Lung Cancer Screening Trials

By Dr. Lance Yokochi
Interviewed by Guest Writer
Wednesday - November 18, 2009
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Dr. Lance Yokochi
Occupational medicine, Principal investigator of the National Lung Screening Trial (NLST)

What is the Pacific Health Research Institute?

It’s an independent, nonprofit organization started by a group of Straub physicians back in 1960. Their thinking was research is the key to better healthcare, both in Hawaii and across the nation, so they started doing research. It has evolved into what it is today with approximately 30 projects.

Can you discuss the types of projects on which PHRI is currently working?

Our project is the National Lung Screening Trial. It’s actually an offshoot of the primary project, the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial that was started in 1993. The NLST study was developed later in 2002. Besides that, PHRI has many different affiliations, and one well-known study is the Honolulu Heart Program. There also are various collaborations with the Veterans Administration and other types of ongoing projects.


Are you directly involved with the National Lung Screening Trial?

Yes. The idea was whether screening for lung cancer would make a difference in the death rate. The PLCO study started screening for lung cancer with a chest X-ray. Just to clarify, screening someone means that they have to have no symptoms and they are healthy. For the PLCO study, we recruited individuals age 55-74, of whom half were screened with a chest X-ray and the other half were not. Over the years, medicine has evolved and the thought processes also have evolved with it. A spiral CT scan can detect smaller cancers versus a chest X-ray. So the thought was to get smokers or former smokers (30-pack-year history), who have an increased risk of developing lung cancers. Half received the chest X-ray screening and half received the spiral CT scan screening, which started in 2002. Enrollment ended in 2004. In Hawaii, we’ve enrolled about 2,400 participants. Nationwide, 54,000 participants have been recruited. So we’ve been following our participants annually. They were all screened for three years and since the screening has ended, we’ve been following them with an annual survey to determine their health status.

Dr. Yokochi (center) with a few of the hard-working staff at Pacific Health Research Institute

The trial recently received $2.8 million in federal funding. Can you explain what this money will be used for?

It’s to continue the study by extending it to September 2011, which coincides with the end of the main study, the PLCO study.

Can you elaborate on the importance of this study?

With certain cancers like lung cancer, once someone has symptoms it has usually spread to outside of the lung. So the premise is that if you can pick up a smaller cancer earlier, then the patient will do better. Intuitively, it would seem that if you can pick up a smaller cancer, then you will have a better chance to cure it. But we don’t know the answer to that, and that’s why we’re doing this study.

Does some of the funding for the project go to compensate the participants?

No. Actually, we’re very fortunate in that we have very dedicated participants who have signed up for our study. They do not get any direct compensation. The only benefit is that they get the screening exam, so that was an incentive to join the study. Other than that, the only participants who were “compensated” were the Neighbor Island participants, who were given a plane ticket to come to Honolulu to get the screening tests. There are other studies that do give financial compensation, but not ours. Many of our participants have stepped up, perhaps not because it will help them directly, but to help the future generations. That’s what we have heard a lot from our participants.

Can you describe your private practice?

In my private practice, I practice occupational medicine, which deals with work injuries. I treat anyone injured on the job and also do independent medical examinations. Also, once an injured worker concludes their care and reaches a point of stability, then they are sent to me for an impairment rating to bring closure to their case.

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