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Implications for Lung Cancer Screening in the Elderly

Mark A. O'Rourke, MD; John R. Feussner, MD; Polly Feigl, PhD; John Laszlo, MD

JAMA. 1987;258(7):921-926.

Abstract
Lung cancer increases in incidence with increasing age and is the leading cause of cancer death in the United States. While mass screening for lung cancer is not indicated, selective screening of high-risk target groups may be beneficial. We tested the hypothesis that lung cancer is initially seen at a less advanced stage with increasing age using incidence cases (N = 22874) from the Centralized Cancer Patient Data System. The percent of lung cancer patients with local stage disease increased from 15.3% of those aged 54 years or younger, to 19.2% of those aged 55 to 64 years, to 21.9% of those aged 65 to 74 years, and to 25.4% of those aged 75 years or older. The percent with distant stage decreased from 48.7%, to 44.5%, to 40.3%, and to 36.7% for the same age groups, respectively. These age-stage trends persisted in subgroup analysis by sex, race, and histological subtype. Furthermore, analysis of 6332 patients who underwent surgical staging showed a greater likelihood of local stage disease with increasing age. Thus, compared with the young, the group aged 65 years or older is at a greater risk for lung cancer and has a higher proportion of lung cancer initially seen at local stage. The efficacy of selective screening for lung cancer in this target group warrants additional study.

(JAMA 1987;258:921-926)

Author Affiliations
From the Divisions of Geriatrics (Dr O'Rourke), Hematology-Oncology (Dr O'Rourke), and General Internal Medicine (Dr Feussner), Duke University Medical Center, and the Durham Veterans Administration Medical Center (Drs O'Rourke and Feussner), Durham, NC; the Statistical Analysis and Quality Control Center, Fred Hutchinson Cancer Research Center, Seattle (Dr Feigl); and the American Cancer Society, New York (Dr Laszlo). Dr O'Rourke is now with the Durwood Medical Clinic, Inc, Charlotte, NC.

Footnotes
Reprint requests to (182) Geriatrics Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC 27705 (Dr Feussner).

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