Is Survey Cancer of the Lung Curable?

¹ Professor of Preventive Medicine and Clinical Professor of Medicine, Woman's Medical College of Pennsylvania and Director of X-ray Surveys, Philadelphia Department of Health
² Associate Professor of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania and Chief, Tuberculosis Control Section, Philadelphia Department of Health.

1. The prevalence per 100,000 of proved bronchogenic carcinoma among 142,156 surveyed Philadelphians on whom appropriate basic data were available was: three for females, 37 for group as a whole, 69 for males, and 284 for males over 45.

2. The survivorship of 100 consecutive cases of proved bronchogenic carcinoma detected by photofluorograms taken from January 1, 1947 to May 31, 1953 at two official Philadelphia survey units is presented. Of the 57 patients with a minimal three-year follow-up period, only five (9 per cent) were resected and alive at the end of the three years after their first abnormal photofluorograms.

3. Exploration was carried out in 52 instances but resection was only possible in 30. Immediate hospital mortality was 17 per cent.

4. Detailed survival studies on the 57 patients surveyed prior to August 31, 1950 suggest a more grave prognosis for those younger than 55, those whose photofluorograms obviously suggested neoplasm or tuberculosis, those with respiratory symptoms severe enough to have caused them to seek medical advice, those with bronchoscopic abnormality of any type, those with undifferentiated carcinomas, and those with concomitant active tuberculosis.

5. Paradoxically, the fate of patients hospitalized within three months of their abnormal photofluorograms was worse than that of those with delays of more than three months. Two factors may obscure the true relationship between prompt hospitalization and ultimate fate. The first is the emergency admission of patients whose photofluorograms at once suggested neoplasm and who were mostly already beyond salvage. The second is the better prognosis of those whose film lesions were inconspicuous.

6. Examination of individual components of delay in hospitalization revealed three causes for significant delay—the radiologist, the patient, and the clinician.

7. Any photofluorographic abnormality in men over 45 should be considered as possibly due to lung cancer. The highest salvage may well lie in the group whose films least suggest malignancy.

8. Of 29 patients on whom earlier "negative" films were available, 13 were still considered negative on review while 16 had lesions which had been missed. The fate of the "erroneous negatives" was better than that of the "true negatives."

9. With present techniques, less than 10 per cent of survey-detected lung cancer appears curable. Suggestions are made for improving the situation currently, but it is recommended that the search continue for new more effective case-finding techniques.