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Smoking Cessation and Lung Cancer Screening Programs: The Rationale and Method to Integration
Published in Ayman El-Baz, Jasjit S. Suri, Lung Imaging and CADx, 2019
Meghan Cahill, Brooke Crawford O'Neill, Kimberly Del Mauro, Courtney Yeager, Bradley B. Pua
In 1999, it was established by the Early Lung Cancer Action Program (ELCAP) that the increased sensitivity of LDCT proved beneficial for detection of small noncalcified nodules and early-stage cancers [8]. Following, in 2006, the International Early Lung Cancer Action Program (I-ELCAP) reported that the vast majority of lung cancers detected by LDCT were in clinical stage I and thus more likely to be curable by surgical resection. This was demonstrated by an observed increase in 10-year survival from 88% to 92% for individuals with stage I cancer who underwent surgical resection within 1 month after diagnosis. Conversely, the few who did not receive treatment died within 5 years [9]. Five years later, the expansive 2011 National Lung Screening Trial (NLST), funded by the National Cancer Institute, solidified the need for screening recommendations in high-risk populations by determining that screening with LDCT, compared to chest radiography, significantly reduced lung cancer mortality by 20% among patients at high risk for developing lung cancer [10].
What is asbestosis and what is not: Radiology and pathology correlates
Published in Dorsett D. Smith, The Health Effects of Asbestos, 2015
American researchers performed a study of 53,454 current or ex-smokers with a history of smoking at least 30 pack-years to compare the sensitivity of low-dose CT scanning with chest x-ray screening. They demonstrated that low-dose CT scanning of current and ex-smokers can find lung cancers at an early stage before they could be visible on chest x-ray. Lung cancer was discovered in 1.1% of the CT-scanned group compared with 0.7% of the chest x-ray-screened group. The limitation of CT scanning for the detection of lung cancer is related to the cost of the frequently found false positives, small scars, and benign nodules that may result in unnecessary surgery for a benign condition. (The National Lung Screening Trial. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 2013;368:1980–91; Ollier M Jr, Chamoux A, Naughton G, Pereira B, Dutheil F. Chest computed tomography screening for lung cancer in asbestos occupational exposure: A systematic review and meta-analysis. Chest 2014;145(6):1339–46.) CT scanning not only discovers early small lung cancers, but also detects many other abnormalities, such as focal lung scarring, which could be confused with an asbestos-related condition.
X-ray Vision: Diagnostic X-rays and CT Scans
Published in Suzanne Amador Kane, Boris A. Gelman, Introduction to Physics in Modern Medicine, 2020
Suzanne Amador Kane, Boris A. Gelman
Now that 60% of US hospitals own a spiral CT scanner, the applications of CT imaging have dramatically expanded as fast, large-volume scans are routinely available. One use of spiral CT being studied is imaging of the lungs to detect cancer. In spite of the fact that lung cancer is the most common cause of cancer-related death in the US, evidence for benefits of lung cancer screening by chest x-ray or spiral CT is very mixed at the moment. There is a lack of evidence to date that early screening of even high-risk groups, such as smokers, saves lives. According to the CDC, in 2015 there were 218,527 people in the US diagnosed with lung cancer; as is true for other cancers, earlier detection can lead to more effective treatment and reduced mortality. While the potential benefit is large, with 90 million current or former smokers at risk in the US alone, the cost of screening is also high, at $300 to $1000 per scan. In addition, there is presently no evidence that spiral CT scans can catch fast-growing lung cancers at an earlier, more treatable stage, rather than just identifying larger, slower-growing tumors, with little improvement in outcomes. Another issue is whether the technique just leads to false positives: detection of suspicious but benign nodules, leading to unnecessary, dangerous biopsies and surgeries. The NIH is presently sponsoring several large scale population studies aimed at clarifying this urgent public health question. The National Lung Screening Trial, conducted in the years 2002–2010, was designed to compare screening by spiral CT and chest x-rays using a large prospective randomized clinical trial. A group of 53,454 former or current smokers were randomly assigned to receive a series of either spiral CT or standard chest x-rays to screen for lung cancer, including the follow-ups. The results, published in 2011, showed that participants who had undergone spiral CT scans had a 15%–20% lower mortality risk from lung cancer than participants who had received standard chest X-rays.* The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial will compare lung cancer mortality in a large group receiving chest x-rays with a control group that does not; preliminary results available from 2006 only show that the chest x-rays indeed detected many early lung cancers, but at the expense of many false positives. Further follow-ups and data collection was done through 2015. The NIH-sponsored Lung Imaging Database Consortium, by contrast, is designed to help understand how to best use spiral CT as a resource for finding lung cancer by creating a database of shared images for use in research, training, and clinical practice; for example, the database can be used to help develop computer algorithms that assist radiologists in identifying likely tumors based on their appearance in spiral CT scans.
Comparing the downstream costs and healthcare utilization associated with the use of low-dose computed tomography (LDCT) in lung cancer screening in patients with and without alzheimer’s disease and related dementias (ADRD)
Published in Current Medical Research and Opinion, 2021
Yahan Zhang, Jiang Bian, Jinhai Huo, Shuang Yang, Yi Guo, Hui Shao
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death worldwide1. In the United States (US), 228,820 new lung cancer cases and 135,720 lung cancer-related deaths were estimated for 2020, accounting for 22.4% of all cancer deaths2. Lung cancer is deadly when diagnosed at an advanced stage, where the 5-year relative survival rate dropped substantially from 59.0% for localized cases to 5.8% for metastasized cases2. Finding an effective screening strategy for the early detection of lung cancer is thus critical as it allows timely cancer treatments at an early stage and offers a better chance of prolonging the life expectancy. In 2011, results from the National Lung Screening Trial (NLST) revealed that screening for lung cancer using low-dose computed tomography (LDCT) had superior clinical efficacy compared to screening using traditional radiography by reducing lung cancer mortality rate by 20%3. Based on findings from the NLST, professional societies including the US Preventive Services Task Force (USPSTF)4, the National Comprehensive Cancer Network (NCCN)5, and the American Cancer Society (ACS)6, published guidelines and recommended annual screening with LDCT in populations at a higher risk for lung cancer. On 5 February 2015, The Centers for Medicare & Medicaid Services (CMS) issued the decision memo for lung cancer screening with LDCT, added the annual screening for LDCT as a preventive service benefit for the eligible populations7.
Interventional pulmonary medicine
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Chrystal Chan, Christopher A. Hergott
Following publication of the U.S.-based National Lung Screening Trial (NLST) in 2011,8 lung cancer screening with low-dose computed tomography (LDCT) has been adopted in the United States, however uptake has been slower in other countries. In the Dutch-Belgian NELSON trial published in February 2020, arguably the only other adequately powered lung cancer screening trial, lung cancer mortality was reduced by 24% at 10 years of follow-up among 13,195 high-risk male participants.9 The NELSON protocol differed from the NLST in utilizing a volume-based nodule management protocol, with scans performed at 1 year, 2 year and 2.5 year intervals, and short-term follow-up imaging for indeterminate nodules. As a result, the positive predictive value of a positive screening test in NELSON was 43.5%, much higher compared to 3.8% in NLST, with lower rates of overdiagnosis and false positive tests. Although women comprised only 16% of the study population, the reduction in lung cancer mortality appeared greater at 33%; similar findings have been suggested in the NLST cohort.10 Despite 2 multicenter adequately powered studies that demonstrate improvement in lung cancer mortality with LDCT screening, there are currently no full-scale lung cancer screening programs in Canada. A publicly funded pilot program was initiated in 2017 in Ontario, and in other provinces, screening opportunities have been offered through research initiatives or philanthropic funding.11 British Columbia recently announced plans to institute a provincial screening program starting in 2022, the first in Canada.12
Socioeconomic Factors Associated with Lack of Treatment in Early Stage Non-Small Cell Lung Cancer
Published in Cancer Investigation, 2019
Shraddha M. Dalwadi, Jun Zhang, Eric H. Bernicker, E. Brian Butler, Bin S. Teh, Andrew M. Farach
The National Lung Screening Trial established the importance of screening high-risk patients in 2011 with 320 screenings needed to prevent one lung cancer death. This prompted the United States Preventative Task Force to incorporate lung cancer screening into national guidelines (22). Other studies validate annual low-dose CT screening for lung cancer, as it provided cure for most high-risk patients diagnosed with early-stage NSCLC. However, all patients forgoing treatment died within 5 years (23). Clearly, definitive treatment is the key link between secondary prevention and survival benefit in lung cancer. Our data identify characteristics of those patients who are most likely to forgo treatment in early stage disease, including: lack of insurance or Medicaid-dependence, unmarried marital status, advancing age, lower income, African American or Asian/Pacific Islander race, and male sex.