivity to detect lung cancer, but low
specificity, which leads to many false positives and a low negative predictive value. The
present study is designed to address both of these limitations by: 1) identifying individuals
in the population at highest risk for developing lung cancer (due to smoking habits and
decreased pulmonary function) for subsequent CT screening, and 2) performing biomarker
testing in conjunction with the CT scan to improve the ability to discern individuals with
benign lung nodules from those with malignant tumors. The 5th Congressional District of
Kentucky has one of the highest rates of lung cancer in the nation and is an ideal location
to test the validity (sensitivity and specificity), feasibility (negative and positive
predictive value), and efficacy (stage distribution shift to earlier stage disease, increased
survival, and decreased cancer-specific mortality) of these strategies to enhance early
detection.