According to results presented at the 97th annual meeting of the American Association for Cancer Research (AACR), the addition of a gene expression test to the standard bronchoscopy procedure significantly improves the detection rate of early lung cancer.
Lung cancer is the leading cause of cancer-related deaths in the U.S. Cure rates for advanced lung cancer remain at approximately 5% at five years following diagnosis. Conversely, patients diagnosed with the earliest stages of lung cancer, prior to its spread from the site of origin, have cure rates of over 60% at five years following diagnosis; this demonstrates the importance of early diagnosis for patients with lung cancer.
Bronchoscopy is a procedure in which a lighted tube is placed into the airways of the lung so that physicians can look for abnormal areas of tissue when lung cancer is suspected. Unfortunately, the existing process for detecting very early lung cancer-involving a bronchoscopy when an X-ray or scan shows abnormalities-needs improvement.
Gene expression is an exciting new approach to individualizing treatment options, identifying individuals at a high risk for the development of certain cancers, and detecting cancer. Researchers continue to evaluate the role of genetic expression in oncology.
Researchers from Boston University and other medical institutions recently conducted a trial to evaluate the effectiveness of using gene expression signatures in addition to bronchoscopy to detect lung cancer.
First, researchers identified a group of genes that could correctly identify lung cancer among smokers. Expression of these genes was then used in addition to bronchoscopy with 152 smokers who were thought to potentially have lung cancer. Physicians collected tissue samples from the large airways of the patients during the bronchoscopy; the tissue was then tested for the genetic expression of the identified gene signature.
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- Bronchoscopy plus the microarray (laboratory analysis of gene expression) identified 95% of patients diagnosed with either early or late stage lung cancer.
- The microarray identified 80% of patients who developed lung cancer.
- Bronchoscopy identified 53% of patients who developed lung cancer.
- Identification rate of stage I lung cancer was 90% with bronchoscopy and microarray; this is significant because identification of stage I lung cancer is typically less than 50%.
The researchers concluded that the combination of gene expression plus bronchoscopy significantly increases the rate of correct identification of lung cancer-even very early lung cancers. This increased detection of early lung cancer may ultimately lead to improved survival for patients with this disease.
Patients who are to undergo a bronchoscopy procedure because of suspicious areas on an X-ray or scan may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating gene signatures or other novel diagnostic measures. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.
Reference: Spira A, Beane J, Shah V, et al. Airway Gene Expression: a Novel Diagnostic Test for Lung Cancer in Smokers. Presented at: 97th Annual Meeting of the American Association for Cancer Research; April 1-5, 2006; Washington. Abstract #2420.
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