South London Lung Cancer Study

Abstract

To assess whether six-monthly routine chest radiography could improve the present poor prognosis of bronchial carcinoma, the South London Lung Cancer Study offered a service aimed at earlier diagnosis to men aged 45 and over by the mass x-ray units in South London. Of the 67,400 men attending for a first examination 75 % came back at least once ; 197,500 repeat examinations were carried out. These revealed 147 patients with confirmed primary bronchial carcinoma, 27% of whom lived four years or more. Of 83 men undergoing resection 39 (47%) were alive four years later. Men aged 45 to 54 (though having as great a proportion of growths resected as the older men) did badly, but the experience with the 84 older men was encouraging. The interval between penultimate and ultimate routine films was found to affect survival, and even more striking was the relation of the interval between examinations to prognosis after resection. Cancer Registry records revealed that six-monthly serial routine mass radiography picked up 56% of all cases in this series ; 44% of cases had fallen ill, to be discovered clinically between the routine examinations. The overall four-year survival rate of the whole group was 18%, compared with 9% for all patients in the region, the difference being wholly in patients aged 55 and over. These findings seem to confirm that prognosis is improved by early diagnosis, which can be improved if routine examinations are carried out at intervals not exceeding six months. Probably a mass x-ray unit concentrating on men aged 55 and over smoking 15 cigarettes a day could salvage four-year survivors at a cost of only £300 each. Every 1,000 films taken would pick up a potential four-year survivor. This study was possible only with the help of many people. We are grateful to them all, particularly the staffs of the Registrar General's Office and of the National Health Service executive councils in England and Wales, the South Metropolitan Cancer Registry, the S.E. and S.W. London Mass X-ray Services, the medical and surgical staff of the Brompton Hospital, and the staff of the Brook Thoracic Surgical Unit. We thank the S.E. and S.W. Metropolitan Regional Hospital Boards for support from research funds. We thank Miss G. Whitworth for invaluable help with drafting this paper and for tabulations ; Miss J. Higgs, Miss M. Ravenscroft, and Miss A. Taylor for help in the follow-up ; and Mr. E. Uztups for the illustration. © 1968, British Medical Journal Publishing Group. All rights reserved.