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The International Early Lung Cancer Action Program (I-ELCAP) is an uncontrolled prospective study of annual lung cancer screening by spiral computed tomography. More than 31,000 people were enrolled from 1993 through 2005; all were at increased risk for lung cancer by virtue of smoking history or occupational exposures, and all were deemed fit to undergo thoracic surgery. Study centers were guided by protocols for evaluating abnormal lung nodules; these evaluations included biopsies or repeat scans at shorter intervals.
During a median follow-up of 40 months, lung cancer was diagnosed in 484 patients; 85% of the cancers were clinical stage I. Estimated 10-year survival was 80% for all patients with lung cancer, and 88% for those with stage I…