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A group focused on reducing the mortality from lung cancer has issued a statement lambasting a new report by the National Cancer Institute (NCI) of the National Institutes of Health (NIH; Bethesda, Maryland), saying that the report does a disservice by discouraging early screening for the disease.

Laurie Fenton, president of Lung Cancer Alliance (Washington), said, “For the third time in three months, the NCI has tried to debunk the grim mortality statistics on lung cancer and ignore the critical need for earlier detection on the nation's No. 1 cancer killer. The question that begs to be answered is 'why?'”

Fenton was referring to an article published in the most recent issue of the Journal of the National Cancer Institute, claiming that lung cancer screening can lead to over-diagnosis, finding tumors that might not otherwise have been found during a person's lifetime and wasting healthcare resources. The study also suggests that the additional testing and treatment that results may lead to substantial toxicity and even premature death.

Pamela Marcus, PhD, of the NCI, and colleagues surveyed 7,118 participants in the Mayo Lung Project for information on their lung cancer diagnosis, health and smoking history, and chest scan results after the study's initial follow-up in July 1983. The patients in the initial project had been randomly placed in two groups, one of which underwent multiple screening chest X-rays and spectrum tests used to identify lung cancer.

The authors identified a total of 585 cancers in the patients in the screened arm and 500 cancers in the group that was not screened. They report that the 85 more cancers found in screened patients suggests that screening can lead to over-diagnosis of the disease.

The authors characterized the number of over-diagnoses with this method “modest,” but said that “the very real and deleterious role that over-diagnosis plays in mass screening can not be discounted. The newest imaging technologies can detect very small lung abnormalities, but these abnormalities may be clinically unimportant. The question remains as to whether early detection of lung cancer through mass screening results in a net benefit to the public's health.”

Fenton, however, said that this conclusion is “exactly what was said by the opponents of mammography screening 30 years ago, yet this is even more ludicrous. First of all, the study they refer to is 40 years old and was so badly designed that it has already been repudiated by the experts years ago.”

She also said that the study focused on the use of X-ray for the screening, “not CT [computed tomography] scans which, it is widely agreed, more accurately detect lung cancer tumors. I do not know why NCI would spend badly needed funding to rehash an old, meaningless study when so much needs to be done on lung cancer.”

She noted that lung cancer continues to have a higher per-year mortality rate than the combined deaths from breast, prostate, colon, kidney, melanoma and liver cancers. “Over-diagnosis is not killing people,” she said. “Lung cancer is – about 440 people a day, one person every three minutes – and three-quarters of them were already at lethal stages when diagnosed.”

Fenton added: “Three months ago, the NCI announced that all cancer mortality was dropping, ignoring the statistics on lung cancer. Last month, NCI said that non-smoking women should feel relieved that their lung cancer mortality rate is slightly less than non-smoking men, ignoring the fact that women of the United States have the second highest lung cancer mortality rate in the world and don't even know it. Now we have the NCI wasting more time and money on anti-lung cancer screening PR.

“Again we call on NCI to address the biggest cancer killer with a sense of urgency and commitment, and to assist those dedicated professionals who have been working so hard to make early detection a reality.”

The Lung Cancer Alliance describes itself as the only national non-profit organization solely dedicated to patient support and advocacy for people living with lung cancer and those at risk for the disease. In January, LCA issued the first-ever Report Card on Lung Cancer, an assessment of progress being made in the battle against the disease. “The majority of grades received were failing,” the organization said.

NIH awards 'bench-to-bedside' $4 million

The NIH yesterday reported it has awarded nearly $4 million to fund 19 bench-to-bedside medical research projects intended to speed translation of laboratory discoveries into medical treatments.

Awards were made in four categories funded by the NIH Office of Rare Diseases; the NIH Office of AIDS Research; the National Center on Minority Health and Health disparities; and the NIH Office of Research on Women's Health. A fifth category is co-funded by sponsoring institutes and, for the projects' extramural components, the NIH National Center for Research Resources. Project teams receive up to $200,000 over two years to support their work.

The bench-to-bedside research program was created within the NIH Clinical Center (Bethesda, Maryland), NIH's clinical research hospital, to encourage collaborations among basic scientists in the laboratories and clinical investigators who work with patients, said John Gallin, MD, NIH Clinical Center director.

“Historically a hallmark of this program has been support for projects that involve partnerships between basic and clinical scientists from across institutes at NIH. The new component started this year profoundly expands the partnerships in medical research to government and non-government scientists,” Gallin said.

“The new bench-to-bedside awards program is a good example of NIH's commitment to transforming medicine through discovery,” said Elias Zerhouni, MD, NIH director. “It encourages innovative partnerships between extramural and intramural researchers and opens new opportunities for advancing medical science.”

This is the first year projects in minority health and health disparities and women's health have been specifically funded. Quality of the science, promise for becoming an active clinical trial and potential for offering a new medical treatment or better understanding an important disease process were among selection criteria.

Eight teams received funding for investigations focusing on rare diseases. Four teams will conduct AIDS-related studies. The work of four teams target minority health and health disparities.

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