New York Early Lung Cancer Action Program: NY-ELCAP

LUNG CANCER SCREENING

The best hope of curing lung cancer is finding it as early as possible.  If you are at risk, this new test can detect tiny spots on your lungs years before they would ever be seen on a regular chest x-ray.  These  tiny spots, or nodules, may be signs of early lung cancer.

ABOUT THE PROGRAM

The New York Early Lung Cancer Action Program, known as NY-ELCAP, is a research study to determine if low-dose CT scanning technology is an effective screening technique to detect lung cancer in it's earliest stages for people at high risk for the disease.

ABOUT THE TEST

The Low-dose screening CT is a quick 20-second scan of your chest and lungs. The CT scanner is shaped like a donut, with a table that quickly slides you in and out of the machine.  No injections or medications needed.

MAKING AN APPOINTMENT

If you qualify for the NY-ELCAP study, the screening CT exam is FREE.  Based on the results, additional diagnostic tests may be necessary.  The payment for those tests will be your responsibility, most insurance companies cover these costs.  Your results will be reviewed by a team of researchers and then will be discussed with you and your sponsoring physician.

BACKGROUND INFORMATION

The Early Lung Cancer Action Project (ELCAP) demonstrated that low-dose chest computed tomography (CT) screening conducted on persons with a high risk for lung cancer has the potential to markedly increase the detection of small, early lung cancer.  In a study of 1,000 individuals with 10 pack-year histories of cigarette smoking reported in Lancet (July 10, 1999;354, pages 99-105), Henschke et al showed that malignancies detected by the CT screening were missed on high quality chest radiographs 85 percent of the time, confirming the expectation that, relative to traditional chest radiography, CT-based screening markedly enhances the detection of small non-calcified nodules and, thus, of lung cancer at earlier and  more curable stages relative to what is known to prevail in absence of screening.  On baseline screening, non-calcified nodules were detected three times as commonly (23% vs 7%) by CT as by chest radiography, malignancies four times as commonly (2.7% vs 0.7%) and Stage I malignancies six times as commonly (2.3% vs 0.4).  Of the 27 lung cancers detected in this population, 23 (85%) were Stage I as compared to only 15% of cancers found in a non-screened population.  Preliminary results of annual repeat CT screening are also very encouraging since the lung cancers found on incidence screening are typically less than 10 mm in size, and over 80% of them are Stage IA and therefore anticipated to have very high cure rates (>80%).

Representing a partnership of 37 of New York’s pre-eminent medical schools, academic health centers, and research institutions, AMDeC is uniquely positioned to implement a broad-scale study to further test the effectiveness of CT screening.  The New York Early Lung Cancer Action Project (NY-ELCAP), using an alternative methodology to the randomized control trial, will validate these results in a larger segment of the population to be screened at 11 of AMDeC’s member institutions.  These institutions will work together to enroll up to 10,000 women and men aged 60 or older who have a ten pack-year history of cigarette smoking, no prior cancer, and are fit to undergo thoracic surgery, if warranted.  Enrollee data will be directly entered by investigators and their research team into the local, as well as central database, and all images will be sent to a central image repository.  The Principal Investigator for the study will be Dr. Claudia Henschke, Professor of Radiology and Division Chief of Chest Imaging at the Weill College of Medicine of Cornell University; the Weill Medical College will serve as the coordinating academic center for the study.

A major focus of the NY-ELCAP will be recruiting minority populations. Lung cancer affects communities of color at disproportionately high rates, and is more fatal in these communities than in comparable populations of Caucasian individuals.  For example, the mortality rate for African American men with lung cancer in the mid-1990s was over 46 percent higher than the mortality rate for white men with the disease.  This difference is in large part due to the fact that many minority communities have limited access to health care information, diagnostic procedures, and medical treatments. Thus any study that evaluates the effectiveness of lung cancer screening should necessarily draw its sample from underserved and medically disadvantaged communities.

This recruitment of minority participants will be done through extensive community outreach efforts.  Participating institutions will partner with community-based organizations in their catchment area in order to enroll participants from target racial and ethnic groups into the study.  In addition, the study will establish a Community Advisory Board made up of prominent leaders from New York’s various communities.  The members of this Board will promote the study within their communities as well as advise the study on its community-based recruitment efforts.


FREQUENTLY ASKED QUESTIONS

Am I at risk for developing lung cancer?
You may be at risk if you are or have been a smoker and are 60 years old and older.  

Why would I want to have a lung cancer screening CT?
The best hope for curing lung cancer is finding it as early as possible.  If you are at risk , this new test is able to detect tiny spots on your lungs (called nodules) that may be indicative of lung cancer in its earliest stage.

I’ve had chest x-rays before, why would I want to have this scan?
A chest x-ray only shows two views of your chest (front and side), while a CT scan shows cross-sectional images all through your chest-from the tips of your lungs through the lung bases.  Thus, tiny abnormalities (that could be early stage lung cancer) can be found which would never have been seen on a chest x-ray.
 
How does the Screening CT test work?
The screening CT test is a quick 20-second scan of your chest and lungs.  The CT machine is shaped like a donut, with a table that quickly slides you in and out of the donut.  No injections or medications are needed.

How much radiation is used in the Screening CT scan?
The screening CT scan is a low-dose scan. The radiation dosage is two to three times more than from a standard chest x-ray.

Will this test (CT) show other lung abnormalities besides cancer?
Yes. Old or new pneumonia, tuberculosis, or emphysema may be detected.

Will my heart be evaluated on the low-dose chest CT?
A limited evaluation will be done.  The radiologists are able to see heart size and can detect calcifications in the arteries when present.

Will I benefit from a low dose lung cancer screening CT?
A study was performed on 1,000 current and former smokers, over 60, with no history of cancer (Lancet) and found a significant number of early stage lung cancers, which would not have been seen on a conventional chest x-ray.

What is the NY-ELCAP CT Screening study?
The New York Early Lung Cancer Action Program, known as NY-ELCAP, is a study to determine if low-dose CT scanning is an effective screening technique to detect lung cancer in its earliest stages for people at high risk for the disease.

Why is the NY-ELCAP research project important?
This research study will confirm whether the use of new CT screening technology can dramatically improve the early detection of lung cancer among people at high risk.
    
Am I eligible to join the NY-ELCAP CT Screening study?
To be eligible you must be:
· 60 years of age or older
·A current or former smoker of at least one (1) pack per day for (10) years ( or two packs per day five years)
·No prior cancer of any type (except non-melanotic skin cancer).
·In good health 

How much will the Screening CT cost?
If you qualify for the NY-ELCAP study, the screening CT exam is free.  Based on the results, diagnostic tests may be recommended for follow-up. The cost of those tests, or insurance coverage for them will be your responsibility.   

How will I receive the results of the CT Screening?
Results will be mailed to you and your sponsoring physician.  In addition to mailing results of the study, they will be discussed with your sponsoring physician.  A team of researchers also will review results.

I’m interested.  How do I make an appointment?
Please call the NY-ELCAP study hotline at toll-free 1-866-693-5227 (NY-ELCAP) or pre-register on line to be connected with a site near you. When you call, a coordinator will determine your eligibility for the study. We ask that you please be prepared to give the following information:
·          Your name, address, phone number, birth date, parent’s first  names and smoking history as well as a convenient time for you to schedule a scan

When can I schedule an appointment?
The times will vary from site to site.  Once we have all your demographic information we will be able to schedule you for a specific time and date. 

How long will my appointment take?
The actual CT scan takes only about 5 minutes total (with set up and scanning time).  So you are only exposed (scanned) for the 20-30 seconds that you will hold your breath.  The registration and interview with the coordinator may add an additional 25-30 minutes to your visit.  We recommend setting aside one hour of your schedule for this appointment, even though it should not take that long.

NYELCAP.org