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Lung Cancer Screening Using Low-Dose Computed Tomography
Published in Ayman El-Baz, Jasjit S. Suri, Lung Imaging and CADx, 2019
Alison Wenholz, Ikenna Okereke
Lung cancer screening programs are designed to detect and diagnose lung cancer in high-risk patients who are asymptomatic at a stage where curing the disease is more likely. In 1960, the Northwest London Mass Radiography Service was the first screening test designed for lung cancer. The study utilized a biannual chest X-ray and sputum cytology in 55,000 male smokers. In 1970, the Memorial Sloan-Kettering Cancer Center, Johns Hopkins, and the Mayo Clinic all instituted screening programs utilizing chest X-ray and sputum cytology. All four studies determined that sputum cytology was unnecessary and that screening with chest X-ray did not significantly alter mortality rates compared to the control group [7]. All four studies had population biases skewed toward white males.
Lung cancer
Published in Louis-Philippe Boulet, Applied Respiratory Pathophysiology, 2017
Despite these new treatments, lung cancer prognosis is generally poor with an approximate overall 5-year survival rate of only 15%. This is essentially due to the late stage at which lung cancer is diagnosed in the majority of patients, when curative surgery in not possible anymore. Because large-scale systematic screening studies have not yet managed to clearly translate into improved survival as in screening programs for breast, prostate, and colon cancer, lung cancer screening is therefore not recommended yet although recent data suggest that screening with low dose CT may reduce lung cancer mortality [25]. At a populational level, primary prevention aiming at tobacco smoking reduction via regulatory measures clearly has to be pursued.
Lung cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Recently, the American National Lung Cancer Screening study was reported.1 This was a large randomized trial involving more than 50,000 participants. High-risk individuals were randomized between annual low-dose computed tomography (LDCT) and CXR. A higher proportion of stage I cancers were identified in the LDCT arm than in the CXR arm (54% vs. 36%), which translated to a significant mortality benefit. Encouraging preliminary results from the Dutch lung cancer screening study NELSON were also recently reported.2 In this study, more than 15,000 high-risk individuals were randomized between no intervention and LDCT at baseline and 1, 3 and 5.5 years. In the study, 209 lung cancers were detected by LDCT and 70% were stage I. Mortality data from this study will not be available for several years. Despite an excess of benign non-calcified lung nodules being identified, leading to further investigations and potential patient anxiety, there is growing evidence that LDCT is effective in detecting early-stage (hence curable) disease. Results from the ongoing U.K. lung cancer screening pilot study are awaited, and together with NELSON they will likely affect U.K. lung cancer screening provisions.
Preliminary Investigation and Imaging Analysis of Early Lung Cancer Screening Among Petroleum Workers in North China
Published in Cancer Investigation, 2021
Zhi-Jun Guo, Quan Zhang, Yan Liu, Ze-mei Bai, Lin Qiang, Hai-yan Li, Yu-huan Zhang, Hong-wei Chi, Ming Men, Qian Xu, Fei Liang, Wen-Qiu Feng, Jun-ying Lu, Hai-Tao Liu, Yan-hong Zeng
Lung cancer is now the commonest cancer worldwide, with 2.1 million people diagnosed in 2018 and 1.8 million deaths (7). LDCT screening is an effective method for early detection of lung cancer (8). This opened a new era in which lung cancer screening is now increasingly recommended by almost every professional organization (3,9). This study mainly focused on petroleum workers in North China, CT screening has been increasingly used in recent years because of attaching the importance to their health. The rapid growth of LDCT screening is due to the fact that their health has always been highly concerned and valued in all aspects. On the other hand, the screening criteria are relatively broad, especially in terms of smoking history and age. These are the reasons why the age of petroleum workers screened with LDCT is lower than that of non-petroleum workers. Whether it is appropriate to broaden the selection criteria for LDCT screening has always been a major problem we are facing, and it is also the problem we are working out and will continue to pay attention.
Patient out-of-pocket costs for suspicious pulmonary nodule biopsy in lung cancer patients
Published in Journal of Medical Economics, 2021
Feibi Zheng, James Lavin, J. Michael Sprafka
Lung cancer remains the leading cause of cancer-related mortality worldwide. Despite the development of lung cancer screening regimens for high-risk patients, the vast majority of lung cancers worldwide are diagnosed at late stage1. Though imaging modalities can discriminate high-risk lesions from low-risk lesions, tissue biopsy is required not only for definitive diagnosis but is also used for molecular testing for further prognostic stratification and determination of treatment with targeted biologics. A new area of study is the financial burden of lung cancer screening and diagnosis on patients. Though some recent studies have examined the financial toxicity to patients from diagnosis through an initial period of treatment or for a specific treatment regimen, virtually nothing is known about the financial burden patients face in their journey to obtain a definitive tissue diagnosis. Financial toxicity or financial stress related to treatment has been correlated with patient non-compliance with recommended treatment, a lower quality of life, and more pain in cancer patients2–4. The purpose of this study is to quantify and characterize patient out-of-pocket costs (OOPCs) for lung cancer patients from the date of initial suspicious imaging to definitive diagnosis of lung cancer.
The potential impact of chronic obstructive pulmonary disease in lung cancer screening: implications for the screening clinic
Published in Expert Review of Respiratory Medicine, 2019
Robert P Young, Raewyn Hopkins
The primary aim of lung cancer screening is to identify early-stage lung cancer and prolong survival following surgical removal [1]. However, the utility of CT screening is dependent on characteristics of both the screening participant (e.g. comorbid disease, gender, and operability) and their lung cancer (e.g. histology, stage and volume doubling time) (Figure 1) [2]. In the National Lung Screening Trial (NLST), a reduction in lung cancer death of 16–20% was observed in those randomized to annual Computed Tomography (CT) screening relative to CXR screening [3]. Although a number of small European lung cancer screening studies have failed to show a significant benefit with annual CT screening, the largest of these has recently announced they have even better reductions in lung cancer mortality than was reported in the NLST [4]. The Dutch-Belgian study (NELSON) randomized 18,000 eligible current or former smokers to CT screening or usual care (no screening) and reported reductions in lung cancer deaths of about 30–40% in their screening group (26% in men and 40–60% in women) [4]. On the back of the initial findings from Henschke and colleagues [5], the positive results of these randomized CT-based screening studies are likely to consolidate support for lung cancer screening worldwide although cost-effectiveness remains an issue and is highly dependent on the characteristics of the screening population, screening outcomes and available resources [6].