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Zhu J, Liu R, Wu X, Li Q, Gong B, Shen Y, Ou Y, Li W. The value of narrow-band imaging bronchoscopy in diagnosing central lung cancer. Front Oncol 2022; 12:998770. [PMID: 36185220 PMCID: PMC9524255 DOI: 10.3389/fonc.2022.998770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Aims This research aimed to study the value of narrow-band imaging(NBI) in the diagnosis of central lung cancer. Materials and methods This study included 916 patients with clinical suspected of central lung cancer or follow-up of patients after curative lung cancer surgery. All of the patients were examined by Olympus Evis Lucera electronic bronchoscope system, any sites that were abnormal when viewed by white-light bronchoscopy (WLB) or NBI were biopsied, four to six biopsies were taken at each site of the abnormal region visualized as lesions, we record the endoscopic features of NBI and compared with histopathology results, to evaluate the diagnostic value of NBI for central lung cancer and the relationship between vascular patterns of NBI and histological types of lung cancer, and try to establish a multinomial logistic regression model for predicting the histological types of lung cancer. The biopsy specimens were examined by CD34 antibody through immunohistochemistry (IHC) method, CD34 marked microvessel density(MVD), compared the number of microvessels between benign and malignant diseases and the number between different histological types of lung cancer, to verify the results of NBI. Results NBI provided high sensitivity (91.7%), specificity (84.9%), positive predictive value (97.6%), negative predictive value (61.5%), and agreement rate (90.7%). The predominant vascular patterns in the well-defined histological types of lung cancer were dotted blood vessels (121 patients), tortuous blood vessels (248 patients), and abrupt-ending blood vessels (227 patients). Logistic regression analysis of the results showed that smoking status of the patient, combined with vascular patterns under NBI, and age partly affect the histological types of lung cancer. Conclusions NBI is highly accurate for the diagnosis of central lung cancer.
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Affiliation(s)
- Juanjuan Zhu
- Provincial Key Laboratory of Respiratory Disease in Anhui, Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Center for Clinical Medicine of Respiratory Disease (Tumor) in Anhui, Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Department of Respiratory Disease, Dangshan County People’s Hospital, Dangshan, China
| | - Rui Liu
- Provincial Key Laboratory of Respiratory Disease in Anhui, Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Center for Clinical Medicine of Respiratory Disease (Tumor) in Anhui, Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiancheng Wu
- Provincial Key Laboratory of Respiratory Disease in Anhui, Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Center for Clinical Medicine of Respiratory Disease (Tumor) in Anhui, Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qin Li
- Provincial Key Laboratory of Respiratory Disease in Anhui, Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Center for Clinical Medicine of Respiratory Disease (Tumor) in Anhui, Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Department of Respiratory Disease, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Beilei Gong
- Provincial Key Laboratory of Respiratory Disease in Anhui, Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Center for Clinical Medicine of Respiratory Disease (Tumor) in Anhui, Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yuanbing Shen
- Provincial Key Laboratory of Respiratory Disease in Anhui, Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Center for Clinical Medicine of Respiratory Disease (Tumor) in Anhui, Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yurong Ou
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Wei Li
- Provincial Key Laboratory of Respiratory Disease in Anhui, Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Center for Clinical Medicine of Respiratory Disease (Tumor) in Anhui, Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- *Correspondence: Wei Li,
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Nestle U, Delorme S. What is the best choice of follow-up procedure following resection of lung cancer? Lancet Oncol 2022; 23:1115-1116. [DOI: 10.1016/s1470-2045(22)00499-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
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Bonney A, Malouf R, Marchal C, Manners D, Fong KM, Marshall HM, Irving LB, Manser R. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev 2022; 8:CD013829. [PMID: 35921047 PMCID: PMC9347663 DOI: 10.1002/14651858.cd013829.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer-related death in the world, however lung cancer screening has not been implemented in most countries at a population level. A previous Cochrane Review found limited evidence for the effectiveness of lung cancer screening with chest radiography (CXR) or sputum cytology in reducing lung cancer-related mortality, however there has been increasing evidence supporting screening with low-dose computed tomography (LDCT). OBJECTIVES: To determine whether screening for lung cancer using LDCT of the chest reduces lung cancer-related mortality and to evaluate the possible harms of LDCT screening. SEARCH METHODS We performed the search in collaboration with the Information Specialist of the Cochrane Lung Cancer Group and included the Cochrane Lung Cancer Group Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, current issue), MEDLINE (accessed via PubMed) and Embase in our search. We also searched the clinical trial registries to identify unpublished and ongoing trials. We did not impose any restriction on language of publication. The search was performed up to 31 July 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) of lung cancer screening using LDCT and reporting mortality or harm outcomes. DATA COLLECTION AND ANALYSIS: Two review authors were involved in independently assessing trials for eligibility, extraction of trial data and characteristics, and assessing risk of bias of the included trials using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. Primary outcomes were lung cancer-related mortality and harms of screening. We performed a meta-analysis, where appropriate, for all outcomes using a random-effects model. We only included trials in the analysis of mortality outcomes if they had at least 5 years of follow-up. We reported risk ratios (RRs) and hazard ratios (HRs), with 95% confidence intervals (CIs) and used the I2 statistic to investigate heterogeneity. MAIN RESULTS: We included 11 trials in this review with a total of 94,445 participants. Trials were conducted in Europe and the USA in people aged 40 years or older, with most trials having an entry requirement of ≥ 20 pack-year smoking history (e.g. 1 pack of cigarettes/day for 20 years or 2 packs/day for 10 years etc.). One trial included male participants only. Eight trials were phase three RCTs, with two feasibility RCTs and one pilot RCT. Seven of the included trials had no screening as a comparison, and four trials had CXR screening as a comparator. Screening frequency included annual, biennial and incrementing intervals. The duration of screening ranged from 1 year to 10 years. Mortality follow-up was from 5 years to approximately 12 years. None of the included trials were at low risk of bias across all domains. The certainty of evidence was moderate to low across different outcomes, as assessed by GRADE. In the meta-analysis of trials assessing lung cancer-related mortality, we included eight trials (91,122 participants), and there was a reduction in mortality of 21% with LDCT screening compared to control groups of no screening or CXR screening (RR 0.79, 95% CI 0.72 to 0.87; 8 trials, 91,122 participants; moderate-certainty evidence). There were probably no differences in subgroups for analyses by control type, sex, geographical region, and nodule management algorithm. Females appeared to have a larger lung cancer-related mortality benefit compared to males with LDCT screening. There was also a reduction in all-cause mortality (including lung cancer-related) of 5% (RR 0.95, 95% CI 0.91 to 0.99; 8 trials, 91,107 participants; moderate-certainty evidence). Invasive tests occurred more frequently in the LDCT group (RR 2.60, 95% CI 2.41 to 2.80; 3 trials, 60,003 participants; moderate-certainty evidence). However, analysis of 60-day postoperative mortality was not significant between groups (RR 0.68, 95% CI 0.24 to 1.94; 2 trials, 409 participants; moderate-certainty evidence). False-positive results and recall rates were higher with LDCT screening compared to screening with CXR, however there was low-certainty evidence in the meta-analyses due to heterogeneity and risk of bias concerns. Estimated overdiagnosis with LDCT screening was 18%, however the 95% CI was 0 to 36% (risk difference (RD) 0.18, 95% CI -0.00 to 0.36; 5 trials, 28,656 participants; low-certainty evidence). Four trials compared different aspects of health-related quality of life (HRQoL) using various measures. Anxiety was pooled from three trials, with participants in LDCT screening reporting lower anxiety scores than in the control group (standardised mean difference (SMD) -0.43, 95% CI -0.59 to -0.27; 3 trials, 8153 participants; low-certainty evidence). There were insufficient data to comment on the impact of LDCT screening on smoking behaviour. AUTHORS' CONCLUSIONS: The current evidence supports a reduction in lung cancer-related mortality with the use of LDCT for lung cancer screening in high-risk populations (those over the age of 40 with a significant smoking exposure). However, there are limited data on harms and further trials are required to determine participant selection and optimal frequency and duration of screening, with potential for significant overdiagnosis of lung cancer. Trials are ongoing for lung cancer screening in non-smokers.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Reem Malouf
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | | | - David Manners
- Respiratory Medicine, Midland St John of God Public and Private Hospital, Midland, Australia
| | - Kwun M Fong
- Thoracic Medicine Program, The Prince Charles Hospital, Brisbane, Australia
- UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Henry M Marshall
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Renée Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Vogel-Claussen J, Lasch F, Bollmann BA, May K, Kuhlmann A, Schmid-Bindert G, Kaaks R, Barkhausen J, Bohnet S, Reck M. Design and Rationale of the HANSE Study: A Holistic German Lung Cancer Screening Trial Using Low-Dose Computed Tomography. ROFO-FORTSCHR RONTG 2022; 194:1333-1345. [PMID: 35917826 DOI: 10.1055/a-1853-8291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Despite the high prevalence and mortality of lung cancer and proven effectiveness of low-dose computed tomography (LDCT) to reduce mortality, Germany still lacks a national screening program. The German Institute for Quality and Efficiency in Health Care (IQWiG) and the Federal Office for Radiation Protection (BfS) both published positive scientific evaluations recommending a quality-controlled national screening program. IQWiG underlined the importance of a clear risk definition, integrated smoking cessation programs, and quality assurance, highlighting the necessity of procedural optimization. METHODS AND OBJECTIVES In the HANSE study, former and current smokers aged 55-79 years are assessed for their lung cancer risk by the NELSON and PLCOM2012 risk scores. 5000 high-risk participants, defined as PLCOM2012 6-year risk ≥ 1.58 % or fulfilling NELSON risk inclusion criteria, will be screened by LDCT at baseline and after 12 months. Lung nodules are analyzed by a modified Lung-RADS 1.1 score of the HANSE study, and values of emphysema and coronary calcium are determined and randomly reported to the participants. 7100 low-risk participants serve as a control. All patients are followed-up for up to 10 years. The sensitivity and specificity of the two risk assessments and LDCT screening, effects of the randomized LDCT reporting, efficiency of lung nodule management, and several other factors are assessed to analyze the success and quality of the holistic screening program. CONCLUSION The HANSE study is designed as a holistic lung cancer screening study in northern Germany to answer pressing questions for a successful implementation of an effective German lung cancer screening program. KEY POINTS · HANSE is designed to address pressing questions for the implementation of lung cancer screening in Germany.. · HANSE compares NELSON and PLCOM2012 risk assessments for optimal definition of the high-risk group. . · HANSE integrates cardiac calcium and pulmonary emphysema scoring in a holistic screening approach.. CITATION FORMAT · Vogel-Claussen J, Lasch F, Bollmann B et al. Design and Rationale of the HANSE Study: A Holistic German Lung Cancer Screening Trial Using Low-Dose Computed Tomography. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1853-8291.
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Affiliation(s)
- Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Giessen, Germany
| | - Florian Lasch
- Department of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Benjamin-Alexander Bollmann
- Department of respiratory medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Giessen, Germany
| | - Katharina May
- Department of Radiology and Nuclear Medicine, University Medical Center Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Alexander Kuhlmann
- Working Group Health Economics, Martin Luther University Halle Wittenberg, Halle, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Giessen, Germany
| | - Gerald Schmid-Bindert
- Oncology Medical Department, AstraZeneca GmbH, Hamburg, Germany.,Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rudolf Kaaks
- Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research, Giessen, Germany.,Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Medical Center Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University Medical Center Schleswig Holstein Campus Lübeck, Lübeck, Germany.,Airway Research Center North (ARCN), German Center for Lung Research, Giessen, Germany
| | - Martin Reck
- Department of Thoracic Oncology, LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research, Giessen, Germany
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Huo B, Manos D, Xu Z, Matheson K, Chun S, Fris J, Wallace AMR, French DG. Screening Criteria Evaluation for Expansion in Pulmonary Neoplasias (SCREEN). Semin Thorac Cardiovasc Surg 2022; 35:769-780. [PMID: 35878739 DOI: 10.1053/j.semtcvs.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022]
Abstract
The SCREEN study investigated screening eligibility and survival outcomes between heavy smokers and light-or-never-smokers with lung cancer to determine whether expanded risk factor analysis is needed to refine screening criteria. SCREEN is a retrospective study of 917 lung cancer patients diagnosed between 2005 and 2018 in Nova Scotia, Canada. Screening eligibility was determined using the National Lung Screening Trial (NSLT) criteria. Mortality risk between heavy smokers and light-or-never-smokers was compared using proportional-hazards models. The median follow-up was 2.9 years. The cohort was comprised of 179 (46.1%) female heavy smokers and 306 (57.8%) female light-or-never-smokers. Light-or-never-smokers were more likely to have a diagnosis of adenocarcinoma [n=378 (71.6%)] compared to heavy smokers [n=234 (60.5%); P< 0.001]. Heavy smokers were more frequently diagnosed with squamous cell carcinoma [n=111 (28.7%)] compared to light-or-never-smokers, [n=100 (18.9%); P< 0.001]. Overall, 36.9% (338) of patients met NLST screening criteria. There was no difference in 5-year survival between light-or-never-smokers and heavy smokers [55.2% (338) vs 58.5% (529); P = 0.408; HR 1.06, 95% CI 0.80-1.40; P = 0.704]. Multivariate analysis showed that males had an increased mortality risk [HR 2.00 (95% CI 1.57-2.54); P< 0.001]. Half of lung cancer patients were missed with the conventional screening criteria. There were more curable, stage 1 tumors among light-or-never-smokers. Smoking status and age alone may be insufficient predictors of lung cancer risk and prognosis. Expanded risk factor analysis is needed to refine lung cancer screening criteria.
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Affiliation(s)
- Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Zhaolin Xu
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Samuel Chun
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - John Fris
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Alison M R Wallace
- Department of Pathology, Dalhousie University, Halifax, NS, Canada; Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Daniel G French
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
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Raskin J, Snoeckx A, Janssens A, De Bondt C, Wener R, van de Wiel M, van Meerbeeck JP, Smits E. New Implications of Patients’ Sex in Today’s Lung Cancer Management. Cancers (Basel) 2022; 14:cancers14143399. [PMID: 35884463 PMCID: PMC9316757 DOI: 10.3390/cancers14143399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
Simple Summary We aim to raise awareness that sex is an important factor to take into account in modern-day thoracic oncology practice. Summarized, women should be specifically targeted in smoking cessation campaigns and sex-specific barriers should be addressed. Women present more often with adenocarcinoma histology and EGFR/ALK alterations, as lung cancer in never-smokers is more common in women compared to men. Lung cancer in female patients may show a poorer response to immune checkpoint inhibition; therefore, the addition of chemotherapy should be considered. On the other hand, women experience more benefits from targeted therapy against EGFR. In general, prognosis for women is better compared to that in men. Lung cancer screening trials report that women derive more benefit from screening, although they have not been designed for women. Future trial designs should take this into account and encourage participation of women. Abstract This paper describes where and how sex matters in today’s management of lung cancer. We consecutively describe the differences between males and females in lung cancer demographics; sex-based differences in the immune system (including the poorer outcomes in women who are treated with immunotherapy but no chemotherapy); the presence of oncogenic drivers and the response to targeted therapies according to sex; the greater benefit women derive from lung cancer screening and why they get screened less; and finally, the barriers to smoking cessation that women experience. We conclude that sex is an important but often overlooked factor in modern-day thoracic oncology practice.
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Affiliation(s)
- Jo Raskin
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium;
| | - Annelies Janssens
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Universiteitsplein 1, 2610 Antwerpen, Belgium;
- Correspondence:
| | - Charlotte De Bondt
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Reinier Wener
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Mick van de Wiel
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Jan P. van Meerbeeck
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Evelien Smits
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Universiteitsplein 1, 2610 Antwerpen, Belgium;
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Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med 2022; 292:68-80. [PMID: 35253286 PMCID: PMC9311401 DOI: 10.1111/joim.13480] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lung cancer causes more deaths than breast, cervical, and colorectal cancer combined. Nevertheless, population-based lung cancer screening is still not considered standard practice in most countries worldwide. Early lung cancer detection leads to better survival outcomes: patients diagnosed with stage 1A lung cancer have a >75% 5-year survival rate, compared to <5% at stage 4. Low-dose computed tomography (LDCT) thorax imaging for the secondary prevention of lung cancer has been studied at length, and has been shown to significantly reduce lung cancer mortality in high-risk populations. The US National Lung Screening Trial reported a 20% overall reduction in lung cancer mortality when comparing LDCT to chest X-ray, and the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial more recently reported a 24% reduction when comparing LDCT to no screening. Hence, the focus has now shifted to implementation research. Consequently, the 4-IN-THE-LUNG-RUN consortium based in five European countries, has set up a large-scale multicenter implementation trial. Successful implementation of and accessibility to LDCT lung cancer screening are dependent on many factors, not limited to population selection, recruitment strategy, computed tomography screening frequency, lung-nodule management, participant compliance, and cost effectiveness. This review provides an overview of current evidence for LDCT lung cancer screening, and draws attention to major factors that need to be addressed to successfully implement standardized, effective, and accessible screening throughout Europe. Evidence shows that through the appropriate use of risk-prediction models and a more personalized approach to screening, efficacy could be improved. Furthermore, extending the screening interval for low-risk individuals to reduce costs and associated harms is a possibility, and through the use of volumetric-based measurement and follow-up, false positive results can be greatly reduced. Finally, smoking cessation programs could be a valuable addition to screening programs and artificial intelligence could offer a solution to the added workload pressures radiologists are facing.
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Affiliation(s)
- Harriet L Lancaster
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Marjolein A Heuvelmans
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy, Groningen, The Netherlands.,Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
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Tremblay A, Ezer N, Burrowes P, MacGregor JH, Lee A, Armstrong GA, Pereira R, Bristow M, Taylor JL, MacEachern P, Taghizadeh N, Koetzler R, Bedard E. Development and application of an electronic synoptic report for reporting and management of low-dose computed tomography lung cancer screening examination. BMC Med Imaging 2022; 22:111. [PMID: 35690733 PMCID: PMC9188213 DOI: 10.1186/s12880-022-00837-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Interpretation of Low Dose CT scans and protocol driven management of findings is a key aspect of lung cancer screening program performance. Reliable and reproducible methods are needed to communicate radiologists’ interpretation to the screening program or clinicians driving management decision.
Methods We performed an audit of a subset of dictated reports from the PANCAN study to assess for omissions. We developed an electronic synoptic reporting tool for radiologists embedded in a clinical documentation system software. The tool was then used for reporting as part of the Alberta Lung Cancer Screening Study and McGill University Health Centre Pilot Lung Cancer Screening Program.
Results Fifty reports were audited for completeness. At least one omission was noted in 30 (70%) of reports, with a major omission (missing lobe, size, type of nodule in report or actionable incidental finding in recommendation section of report) in 24 (48%). Details of the reporting template and functionality such as automated nodule cancer risk assessment, Lung-RADS category assignment, auto-generated narrative type report as well as personalize participant results letter is provided. A description of the system’s performance in its application in 2815 CT reports is then summarized. Conclusions We found that narrative type radiologist reports for lung cancer screening CT examinations frequently lacked specific discrete data elements required for management. We demonstrate the successful implementation of a radiology synoptic reporting system for use in lung cancer screening, and the use of this information to drive program management and communications.
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Affiliation(s)
- Alain Tremblay
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Nicole Ezer
- Department of Medicine, McGill University Health Centre, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Paul Burrowes
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - John Henry MacGregor
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Andrew Lee
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Gavin A Armstrong
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Raoul Pereira
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Michael Bristow
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Jana L Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Paul MacEachern
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Niloofar Taghizadeh
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Rommy Koetzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Eric Bedard
- Department of Surgery, Faculty of Medicine and Dentistry, Walter C. MacKenzie Health Sciences Centre, University of Alberta, Edmonton, 2J2.00T6G 2R7, Canada
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Li C, Wang H, Jiang Y, Fu W, Liu X, Zhong R, Cheng B, Zhu F, Xiang Y, He J, Liang W. Advances in lung cancer screening and early detection. Cancer Biol Med 2022; 19:j.issn.2095-3941.2021.0690. [PMID: 35535966 PMCID: PMC9196057 DOI: 10.20892/j.issn.2095-3941.2021.0690] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Lung cancer is associated with a heavy cancer-related burden in terms of patients' physical and mental health worldwide. Two randomized controlled trials, the US-National Lung Screening Trial (NLST) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON), indicated that low-dose CT (LDCT) screening results in a statistically significant decrease in mortality in patients with lung cancer, LDCT has become the standard approach for lung cancer screening. However, many issues in lung cancer screening remain unresolved, such as the screening criteria, high false-positive rate, and radiation exposure. This review first summarizes recent studies on lung cancer screening from the US, Europe, and Asia, and discusses risk-based selection for screening and the related issues. Second, an overview of novel techniques for the differential diagnosis of pulmonary nodules, including artificial intelligence and molecular biomarker-based screening, is presented. Third, current explorations of strategies for suspected malignancy are summarized. Overall, this review aims to help clinicians understand recent progress in lung cancer screening and alleviate the burden of lung cancer.
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Affiliation(s)
- Caichen Li
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Huiting Wang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Yu Jiang
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Wenhai Fu
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Xiwen Liu
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Ran Zhong
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Bo Cheng
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Feng Zhu
- Department of Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, Michigan 48235, USA
| | - Yang Xiang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Jianxing He
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China
| | - Wenhua Liang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
- Department of Oncology, the First People’s Hospital of Zhaoqing, Zhaoqing 526020, China
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Lung Cancer Screening: New Perspective and Challenges in Europe. Cancers (Basel) 2022; 14:cancers14092343. [PMID: 35565472 PMCID: PMC9099920 DOI: 10.3390/cancers14092343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Screening for lung cancer in a high-risk population has been shown to be beneficial, with reduced mortality in large randomised trials. However, the general implementation of screening is not evident and many factors have to be considered. In this paper, we will review the current status of screening for lung cancer in Europe and the many hurdles that have to be overcome. Multidisciplinary cooperation between all specialists dealing with lung cancer is required to obtain the best outcome. Hopefully, Europe’s Beating Cancer Plan will incorporate screening for lung cancer to allow general implementation by similar programmes in every European Member State. This will also provide an opportunity for further, large-scale studies to refine the inclusion of specific risk populations, diagnosis and management of screen-detected nodules. Abstract Randomized-controlled trials have shown clear evidence that lung cancer screening with low-dose CT in a high-risk population of current or former smokers can significantly reduce lung-cancer-specific mortality by an inversion of stage distribution at diagnosis. This paper will review areas in which there is good or emerging evidence and areas which still require investment, research or represent implementation challenges. The implementation of population-based lung cancer screening in Europe is variable and fragmented. A number of European countries seem be on the verge of implementing lung cancer screening, mainly through the implementation of studies or trials. The cost and capacity of CT scanners and radiologists are considered to be the main hurdles for future implementation. Actions by the European Commission, related to its published Europe’s Beating Cancer Plan and the proposal to update recommendations on cancer screening, could be an incentive to help speed up its implementation.
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Murchison JT, Ritchie G, Senyszak D, Nijwening JH, van Veenendaal G, Wakkie J, van Beek EJR. Validation of a deep learning computer aided system for CT based lung nodule detection, classification, and growth rate estimation in a routine clinical population. PLoS One 2022; 17:e0266799. [PMID: 35511758 PMCID: PMC9070877 DOI: 10.1371/journal.pone.0266799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/28/2022] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE In this study, we evaluated a commercially available computer assisted diagnosis system (CAD). The deep learning algorithm of the CAD was trained with a lung cancer screening cohort and developed for detection, classification, quantification, and growth of actionable pulmonary nodules on chest CT scans. Here, we evaluated the CAD in a retrospective cohort of a routine clinical population. MATERIALS AND METHODS In total, a number of 337 scans of 314 different subjects with reported nodules of 3-30 mm in size were included into the evaluation. Two independent thoracic radiologists alternately reviewed scans with or without CAD assistance to detect, classify, segment, and register pulmonary nodules. A third, more experienced, radiologist served as an adjudicator. In addition, the cohort was analyzed by the CAD alone. The study cohort was divided into five different groups: 1) 178 CT studies without reported pulmonary nodules, 2) 95 studies with 1-10 pulmonary nodules, 23 studies from the same patients with 3) baseline and 4) follow-up studies, and 5) 18 CT studies with subsolid nodules. A reference standard for nodules was based on majority consensus with the third thoracic radiologist as required. Sensitivity, false positive (FP) rate and Dice inter-reader coefficient were calculated. RESULTS After analysis of 470 pulmonary nodules, the sensitivity readings for radiologists without CAD and radiologist with CAD, were 71.9% (95% CI: 66.0%, 77.0%) and 80.3% (95% CI: 75.2%, 85.0%) (p < 0.01), with average FP rate of 0.11 and 0.16 per CT scan, respectively. Accuracy and kappa of CAD for classifying solid vs sub-solid nodules was 94.2% and 0.77, respectively. Average inter-reader Dice coefficient for nodule segmentation was 0.83 (95% CI: 0.39, 0.96) and 0.86 (95% CI: 0.51, 0.95) for CAD versus readers. Mean growth percentage discrepancy of readers and CAD alone was 1.30 (95% CI: 1.02, 2.21) and 1.35 (95% CI: 1.01, 4.99), respectively. CONCLUSION The applied CAD significantly increased radiologist's detection of actionable nodules yet also minimally increasing the false positive rate. The CAD can automatically classify and quantify nodules and calculate nodule growth rate in a cohort of a routine clinical population. Results suggest this Deep Learning software has the potential to assist chest radiologists in the tasks of pulmonary nodule detection and management within their routine clinical practice.
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Affiliation(s)
- John T. Murchison
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- * E-mail: (JTM); (JHN)
| | - Gillian Ritchie
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - David Senyszak
- Edinburgh Imaging facility QMRI, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Edwin J. R. van Beek
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging facility QMRI, University of Edinburgh, Edinburgh, United Kingdom
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Silva M, Milanese G, Ledda RE, Nayak SM, Pastorino U, Sverzellati N. European lung cancer screening: valuable trial evidence for optimal practice implementation. Br J Radiol 2022; 95:20200260. [PMID: 34995141 PMCID: PMC10993986 DOI: 10.1259/bjr.20200260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 11/05/2022] Open
Abstract
Lung cancer screening (LCS) by low-dose computed tomography is a strategy for secondary prevention of lung cancer. In the last two decades, LCS trials showed several options to practice secondary prevention in association with primary prevention, however, the translation from trial to practice is everything but simple. In 2020, the European Society of Radiology and European Respiratory Society published their joint statement paper on LCS. This commentary aims to provide the readership with detailed description about hurdles and potential solutions that could be encountered in the practice of LCS.
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Affiliation(s)
- Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Roberta E Ledda
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Sundeep M Nayak
- Department of Radiology, Kaiser Permanente Northern
California, San Leandro,
California, USA
| | - Ugo Pastorino
- Section of Thoracic Surgery, IRCCS Istituto Nazionale
Tumori, Milano,
Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
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Ngo PJ, Wade S, Vaneckova P, Behar-Harpaz S, Caruana M, Cressman S, Tammemagi M, Karikios D, Canfell K, Weber M. Health utilities for participants in a population-based sample who meet eligibility criteria for lung cancer screening. Lung Cancer 2022; 169:47-54. [DOI: 10.1016/j.lungcan.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 12/17/2022]
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Global, regional and national burden of lung cancer and its attributable risk factors in 204 countries and territories, 1990-2019. Eur J Cancer Prev 2022; 31:253-259. [PMID: 34010240 DOI: 10.1097/cej.0000000000000687] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore the lung cancer burden and related risk factors in groups of different sex, ages and levels of sociodemographic index (SDI) at global, regional and national levels. METHODS Using newly released GBD 2019 data, we explored the trends of lung cancer burden and its related risk factors in groups of different sex, ages and levels of SDI at global, regional and national levels. The Global Health Data Exchange query tool was used to obtain the data. RESULTS While lung cancer has an overall stable age-standardized incidence rate (ASIR), the death rate (ASDR) and disability-adjusted life-years (DALYs) rate (with even a trend of decline), it is still the number one malignant tumor. The ASIR and ASDR grew slowly in women worldwide. In 2019, High-income North America, East Asia and Central Europe ranked top three in ASIR, ASDR and age-standardized DALY rate, with growth in East Asia the highest. These three indicators were not in a single linear relation with SDI at a national level, and a peak appeared when SDI was about 0.8. The top three attributable risk factors to DALYs were smoking, particulate matter pollution and occupational carcinogens. CONCLUSIONS Given the high heterogeneity in lung cancer burden among different populations, decision-makers should understand local epidemiological characteristics of lung cancer in detail to formulate effective policies. Stricter tobacco control and improvement in lung cancer screening and treatment are imperative.
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Bhardwaj M, Schöttker B, Holleczek B, Benner A, Schrotz-King P, Brenner H. Potential of Inflammatory Protein Signatures for Enhanced Selection of People for Lung Cancer Screening. Cancers (Basel) 2022; 14:2146. [PMID: 35565275 PMCID: PMC9103423 DOI: 10.3390/cancers14092146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 12/10/2022] Open
Abstract
Randomized trials have demonstrated a substantial reduction in lung cancer (LC) mortality by screening heavy smokers with low-dose computed tomography (LDCT). The aim of this study was to assess if and to what extent blood-based inflammatory protein biomarkers might enhance selection of those at highest risk for LC screening. Ever smoking participants were chosen from 9940 participants, aged 50-75 years, who were followed up with respect to LC incidence for 17 years in a prospective population-based cohort study conducted in Saarland, Germany. Using proximity extension assay, 92 inflammation protein biomarkers were measured in baseline plasma samples of ever smoking participants, including 172 incident LC cases and 285 randomly selected participants free of LC. Smoothly clipped absolute deviation (SCAD) penalized regression with 0.632+ bootstrap for correction of overoptimism was applied to derive an inflammation protein biomarker score (INS) and a combined INS-pack-years score in a training set, and algorithms were further evaluated in an independent validation set. Furthermore, the performances of nine LC risk prediction models individually and in combination with inflammatory plasma protein biomarkers for predicting LC incidence were comparatively evaluated. The combined INS-pack-years score predicted LC incidence with area under the curves (AUCs) of 0.811 and 0.782 in the training and the validation sets, respectively. The addition of inflammatory plasma protein biomarkers to established nine LC risk models increased the AUCs up to 0.121 and 0.070 among ever smoking participants from training and validation sets, respectively. Our results suggest that inflammatory protein biomarkers may have potential to improve the selection of people for LC screening and thereby enhance screening efficiency.
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Affiliation(s)
- Megha Bhardwaj
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (B.S.); (H.B.)
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (B.S.); (H.B.)
- Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, 69115 Heidelberg, Germany
| | - Bernd Holleczek
- Saarland Cancer Registry, Präsident-Baltz-Strasse 5, 66119 Saarbrücken, Germany;
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Petra Schrotz-King
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (B.S.); (H.B.)
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, 69115 Heidelberg, Germany
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Nielsen AH, Fredberg U. Earlier diagnosis of lung cancer. Cancer Treat Res Commun 2022; 31:100561. [PMID: 35489228 DOI: 10.1016/j.ctarc.2022.100561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this article is to review options for more rapid diagnosis of lung cancer at an earlier stage, thereby improving survival. These options include screening, allowing general practitioners to refer patients directly to low-dose computed tomography scan instead of a chest X-ray and the abolition of the "visitation filter", i.e. hospital doctors' ability to reject referrals from general practitioners without prior discussion with the referring doctor.
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Pérez-Morales J, Lu H, Mu W, Tunali I, Kutuk T, Eschrich SA, Balagurunathan Y, Gillies RJ, Schabath MB. Volume doubling time and radiomic features predict tumor behavior of screen-detected lung cancers. Cancer Biomark 2022; 33:489-501. [DOI: 10.3233/cbm-210194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Image-based biomarkers could have translational implications by characterizing tumor behavior of lung cancers diagnosed during lung cancer screening. In this study, peritumoral and intratumoral radiomics and volume doubling time (VDT) were used to identify high-risk subsets of lung patients diagnosed in lung cancer screening that are associated with poor survival outcomes. METHODS: Data and images were acquired from the National Lung Screening Trial. VDT was calculated between two consequent screening intervals approximately 1 year apart; peritumoral and intratumoral radiomics were extracted from the baseline screen. Overall survival (OS) was the main endpoint. Classification and Regression Tree analyses identified the most predictive covariates to classify patient outcomes. RESULTS: Decision tree analysis stratified patients into three risk-groups (low, intermediate, and high) based on VDT and one radiomic feature (compactness). High-risk patients had extremely poor survival outcomes (hazard ratio [HR] = 8.15; 25% 5-year OS) versus low-risk patients (HR = 1.00; 83.3% 5-year OS). Among early-stage lung cancers, high-risk patients had poor survival outcomes (HR = 9.07; 44.4% 5-year OS) versus the low-risk group (HR = 1.00; 90.9% 5-year OS). For VDT, the decision tree analysis identified a novel cut-point of 279 days and using this cut-point VDT alone discriminated between aggressive (HR = 4.18; 45% 5-year OS) versus indolent/low-risk cancers (HR = 1.00; 82.8% 5-year OS). CONCLUSION: We utilized peritumoral and intratumoral radiomic features and VDT to generate a model that identify a high-risk group of screen-detected lung cancers associated with poor survival outcomes. These vulnerable subset of screen-detected lung cancers may be candidates for more aggressive surveillance/follow-up and treatment, such as adjuvant therapy.
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Affiliation(s)
- Jaileene Pérez-Morales
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hong Lu
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wei Mu
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ilke Tunali
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Tugce Kutuk
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Steven A. Eschrich
- Department of Bioinformatics and Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yoganand Balagurunathan
- Department of Bioinformatics and Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Robert J. Gillies
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Matthew B. Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Risk Assessment of Early Lung Cancer with LDCT and Health Examinations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084633. [PMID: 35457500 PMCID: PMC9033135 DOI: 10.3390/ijerph19084633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 12/19/2022]
Abstract
Early detection of lung cancer has a higher likelihood of curative treatment and thus improves survival rate. Low-dose computed tomography (LDCT) screening has been shown to be effective for high-risk individuals in several clinical trials, but has high false positive rates. To evaluate the risk of stage I lung cancer in the general population not limited to smokers, a retrospective study of 133 subjects was conducted in a medical center in Taiwan. Regularized regression was used to build the risk prediction model by using LDCT and health examinations. The proposed model selected seven variables related to nodule morphology, counts and location, and ten variables related to blood tests and medical history, achieving an area under the curve (AUC) value of 0.93. The higher the age, white blood cell count (WBC), blood urea nitrogen (BUN), diabetes, gout, chronic obstructive pulmonary disease (COPD), other cancers, and the presence of spiculation, ground-glass opacity (GGO), and part solid nodules, the higher the risk of lung cancer. Subjects with calcification, solid nodules, nodules in the middle lobes, more nodules, and diseases related to thyroid, liver, and digestive systems were at a lower risk. The selected variables did not indicate causation.
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Referring high-risk individuals for lung cancer screening: A systematic review of interventions with healthcare professionals. Eur J Cancer Prev 2022; 31:540-550. [PMID: 35383631 DOI: 10.1097/cej.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review described the effect of interventions aimed at helping Healthcare Professionals refer high-risk individuals for lung cancer screening. Primary outcomes included: patient outcomes such as lung cancer detection, screening for lung cancer, lung cancer treatments received and lung cancer mortality. Healthcare professionals' knowledge and awareness of lung cancer screening served as secondary outcomes. METHODS Experimental studies published between January 2016 and 2021 were included. The search was conducted in MEDLINE, CINAHL, ERIC, PsycARTICLES, PsycInfo and Psychology and Behavioral Sciences Collection. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool and the level of evidence was assessed using the Scottish Intercollegiate Guidelines Network grading system. RESULTS Nine studies were included. Nurse navigation, electronic prompts for lung cancer screening and shared decision-making helped improve patient outcomes. Specialist screenings yielded more significant incidental findings and a higher percentage of Lung-RADS 1 results (i.e. no nodules/definitely benign nodules), while Primary Care Physician screenings were associated with higher numbers of Lung-RADS 2 results (i.e. benign nodules with a very low likelihood to becoming malignant). An increase in Healthcare Professionals' knowledge and awareness of lung cancer screening was achieved using group-based learning compared to lecture-based education delivery. CONCLUSIONS The effectiveness of Nurse navigation is evident, as are the benefits of adequate training, shared decision-making, as well as a structured, clear and well-understood referral processes supported by the use of electronic system-incorporated prompts.
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de Koning HJ. One-off low-dose CT lung cancer screening in China: an appropriate strategy? THE LANCET. RESPIRATORY MEDICINE 2022; 10:320-322. [PMID: 35276088 DOI: 10.1016/s2213-2600(22)00047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Harry J de Koning
- Department of Public Health, Erasmus MC, 3015 GD Rotterdam, Netherlands.
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121
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Li N, Tan F, Chen W, Dai M, Wang F, Shen S, Tang W, Li J, Yu Y, Cao W, Xu Y, Qin C, Zhao L, Zhu M, Guo L, Wu Z, Yang Z, Zheng Y, Chen H, Liu Y, Wei D, Dong D, Cao J, Zhang S, Yan S, Wang N, Du L, Shen H, Wu N, He J. One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort study. THE LANCET. RESPIRATORY MEDICINE 2022; 10:378-391. [PMID: 35276087 DOI: 10.1016/s2213-2600(21)00560-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/10/2021] [Accepted: 12/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death worldwide. Data on the effectiveness of one-off low-dose CT (LDCT) in reducing lung cancer mortality and all-cause mortality are needed to inform screening programmes in countries with limited medical resources. We aimed to evaluate the effectiveness of one-off LDCT screening in the early detection of lung cancer in China. METHODS A multicentre, population-based, prospective cohort study was done in 12 cities of eight provinces across China, recruiting individuals aged 40-74 years who were asymptomatic for lung cancer with no lung cancer history. Participants were classified as at high risk or low risk of lung cancer using a sex-specific risk score that incorporated cigarette smoking, level of physical activity, occupational exposures, history of chronic respiratory diseases, family history of lung cancer, diet, and passive smoking (women only). Participants at high risk were invited for a one-off LDCT scan and were classified into screened and non-screened groups on the basis of whether or not they had the scan. Lung cancer incidence density, lung cancer mortality, and all-cause mortality were calculated for the screened and non-screened groups. The effectiveness of a one-off LDCT scan was evaluated by a comparison of the screened and non-screened groups in terms of lung cancer mortality and all-cause mortality in the period from cohort entry until administrative censoring (June 20, 2020). Inverse probability weighting was adopted to account for potential imbalanced factors between the two groups and Cox proportional hazards model was used to estimate the weighted associations between mortality and one-off LDCT scans. FINDINGS Between Feb 19, 2013, and Oct 31, 2018, 1 032 639 individuals were assessed for eligibility. 1 016 740 participants were enrolled in the study, of whom 3581 had a lung cancer diagnosis after a median follow-up of 3·6 years (IQR 2·8-5·1). Among the 223 302 participants at high risk, 79 581 (35·6%) had an LDCT scan (screened group) and 143 721 (64·4%) did not (non-screened group). After inverse probability weighting, lung cancer incidence density was 47·0% higher (hazard ratio 1·47 [95% CI 1·27-1·70]; p<0·0001), lung cancer mortality was 31·0% lower (0·69 [95% CI 0·53-0·92]; p=0·010) and all-cause mortality was 32·0% lower (0·68 [0·57-0·82]; p<0·0001) for participants in the screened group compared with those in the non-screened group. INTERPRETATION One-off LDCT screening was associated with significantly lower lung cancer mortality and all-cause mortality in a large population in China. Our results point to the promise of one-off LDCT screening in countries with limited medical resources. Further studies are needed to explore interactions by subgroup-including sex, age, smoking status, and economic status-to develop population-specific screening strategies. FUNDING Ministry of Finance and National Health Commission of the People's Republic of China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cancer Data Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cancer Data Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Dai
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sipeng Shen
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Wei Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cancer Data Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiwen Yu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjie Xu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Qin
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Zhu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Lanwei Guo
- Henan Office for Cancer Control and Research, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Zheng Wu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuoyu Yang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yadi Zheng
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongda Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunyong Liu
- Liaoning Office for Cancer Control and Research, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Donghua Wei
- Office for Cancer Prevention and Control, Anhui Provincial Cancer Hospital, Hefei, China
| | - Dong Dong
- Office of Cancer Prevention and Treatment, Xuzhou Cancer Hospital, Xuzhou, China
| | - Ji Cao
- Cancer Prevention and Control Office, Cancer Hospital, Guangxi Medical University, Nanning, China
| | - Shaokai Zhang
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Shipeng Yan
- Department of Cancer Prevention and Control, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ning Wang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education Beijing, Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lingbin Du
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Hongbing Shen
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Ragavan M, Patel MI. The evolving landscape of sex-based differences in lung cancer: a distinct disease in women. Eur Respir Rev 2022; 31:31/163/210100. [PMID: 35022255 PMCID: PMC9488944 DOI: 10.1183/16000617.0100-2021] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022] Open
Abstract
In stark contrast to a few decades ago when lung cancer was predominantly a disease of men who smoke, incidence rates of lung cancer in women are now comparable to or higher than those in men and are rising alarmingly in many parts of the world. Women face a unique set of risk factors for lung cancer compared to men. These include exogenous exposures including radon, prior radiation, and fumes from indoor cooking materials such as coal, in addition to endogenous exposures such as oestrogen and distinct genetic polymorphisms. Current screening guidelines only address tobacco use and likely underrepresent lung cancer risk in women. Women were also not well represented in some of the landmark prospective studies that led to the development of current screening guidelines. Women diagnosed with lung cancer have a clear mortality benefit compared to men even when other clinical and demographic characteristics are accounted for. However, there may be sex-based differences in outcomes and side effects of systemic therapy, particularly with chemotherapy and immunotherapy. Ongoing research is needed to better investigate these differences to address the rapidly changing demographics of lung cancer worldwide. Sex-based differences in lung cancer span the care continuum. This suggests lung cancer may increasingly be viewed as a distinct disease in women, with implications for screening and treatment. Lung cancer research should capture these sex-based differences.https://bit.ly/2WfhaB4
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Affiliation(s)
- Meera Ragavan
- Division of Hematology/Oncology, Dept of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Manali I Patel
- Division of Oncology, Dept of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, VA Palo Alto Healthcare System, Palo Alto, CA, USA.,Dept of Medicine, Center for Health Policy/Primary Care Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
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Silva M, Picozzi G, Sverzellati N, Anglesio S, Bartolucci M, Cavigli E, Deliperi A, Falchini M, Falaschi F, Ghio D, Gollini P, Larici AR, Marchianò AV, Palmucci S, Preda L, Romei C, Tessa C, Rampinelli C, Mascalchi M. Low-dose CT for lung cancer screening: position paper from the Italian college of thoracic radiology. Radiol Med 2022; 127:543-559. [PMID: 35306638 PMCID: PMC8934407 DOI: 10.1007/s11547-022-01471-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/18/2022] [Indexed: 12/24/2022]
Abstract
Smoking is the main risk factor for lung cancer (LC), which is the leading cause of cancer-related death worldwide. Independent randomized controlled trials, governmental and inter-governmental task forces, and meta-analyses established that LC screening (LCS) with chest low dose computed tomography (LDCT) decreases the mortality of LC in smokers and former smokers, compared to no-screening, especially in women. Accordingly, several Italian initiatives are offering LCS by LDCT and smoking cessation to about 10,000 high-risk subjects, supported by Private or Public Health Institutions, envisaging a possible population-based screening program. Because LDCT is the backbone of LCS, Italian radiologists with LCS expertise are presenting this position paper that encompasses recommendations for LDCT scan protocol and its reading. Moreover, fundamentals for classification of lung nodules and other findings at LDCT test are detailed along with international guidelines, from the European Society of Thoracic Imaging, the British Thoracic Society, and the American College of Radiology, for their reporting and management in LCS. The Italian College of Thoracic Radiologists produced this document to provide the basics for radiologists who plan to set up or to be involved in LCS, thus fostering homogenous evidence-based approach to the LDCT test over the Italian territory and warrant comparison and analyses throughout National and International practices.
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Affiliation(s)
- Mario Silva
- Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, Parma, Italy.
- Unit of "Scienze Radiologiche", University Hospital of Parma, Pad. Barbieri, Via Gramsci 14, 43126, Parma, Italy.
| | - Giulia Picozzi
- Istituto Di Studio Prevenzione E Rete Oncologica, Firenze, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, Parma, Italy
- Unit of "Scienze Radiologiche", University Hospital of Parma, Pad. Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | | | | | | | | | | | | | - Domenico Ghio
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Anna Rita Larici
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore Di Roma, Roma, Italy
| | - Alfonso V Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, MI, Italy
| | - Stefano Palmucci
- UOC Radiologia 1, Dipartimento Scienze Mediche Chirurgiche E Tecnologie Avanzate "GF Ingrassia", Università Di Catania, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Lorenzo Preda
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Dipartimento Di Scienze Clinico-Chirurgiche, Diagnostiche E Pediatriche, Università Degli Studi Di Pavia, Pavia, Italy
| | | | - Carlo Tessa
- Radiologia Apuane E Lunigiana, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | | | - Mario Mascalchi
- Istituto Di Studio Prevenzione E Rete Oncologica, Firenze, Italy
- Università Di Firenze, Firenze, Italy
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Kerpel-Fronius A, Monostori Z, Kovacs G, Ostoros G, Horvath I, Solymosi D, Pipek O, Szatmari F, Kovacs A, Markoczy Z, Rojko L, Renyi-Vamos F, Hoetzenecker K, Bogos K, Megyesfalvi Z, Dome B. Nationwide lung cancer screening with low-dose computed tomography: implementation and first results of the HUNCHEST screening program. Eur Radiol 2022; 32:4457-4467. [PMID: 35247089 DOI: 10.1007/s00330-022-08589-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Lung cancer (LC) kills more people than any other cancer in Hungary. Hence, there is a clear rationale for considering a national screening program. The HUNCHEST pilot program primarily aimed to investigate the feasibility of a population-based LC screening in Hungary, and determine the incidence and LC probability of solitary pulmonary nodules. METHODS A total of 1890 participants were assigned to undergo low-dose CT (LDCT) screening, with intervals of 1 year between procedures. Depending on the volume, growth, and volume doubling time (VDT), screenings were defined as negative, indeterminate, or positive. Non-calcified lung nodules with a volume > 500 mm3 and/or a VDT < 400 days were considered positive. LC diagnosis was based on histology. RESULTS At baseline, the percentage of negative, indeterminate, and positive tests was 81.2%, 15.1%, and 3.7%, respectively. The frequency of positive and indeterminate LDCT results was significantly higher in current smokers (vs. non-smokers or former smokers; p < 0.0001) and in individuals with COPD (vs. those without COPD, p < 0.001). In the first screening round, 1.2% (n = 23) of the participants had a malignant lesion, whereas altogether 1.5% (n = 29) of the individuals were diagnosed with LC. The overall positive predictive value of the positive tests was 31.6%. Most lung malignancies were diagnosed at an early stage (86.2% of all cases). CONCLUSIONS In terms of key characteristics, our prospective cohort study appears consistent to that of comparable studies. Altogether, the results of the HUNCHEST pilot program suggest that LDCT screening may facilitate early diagnosis and thus curative-intent treatment in LC. KEY POINTS • The HUNCHEST pilot study is the first nationwide low-dose CT screening program in Hungary. • In the first screening round, 1.2% of the participants had a malignant lesion, whereas altogether 1.5% of the individuals were diagnosed with lung cancer. • The overall positive predictive value of the positive tests in the HUNCHEST screening program was 31.6%.
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Affiliation(s)
- Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Zsuzsanna Monostori
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Gabor Kovacs
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Gyula Ostoros
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Istvan Horvath
- Affidea Diagnostics Hungary, Szent Margit and Nyiro Gyula Hospitals, Budapest, Hungary
| | - Diana Solymosi
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Orsolya Pipek
- Department of Physics of Complex Systems, Eotvos Lorand University, Budapest, Hungary
| | - Ferenc Szatmari
- Affidea Diagnostics Hungary, Petz Aladar Hospital, Gyor, Hungary
| | - Anita Kovacs
- Department of Radiology, Albert Szent-Gyorgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsolt Markoczy
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Livia Rojko
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Ferenc Renyi-Vamos
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary.,Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Krisztina Bogos
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary.
| | - Zsolt Megyesfalvi
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary.,Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Balazs Dome
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary. .,Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary. .,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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Impact of the National Lung Screening Trial (NLST) publication and Medicare Lung cancer screening payment on lung cancer incidence rates: An interrupted time series analysis. J Cancer Policy 2022; 31:100318. [DOI: 10.1016/j.jcpo.2021.100318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/17/2022]
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Yuan H, Gao Z, He X, Li D, Duan S, Effah CY, Wang W, Wang J, Qu L, Wu Y. Application of logistic regression and convolutional neural network in prediction and diagnosis of high-risk populations of lung cancer. Eur J Cancer Prev 2022; 31:145-151. [PMID: 33859129 DOI: 10.1097/cej.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The early detection, early diagnosis, and early treatment of lung cancer are the best strategies to improve the 5-year survival rate. Logistic regression analysis can be a helpful tool in the early detection of high-risk groups of lung cancer. Convolutional neural network (CNN) could distinguish benign from malignant pulmonary nodules, which is critical for early precise diagnosis and treatment. Here, we developed a risk assessment model of lung cancer and a high-precision classification diagnostic model using these technologies so as to provide a basis for early screening of lung cancer and for intelligent differential diagnosis. METHODS A total of 355 lung cancer patients, 444 patients with benign lung disease and 472 healthy people from The First Affiliated Hospital of Zhengzhou University were included in this study. Moreover, the dataset of 607 lung computed tomography images was collected from the above patients. The logistic regression method was employed to screen the high-risk groups of lung cancer, and the CNN model was designed to classify pulmonary nodules into benign or malignant nodules. RESULTS The area under the curve of the lung cancer risk assessment model in the training set and the testing set were 0.823 and 0.710, respectively. After finely optimizing the settings of the CNN, the area under the curve could reach 0.984. CONCLUSIONS This performance demonstrated that the lung cancer risk assessment model could be used to screen for high-risk individuals with lung cancer and the CNN framework was suitable for the differential diagnosis of pulmonary nodules.
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Affiliation(s)
| | | | | | - Di Li
- Departments of Toxicology
| | | | | | | | - Jing Wang
- Occupational and Environmental Health
| | - Lingbo Qu
- Nutrition and Food Hygiene, College of Public Health, Zhengzhou University
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127
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Informing Patient Surveillance for the Growing Number of Survivors of Lung Cancer. J Thorac Oncol 2022; 17:345-347. [PMID: 35216728 DOI: 10.1016/j.jtho.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022]
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128
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Comparative effect of different strategies for the screening of lung cancer: a systematic review and network meta-analysis. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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129
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PERROTTA F, D’AGNANO V, SCIALÒ F, KOMICI K, ALLOCCA V, NUCERA F, SALVI R, STELLA GM, BIANCO A. Evolving concepts in COPD and lung cancer: a narrative review. Minerva Med 2022; 113:436-448. [DOI: 10.23736/s0026-4806.22.07962-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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130
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Nekolla EA, Brix G, Griebel J. Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit-Risk Assessment for Different Screening Scenarios. Diagnostics (Basel) 2022; 12:diagnostics12020364. [PMID: 35204455 PMCID: PMC8870982 DOI: 10.3390/diagnostics12020364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 01/04/2023] Open
Abstract
Lung cancer is a severe disease that affects predominantly smokers and represents a leading cause of cancer death in Europe. Recent meta-analyses of randomized controlled trials (RCTs) have yielded that low-dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in heavy smokers or ex-smokers by about 20% compared to a control group of persons who did not receive LDCT. This benefit must be weighed against adverse health effects associated with LDCT lung screening, in particular radiation risks. For this purpose, representative organ doses were determined for a volume CT dose index of 1 mGy that can be achieved on modern devices. Using these values, radiation risks were estimated for different screening scenarios by means of sex-, organ-, and age-dependent radio-epidemiologic models. In particular, the approach was adjusted to a Western European population. For an annual LDCT screening of (ex-)smokers aged between 50 and 75 years, the estimated radiation-related lifetime attributable risk to develop cancer is below 0.25% for women and about 0.1% for men. Assuming a mortality reduction of about 20% and taking only radiation risks into account, this screening scenario results in a benefit–risk ratio of about 10 for women and about 25 for men. These benefit–risk ratio estimates are based on the results of RCTs of the highest evidence level. To ensure that the benefit outweighs the radiation risk even in standard healthcare, strict conditions and requirements must be established for the entire screening process to achieve a quality level at least as high as that of the considered RCTs.
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Carr LL, Dyer DS, Zelarney PT, Kern EO. Improvement in Stage of Lung Cancer Diagnosis with Incident Pulmonary Nodules followed with a Patient Tracking System and Computerized Registry. JTO Clin Res Rep 2022; 3:100297. [PMID: 35310139 PMCID: PMC8924678 DOI: 10.1016/j.jtocrr.2022.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Given that an incidental pulmonary nodule (IPN) on chest computed tomography (CT) may represent nascent lung cancer, timely follow-up imaging is critical to assess nodule growth and the need for tissue sampling. We previously reported our institution’s systematic process to identify and track patients with an IPN associated with improved CT on follow-up. We hypothesized that this improvement may have led to a higher frequency of early-stage lung cancer. To evaluate this, we performed a study to determine whether cases of early-stage lung cancer were more likely to have had our tracking system applied to suspicious findings. Methods An observational study was performed by identifying cases of lung cancer that were detected as IPNs on chest CT scans performed at our institution, from 2006 to 2016. A total of 314 cases were dichotomized into early-stage (stage 1) or late-stage (stages II to IV) disease. A multivariant regression analysis with modeling was used to determine factors associated with a diagnosis of early-stage disease. Factors included the use of the tracking system and nodule registry. Results The following factors were independently associated with early-stage lung cancer: index nodule diameter, (OR = 0.971, confidence interval [CI]: 0.948–0.995], p = 0.016), adenocarcinoma histology (OR = 2.930 [CI: 1.695–5.064], p = 0.0001) and use of tracker phrases on CT reports (OR = 1.939 [CI: 1.126–3.339], p = 0.016). Conclusions The application of a patient tracking system and computerized lung nodule registry lead to an increased frequency in the diagnosis of stage 1 NSCLC from IPNs. This is a meaningful outcome for patients and should be adapted for IPN management.
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Affiliation(s)
- Laurie L. Carr
- Division of Oncology, Department of Medicine, National Jewish Health, Denver, Colorado
- Corresponding author. Address for correspondence: Laurie L. Carr, MD, Division of Oncology, Department of Medicine, National Jewish Health, 1400 Jackson Street, J328, Denver, CO 80207.
| | - Debra S. Dyer
- Department of Radiology, National Jewish Health, Denver, Colorado
| | | | - Elizabeth O. Kern
- Division of Medical, Behavioral, and Community Health, Department of Medicine, National Jewish Health, Denver, Colorado
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Aredo JV, Choi E, Ding VY, Tammemägi MC, ten Haaf K, Luo SJ, Freedman ND, Wilkens LR, Le Marchand L, Wakelee HA, Meza R, Park SSL, Cheng I, Han SS. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6583194. [PMID: 35642317 PMCID: PMC9156850 DOI: 10.1093/jncics/pkac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/05/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Jacqueline V Aredo
- Department of Medicine, University of California, San Francisco, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Eunji Choi
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Kevin ten Haaf
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sophia J Luo
- Stanford University School of Medicine, Stanford, CA, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Heather A Wakelee
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Division of Oncology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sung-Shim Lani Park
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Summer S Han
- Stanford University School of Medicine, Stanford, CA, USA
- Correspondence to: Summer S. Han, PhD, Stanford University School of Medicine, 1701 Page Mill Rd, Room 234, Stanford, CA 94304, USA (e-mail: )
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Tammemägi MC, Ruparel M, Tremblay A, Myers R, Mayo J, Yee J, Atkar-Khattra S, Yuan R, Cressman S, English J, Bedard E, MacEachern P, Burrowes P, Quaife SL, Marshall H, Yang I, Bowman R, Passmore L, McWilliams A, Brims F, Lim KP, Mo L, Melsom S, Saffar B, Teh M, Sheehan R, Kuok Y, Manser R, Irving L, Steinfort D, McCusker M, Pascoe D, Fogarty P, Stone E, Lam DCL, Ng MY, Vardhanabhuti V, Berg CD, Hung RJ, Janes SM, Fong K, Lam S. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study. Lancet Oncol 2022; 23:138-148. [PMID: 34902336 PMCID: PMC8716337 DOI: 10.1016/s1470-2045(21)00590-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lung cancer is a major health problem. CT lung screening can reduce lung cancer mortality through early diagnosis by at least 20%. Screening high-risk individuals is most effective. Retrospective analyses suggest that identifying individuals for screening by accurate prediction models is more efficient than using categorical age-smoking criteria, such as the US Preventive Services Task Force (USPSTF) criteria. This study prospectively compared the effectiveness of the USPSTF2013 and PLCOm2012 model eligibility criteria. METHODS In this prospective cohort study, participants from the International Lung Screening Trial (ILST), aged 55-80 years, who were current or former smokers (ie, had ≥30 pack-years smoking history or ≤15 quit-years since last permanently quitting), and who met USPSTF2013 criteria or a PLCOm2012 risk threshold of at least 1·51% within 6 years of screening, were recruited from nine screening sites in Canada, Australia, Hong Kong, and the UK. After enrolment, patients were assessed with the USPSTF2013 criteria and the PLCOm2012 risk model with a threshold of at least 1·70% at 6 years. Data were collected locally and centralised. Main outcomes were the comparison of lung cancer detection rates and cumulative life expectancies in patients with lung cancer between USPSTF2013 criteria and the PLCOm2012 model. In this Article, we present data from an interim analysis. To estimate the incidence of lung cancers in individuals who were USPSTF2013-negative and had PLCOm2012 of less than 1·51% at 6 years, ever-smokers in the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) who met these criteria and their lung cancer incidence were applied to the ILST sample size for the mean follow-up occurring in the ILST. This trial is registered at ClinicalTrials.gov, NCT02871856. Study enrolment is almost complete. FINDINGS Between June 17, 2015, and Dec 29, 2020, 5819 participants from the International Lung Screening Trial (ILST) were enrolled on the basis of meeting USPSTF2013 criteria or the PLCOm2012 risk threshold of at least 1·51% at 6 years. The same number of individuals was selected for the PLCOm2012 model as for the USPSTF2013 criteria (4540 [78%] of 5819). After a mean follow-up of 2·3 years (SD 1·0), 135 lung cancers occurred in 4540 USPSTF2013-positive participants and 162 in 4540 participants included in the PLCOm2012 of at least 1·70% at 6 years group (cancer sensitivity difference 15·8%, 95% CI 10·7-22·1%; absolute odds ratio 4·00, 95% CI 1·89-9·44; p<0·0001). Compared to USPSTF2013-positive individuals, PLCOm2012-selected participants were older (mean age 65·7 years [SD 5·9] vs 63·3 years [5·7]; p<0·0001), had more comorbidities (median 2 [IQR 1-3] vs 1 [1-2]; p<0·0001), and shorter life expectancy (13·9 years [95% CI 12·8-14·9] vs 14·8 [13·6-16·0] years). Model-based difference in cumulative life expectancies for those diagnosed with lung cancer were higher in those who had PLCOm2012 risk of at least 1·70% at 6 years than individuals who were USPSTF2013-positive (2248·6 years [95% CI 2089·6-2425·9] vs 2000·7 years [1841·2-2160·3]; difference 247·9 years, p=0·015). INTERPRETATION PLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes. FUNDING Terry Fox Research Institute, The UBC-VGH Hospital Foundation and the BC Cancer Foundation, the Alberta Cancer Foundation, the Australian National Health and Medical Research Council, Cancer Research UK and a consortium of funders, and the Roy Castle Lung Cancer Foundation for the UK Lung Screen Uptake Trial.
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Affiliation(s)
- Martin C Tammemägi
- Department of Health Sciences, Brock University, St Catharines, ON, Canada.
| | - Mamta Ruparel
- Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Alain Tremblay
- Division of Respiratory Medicine & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Renelle Myers
- BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Mayo
- Department of Radiology, Vancouver, BC, Canada
| | - John Yee
- Department of Thoracic Surgery, Vancouver, BC, Canada
| | | | - Ren Yuan
- Vancouver Coastal Health, Vancouver, BC, Canada; Department of Radiology, BC Cancer, Vancouver, BC, Canada
| | - Sonya Cressman
- Centre for Epidemiology and Evaluation, SFU, Burnaby, BC, Canada
| | | | - Eric Bedard
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Paul MacEachern
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Burrowes
- Department of Diagnostic Imaging, Foothills Medical Center, Calgary, AB, Canada
| | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Henry Marshall
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Ian Yang
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Rayleen Bowman
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Linda Passmore
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Curtin Medical School, National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA, Australia
| | - Kuan Pin Lim
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Lin Mo
- Royal Darwin Hospital, Tiwi, NT, Australia
| | - Stephen Melsom
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Bann Saffar
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Mark Teh
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ramon Sheehan
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Yijin Kuok
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Renee Manser
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mark McCusker
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Diane Pascoe
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Paul Fogarty
- Epworth Internal Medicine Clinical Institute, Melbourne VIC, Australia
| | - Emily Stone
- St Vincent's Hospital, Kinghorn Cancer Centre, University of New South Wales, Sydney, NSW, Australia
| | - David C L Lam
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong
| | | | | | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Samuel M Janes
- Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Kwun Fong
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Stephen Lam
- BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada
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Urrutia Argueta S, Basnet N, Abdul-Kafi O, Hanna N. Lung Cancer Screening Knowledge in Four Internal Medicine Programs. Cancer Control 2022; 29:10732748221081383. [PMID: 36895164 PMCID: PMC10009012 DOI: 10.1177/10732748221081383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Lung cancer remains the leading cause of cancer-related death in the United States. Low density CT (LDCT) has been shown to reduce mortality in high-risk populations. Recognizing and mitigating gaps in knowledge in early medical training could result in increased utilization of screening CT in high risk-populations. METHODS An electronic survey was conducted among Internal Medicine (IM) residents at 4 academic programs in the Midwestern United States. A survey was distributed to evaluate knowledge about high-risk populations, mortality benefits, and a comparison in mortality benefits between LDCT and other screening modalities using number needed to screen (NNS). Results: There was a 46.6% (166/360) response rate. Residents correctly answered an average of 2.9/7 (43.1%) questions. PGY-1 (post-graduate year) and PGY-2 residents performed better than PGY-3 (P = .022). Only 1/3 rd of all respondents correctly identified the population needed to be screened. Over 80% of residents thought screening with LDCT had a cancer-specific mortality benefit but were evenly split (except Program 2 residents), on recognizing an all-cause mortality benefit with LDCT, (P = .016). Only 7.7% thought women benefited the most from LDCT. Self-assess and attained knowledge were similar among programs. CONCLUSIONS LDCT is a noninvasive intervention with a substantial mortality reduction, especially in states with high rates of smoking, and is widely covered by insurers. With average knowledge score less than 50%, this study shows there is a substantial need to increase the knowledge of LCS in IM residency programs.
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Affiliation(s)
| | - Nishraj Basnet
- Department of Medicine, 3078Michigan State University, Indianapolis, IN, USA
| | - Owais Abdul-Kafi
- Department of Medicine, 14681University of Illinois Chicago, Chicago, IL, USA
| | - Nasser Hanna
- Department of Medicine, 12250Indiana University, Indianapolis, IN, USA
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Kian W, Zemel M, Levitas D, Alguayn W, Remilah AA, Rahman NA, Peled N. Lung cancer screening: a critical appraisal. Curr Opin Oncol 2022; 34:36-43. [PMID: 34652284 DOI: 10.1097/cco.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The recently published large-scale NELSON trial showed a reduction in lung cancer (LC) mortality with the use of low-dose computed tomography (LDCT) in high-risk patients. This is the first such European-based trial to mirror the results of the US National Lung Screening Trial (NLST). The NLST was responsible for nationwide implementation of LC screening protocols which has shown a decrease in LC mortality. However, the implementation of such screening in Europe has been challenging. With the findings from the NELSON trial, implementation of LC screening throughout Europe should once again be evaluated. RECENT FINDINGS This review article further elaborates on the advantages of LDCT in LC screening. It also discusses promising future approaches that can supplement the current LC screening guidelines. SUMMARY Implementation of LC screening with LDCT should again be evaluated throughout Europe as it could substantially decrease LC-related mortality.
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Affiliation(s)
- Waleed Kian
- The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem
| | - Melanie Zemel
- Medical School for International Health, Ben-Gurion University of the Negev
| | - Dina Levitas
- The Legacy Heritage Center & Dr Larry Norton Institute, Soroka Medical Center & Ben-Gurion University of the Negev
| | - Wafeek Alguayn
- Thoracic Surgery Department, Soroka Medical Center, Be'er Sheva
| | - Areen A Remilah
- The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem
| | - Nader Abdel Rahman
- Interventional Pulmonology and Bronchoscopy, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nir Peled
- The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem
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Du Y, Sidorenkov G, Heuvelmans MA, Vliegenthart R, Groen HJ, Greuter MJ, de Bock GH. Lung cancer screening with low-dose CT: simulating the effect of starting screening at a younger age in women. Eur J Radiol 2022; 148:110182. [DOI: 10.1016/j.ejrad.2022.110182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
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Miranda-Filho A, Charvat H, Bray F, Migowski A, Cheung LC, Vaccarella S, Johansson M, Carvalho AL, Robbins HA. A modeling analysis to compare eligibility strategies for lung cancer screening in Brazil. EClinicalMedicine 2021; 42:101176. [PMID: 34765952 PMCID: PMC8571533 DOI: 10.1016/j.eclinm.2021.101176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Country-specific evidence is needed to guide decisions regarding whether and how to implement lung cancer screening in different settings. For this study, we estimated the potential numbers of individuals screened and lung cancer deaths prevented in Brazil after applying different strategies to define screening eligibility. METHODS We applied the Lung Cancer Death Risk Assessment Tool (LCDRAT) to survey data on current and former smokers (ever-smokers) in 15 Brazilian state capital cities that comprise 18% of the Brazilian population. We evaluated three strategies to define eligibility for screening: (1) pack-years and cessation time (≥30 pack-years and <15 years since cessation); (2) the LCDRAT risk model with a fixed risk threshold; and (3) LCDRAT with age-specific risk thresholds. FINDINGS Among 2.3 million Brazilian ever-smokers aged 55-79 years, 21,459 (95%CI 20,532-22,387) lung cancer deaths were predicted over 5 years without screening. Applying the fixed risk-based eligibility definition would prevent more lung cancer deaths than the pack-years definition [2,939 (95%CI 2751-3127) vs. 2,500 (95%CI 2318-2681) lung cancer deaths], and with higher screening efficiency [NNS=177 (95%CI 170-183) vs. 205 (95%CI 194-216)], but would tend to screen older individuals [mean age 67.8 (95%CI 67.5-68.2) vs. 63.4 (95%CI 63.0-63.9) years]. Applying age-specific risk thresholds would allow younger ever-smokers to be screened, although these individuals would be at lower risk. The age-specific thresholds strategy would avert three-fifths (60.1%) of preventable lung cancer deaths [N = 2629 (95%CI 2448-2810)] by screening 21.9% of ever-smokers. INTERPRETATION The definition of eligibility impacts the efficiency of lung cancer screening and the mean age of the eligible population. As implementation of lung screening proceeds in different countries, our analytical framework can be used to guide similar analyses in other contexts. Due to limitations of our models, more research would be needed.
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Affiliation(s)
- Adalberto Miranda-Filho
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Hadrien Charvat
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Freddie Bray
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Arn Migowski
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Brazil
- National Institute of Cardiology (INC), Rio de Janeiro, Brazil
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Salvatore Vaccarella
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Mattias Johansson
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Andre L. Carvalho
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Hilary A. Robbins
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
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Li J, Hu P, Shi J, Fan Y, Ren J, Chen H, Li N, Liao X, Liu Y, Du L, Wu N, Tang W, Zhang Y, Zou S, Pinsky P, Prorok P, Fagerstrom R, Taylor M, Kramer B, Dai M, He J. Results of the cancer screening feasibility study in China: a multicentered randomized controlled trial of lung and colorectal cancer screening. JOURNAL OF THE NATIONAL CANCER CENTER 2021; 1:132-138. [PMID: 39036801 PMCID: PMC11256538 DOI: 10.1016/j.jncc.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background To provide an understanding of important aspects of the participant recruitment and data collection, become aware of any potential problems, and obtain necessary information in order to design a large-scale randomized controlled trial (RCT) for lung cancer and colorectal cancer (CRC) screening in China. Methods This feasibility study was a multicentered, open-label, pilot randomized trial. A total of 2696 participants who were at high risk of lung cancer were recruited from three screening centers and randomly allocated to arm 1 (n = 894), annual low-dose computed tomography (LDCT) plus a baseline colonoscopy; arm 2 (n = 902), biennial LDCT plus annual fecal immunochemical test (FIT) with OC-Sensor (OC-FIT); and arm 3 (n = 900), annual Insure-FIT plus Septin 9 blood test. Information on randomization, compliance, positivity rate, cancer case detection, and contamination with screening for lung cancer and CRC were collected. Results Participant characteristics were similar across study arms. The compliance rate of annual LDCT screening in arm 1 was 86.4% (95% CI: 83.9%, 88.5%) at baseline (T0), and 69.0% (95% CI: 65.8%, 72.0%) and 70.7% (95% CI: 67.6%, 73.7%) at the following two rounds (T1 and T2). The compliance rates of biennial LDCT screening in arm 2 were similar to those in arm 1 in the corresponding rounds. The compliance rate was 55.5% (95% CI: 52.2%, 58.8%) for colonoscopy in arm 1, while the compliance rates of OC-FIT, Insure-FIT, and the Septin 9 test in arms 2 and 3 were all approximately 90% at T0, decreasing to 65%-80% at T1 and T2. The positivity rate, cancer case detection rate, and contamination rate of screening for lung cancer and CRC were also reported. Conclusion In this pilot study, the feasibility of an RCT in China of lung cancer and CRC screening was demonstrated.
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Affiliation(s)
- Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Hu
- National Cancer Institute, Bethesda, USA
| | - Jufang Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaguang Fan
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiansong Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongda Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Yuqin Liu
- Gansu Cancer Hospital, Lanzhou, China
| | - Lingbin Du
- Zhejiang Cancer Hospital, Hangzhou, China
| | - Ning Wu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Tang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yueming Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuangmei Zou
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | - Min Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - China Cancer Screening Trial Feasibility Study Group
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Cancer Institute, Bethesda, USA
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Hunan Cancer Hospital, Changsha, China
- Gansu Cancer Hospital, Lanzhou, China
- Zhejiang Cancer Hospital, Hangzhou, China
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Urrutia Argueta S, Hanna N. Lung Cancer Screening Knowledge Among Internal Medicine Residents in a University Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1186-1192. [PMID: 32307666 DOI: 10.1007/s13187-020-01747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Lung cancer remains the main cause of cancer-related death. Even though several societies recommend that certain populations may benefit from lung cancer screening with low-dose computed tomography (LDCT), its nationwide adoption has been slow. Practices in primary care are closely linked to residency training. Recognizing gaps in knowledge during training may translate into increased utilization of life-saving measures. Sixty internal medicine residents training at a university-based program were presented with an anonymous online-based survey designed to measure their knowledge about lung cancer screening. In the second phase, residents were presented with an infographic containing the answers to the initial survey. They were surveyed again 30 days after this intervention. The average correct response rate among all years was 42%. PGY-1 residents performed better compared with PGY-2 and PGY-3 residents (p = 0.015). Ninety-two percent of residents did not think screening improved all-cause mortality. Less than half thought screening had a lung cancer-specific mortality benefit. Fifty-three percent rated their self-perceived knowledge above 50%. There was no difference in knowledge after the intervention. Specific populations may benefit from LDCT screening. Even if these benefits do not directly translate to population settings, the burden and mortality of lung cancer calls for urgent measures to attempt an earlier diagnosis. Internal medicine residents in this program may have several concerns about lung cancer screening including coverage, benefit, and false positive rate. Educational methods such as infographics may not be effective in improving knowledge among residents. Lung cancer screening should be a priority in medical education, especially in states with high smoking rates and lung cancer mortality.
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Affiliation(s)
| | - Nasser Hanna
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
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Wilkinson AN, Lam S. Lung cancer screening primer: Key information for primary care providers. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:817-822. [PMID: 34772708 DOI: 10.46747/cfp.6711817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review new evidence reported since the 2016 publication of the Canadian Task Force on Preventive Health Care recommendations and to summarize key facets of lung cancer screening to better equip primary care providers (PCPs) in anticipation of wider implementation of the recommendations. QUALITY OF EVIDENCE A new, large randomized controlled trial has been published since 2016, as have updates from 4 other trials. PubMed was searched for studies published between January 1, 2004, and December 31, 2020, using search words including lung cancer screening eligibility, lung cancer screening criteria, and lung cancer screening guidelines. All information from peer-reviewed articles, reference lists, books, and websites was considered. MAIN MESSAGE Lung cancers diagnosed at stage 4 have a 5-year survival rate of only 5% and have a disproportionate impact on those with lower socioeconomic status, rural populations, and Indigenous populations. By downstaging, or diagnosing lung cancers at an earlier and more treatable stage, lung cancer screening reduces mortality with a number needed to screen of 250 to prevent 1 death. Practical aspects of lung cancer screening are reviewed, including criteria to screen, appropriate low-dose computed tomography screening, and management of findings. Harms of screening, such as overdiagnosis and incidental findings, are discussed to allow PCPs to appropriately counsel their patients in the face of ongoing implementation of new lung cancer screening programs. CONCLUSION Lung cancer screening, with its embedded emphasis on smoking cessation, is an excellent addition to PCPs' preventive health care tools. The implementation of formal and pilot lung cancer screening programs across Canada means that PCPs will be increasingly required to counsel their patients around the uptake of lung cancer screening.
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Affiliation(s)
- Anna N Wilkinson
- Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, a family physician with the Ottawa Academic Family Health Team, a general practitioner oncologist at The Ottawa Hospital Cancer Centre, Program Director of PGY-3 FP-Oncology, Chair of the Cancer Care Member Interest Group at the College of Family Physicians of Canada, and Regional Cancer Primary Care Lead for Champlain Region.
| | - Stephen Lam
- Professor of Medicine at the University of British Columbia in Vancouver, a respirologist at BC Cancer, and Distinguished Scientist Leon Judah Blackmore Chair in Lung Cancer Research and Medical Director of the BC Lung Screening Program at the BC Cancer Research Centre
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141
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Broadbent R, Gorman L, Armitage CJ, Radford J, Linton K. The perspectives of survivors of Hodgkin lymphoma on lung cancer screening: A qualitative study. Health Expect 2021; 25:116-124. [PMID: 34755419 DOI: 10.1111/hex.13353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma survivors (HLS) are at excess risk of lung cancer as a consequence of HL treatment. HLS without a heavy smoking history are currently unable to access lung cancer screening (LCS) programmes aimed at ever smokers, and there is an unmet need to develop a targeted LCS programme. In this study we prospectively explored HLS perspectives on a future LCS programme, including motivating factors and potential barriers to participation, with the aim of identifying ways to optimise uptake in a future programme. METHODS Semistructured telephone interviews were conducted with HLS, aged 18-80 and lymphoma-free for ≥5 years, selected from a clinical database (ADAPT). Participants provided informed consent. Data were analysed using inductive thematic analysis. RESULTS Despite awareness of other late effects, most participants were unaware of their excess risk of lung cancer. Most were willing to participate in a future LCS programme, citing the potential curability of early-stage lung cancer and reassurance as motivating factors, whilst prior experience of healthcare was a facilitator. Whilst the screening test (a low dose CT scan) was considered acceptable, radiation risk was a concern for some and travel and time off work were potential barriers to participation. CONCLUSIONS Our results suggest that most HLS would participate in a future LCS programme, motivated by perceived benefits. Their feedback identified a need to develop educational materials addressing lung cancer risk and concerns about screening, including radiation risk. Such materials could be provided upon an invitation to LCS. Uptake in a future programme may be further optimized by offering flexible screening appointments close to home.
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Affiliation(s)
- Rachel Broadbent
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Louise Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Mental Health and Safety, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Radford
- Manchester Cancer Research Centre, Manchester, UK
| | - Kim Linton
- Manchester Cancer Research Centre, Manchester, UK
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Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death for women in the United States. Clinical characteristics, histology, epidemiology, and treatment responses are unique for women with lung cancer. METHODS Literature search of MEDLINE publications from 1989 to 2021 was conducted for lung cancer in women. Subsequent narrative review focused on identified differences in risk factors, diagnosis, and treatment of importance to the surgical care of these patients. RESULTS Studies investigating lung cancer, in which sex-differences are explored, demonstrated differences in risk factors, histology, and treatment response among women, with a significant post-surgical survival advantage over men (41.8 months vs 26.8 months, p=0.007) and greater clinical benefit from anti-PD1 combined with chemotherapy (HR=0.44, 95% CI: 0.25-0.76) compared with men (HR=0.76, 95% CI: 0.64-0.91). Smoking remains a dominant risk factor and multiple clinical trials suggest lung cancer screening provides greater benefit for women. However, young non-smoking patients with lung cancer are 2-fold more likely to be female, advocating for broader sex-based screening criteria. Potential roles of genetic mutations, estrogen signaling, and infectious elements in sex-based differences in presentation, histology, prognosis and treatment response are explored. CONCLUSIONS Overall, much remains unknown regarding how sex influences lung cancer risk, treatment decisions and outcomes. However, evidence of specific differences in presentation, environmental risk, molecular drivers, and mutational burden support the need to better leverage these sex-associated differences to further improve detection, diagnosis, surgical outcomes and systemic regimens in order to advance the overall care strategy for women with lung cancer.
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143
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Field JK, Vulkan D, Davies MP, Baldwin DR, Brain KE, Devaraj A, Eisen T, Gosney J, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MK, Rassl DM, Rintoul RC, Screaton NJ, Wald NJ, Weller D, Whynes DK, Williamson PR, Yadegarfar G, Gabe R, Duffy SW. Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100179. [PMID: 34806061 PMCID: PMC8589726 DOI: 10.1016/j.lanepe.2021.100179] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial. METHODS From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50-75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence. FINDINGS 1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1-7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41-1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76-0.92) from nine eligible trials. INTERPRETATION The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups. FUNDING NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.
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Affiliation(s)
- John K. Field
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Daniel Vulkan
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael P.A. Davies
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Kate E. Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, and National Heart and Lung Institute, Imperial College, London, UK
| | - Tim Eisen
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - John Gosney
- Department of Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Beverley A. Green
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - John A. Holemans
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Keith M. Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Kate J. Lifford
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Fiona E. McRonald
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Arjun Nair
- Department of Radiology, University College, London Hospital, London, UK
| | - Richard D. Page
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Doris M. Rassl
- Department of Pathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Robert C. Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J. Screaton
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J. Wald
- Faculty of Population Health Sciences, University College London, London, UK
| | - David Weller
- School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK
| | - David K. Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | | | - Gasham Yadegarfar
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Rhian Gabe
- Center for Evaluation and Methods, Wolfson Institute of Population Health. Queen Mary University of London, London, UK
| | - Stephen W. Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest 2021; 160:e427-e494. [PMID: 34270968 PMCID: PMC8727886 DOI: 10.1016/j.chest.2021.06.063] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. METHODS Approved panelists reviewed previously developed key questions using the Population, Intervention, Comparator, Outcome format to address the benefit and harms of low-dose CT screening, and key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analyses were performed when enough evidence was available. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached. RESULTS The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in seven graded recommendations and nine ungraded consensus statements. CONCLUSIONS Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance.
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Affiliation(s)
| | | | | | - Tanner J Caverly
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA; Boston University School of Medicine, Boston, MA
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An evaluation of a national mass media campaign to raise public awareness of possible lung cancer symptoms in England in 2016 and 2017. Br J Cancer 2021; 126:187-195. [PMID: 34718357 PMCID: PMC8770501 DOI: 10.1038/s41416-021-01573-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A two-phase 'respiratory symptoms' mass media campaign was conducted in 2016 and 2017 in England raising awareness of cough and worsening shortness of breath as symptoms warranting a general practitioner (GP) visit. METHOD A prospectively planned pre-post evaluation was done using routinely collected data on 15 metrics, including GP attendance, GP referral, emergency presentations, cancers diagnosed (five metrics), cancer stage, investigations (two metrics), outpatient attendances, inpatient admissions, major lung resections and 1-year survival. The primary analysis compared 2015 with 2017. Trends in metrics over the whole period were also considered. The effects of the campaign on awareness of lung cancer symptoms were evaluated using bespoke surveys. RESULTS There were small favourable statistically significant and clinically important changes over 2 years in 11 of the 15 metrics measured, including a 2.11% (95% confidence interval 1.02-3.20, p < 0.001) improvement in the percentage of lung cancers diagnosed at an early stage. However, these changes were not accompanied by increases in GP attendances. Furthermore, the time trends showed a gradual change in the metrics rather than steep changes occurring during or after the campaigns. CONCLUSION There were small positive changes in most metrics relating to lung cancer diagnosis after this campaign. However, the pattern over time challenges whether the improvements are wholly attributable to the campaign. Given the importance of education on cancer in its own right, raising awareness of symptoms should remain important. However further research is needed to maximise the effect on health outcomes.
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146
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Using Electronic Medical Records to Identify Potentially Eligible Study Subjects for Lung Cancer Screening with Biomarkers. Cancers (Basel) 2021; 13:cancers13215449. [PMID: 34771612 PMCID: PMC8582572 DOI: 10.3390/cancers13215449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Recent cancer screening trials have found that using low-dose computed tomography (LDCT), compared to chest radiography, resulted in a significant reduction in lung cancer mortality. To effectively carry out this intervention, individuals at a high risk of developing lung cancer are targeted. However, accurately identifying and retaining these groups can be challenging. As electronic medical records (EMRs) contain important demographic and clinical information, they could be used to accurately identify subjects for screening. To determine whether EMRs can be used for this purpose, this paper examines the evidence around the use of EMRs in screening trials and the information contained in them that could be used to aid researchers in identifying eligible subjects. Abstract Lung cancer screening trials using low-dose computed tomography (LDCT) show reduced late-stage diagnosis and mortality rates. These trials have identified high-risk groups that would benefit from screening. However, these sub-populations can be difficult to access and retain in trials. Implementation of national screening programmes further suggests that there is poor uptake in eligible populations. A new approach to participant selection may be more effective. Electronic medical records (EMRs) are a viable alternative to population-based or health registries, as they contain detailed clinical and demographic information. Trials have identified that e-screening using EMRs has improved trial retention and eligible subject identification. As such, this paper argues for greater use of EMRs in trial recruitment and screening programmes. Moreover, this opinion paper explores the current issues in and approaches to lung cancer screening, whether records can be used to identify eligible subjects for screening and the challenges that researchers face when using EMR data.
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147
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Li Y, Du Y, Huang Y, Zhao Y, Sidorenkov G, Vonder M, Cui X, Fan S, Dorrius MD, Vliegenthart R, Groen HJM, Liu S, Song F, Chen K, de Bock GH, Ye Z. Community-based lung cancer screening by low-dose computed tomography in China: First round results and a meta-analysis. Eur J Radiol 2021; 144:109988. [PMID: 34695695 DOI: 10.1016/j.ejrad.2021.109988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the efficiency of low-dose computed tomography (LDCT) screening for lung cancer in China by analyzing the baseline results of a community-based screening study accompanied with a meta-analysis. METHODS A first round of community-based lung cancer screening with LDCT was conducted in Tianjin, China, and a systematic literature search was performed to identify LDCT screening and registry-based clinical studies for lung cancer in China. Baseline results in the community-based screening study were described by participant risk level and the lung cancer detection rate was compared with the pooled rate among the screening studies. The percentage of patients per stage was compared between the community-based study and screening and clinical studies. RESULTS In the community-based study, 5523 participants (43.6% men) underwent LDCT. The lung cancer detection rate was 0.5% (high-risk, 1.2%; low-risk, 0.4%), with stage I disease present in 70.0% (high-risk, 50.0%; low-risk, 83.3%), and the adenocarcinoma present in 84.4% (high-risk, 61.5%; low-risk, 100%). Among all screen-detected lung cancer, women accounted for 8.3% and 66.7% in the high- and low-risk group, respectively. In the screening studies from mainland China, the lung cancer detection rate 0.6% (95 %CI: 0.3%-0.9%) for high-risk populations. The proportions with carcinoma in situ and stage I disease in the screening and clinical studies were 76.4% (95 %CI: 66.3%-85.3%) and 15.2% (95 %CI: 11.8%-18.9%), respectively. CONCLUSIONS The stage shift of lung cancer due to screening suggests a potential effectiveness of LDCT screening in China. Nearly 70% of screen-detected lung cancers in low-risk populations are identified in women.
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Affiliation(s)
- Yanju Li
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Department of Radiology, Tianjin, People's Republic of China
| | - Yihui Du
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Yubei Huang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Molecular Epidemiology, Tianjin, Tianjin's Clinical Research Center for Cancer, Department of Cancer Epidemiology and Biostatistics, Tianjin, People's Republic of China
| | - Yingru Zhao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Department of Radiology, Tianjin, People's Republic of China
| | - Grigory Sidorenkov
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Marleen Vonder
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Xiaonan Cui
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Department of Radiology, Tianjin, People's Republic of China
| | - Shuxuan Fan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Department of Radiology, Tianjin, People's Republic of China
| | - Monique D Dorrius
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Harry J M Groen
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, the Netherlands
| | - Shiyuan Liu
- Shanghai Changzheng Hospital, The Second Military Medical University Shanghai, Department of Radiology, Shanghai, People's Republic of China
| | - Fengju Song
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Molecular Epidemiology, Tianjin, Tianjin's Clinical Research Center for Cancer, Department of Cancer Epidemiology and Biostatistics, Tianjin, People's Republic of China
| | - Kexin Chen
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Molecular Epidemiology, Tianjin, Tianjin's Clinical Research Center for Cancer, Department of Cancer Epidemiology and Biostatistics, Tianjin, People's Republic of China.
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
| | - Zhaoxiang Ye
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Department of Radiology, Tianjin, People's Republic of China.
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148
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Franck C, Snoeckx A, Spinhoven M, El Addouli H, Nicolay S, Van Hoyweghen A, Deak P, Zanca F. PULMONARY NODULE DETECTION IN CHEST CT USING A DEEP LEARNING-BASED RECONSTRUCTION ALGORITHM. RADIATION PROTECTION DOSIMETRY 2021; 195:158-163. [PMID: 33723584 DOI: 10.1093/rpd/ncab025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
This study's aim was to assess whether deep learning image reconstruction (DLIR) techniques are non-inferior to ASIR-V for the clinical task of pulmonary nodule detection in chest computed tomography. Up to 6 (range 3-6, mean 4.2) artificial lung nodules (diameter: 3, 5, 8 mm; density: -800, -630, +100 HU) were inserted at different locations in the Kyoto Kagaku Lungman phantom. In total, 16 configurations (10 abnormal, 6 normal) were scanned at 7.6, 3, 1.6 and 0.38 mGy CTDIvol (respectively 0, 60, 80 and 95% dose reduction). Images were reconstructed using 50% ASIR-V and a deep learning-based algorithm with low (DL-L), medium (DL-M) and high (DL-H) strength. Four chest radiologists evaluated 256 series by locating and scoring nodules on a five-point scale. No statistically significant difference was found among the reconstruction algorithms (p = 0.987, average across readers AUC: 0.555, 0.561, 0.557, 0.558 for ASIR-V, DL-L, DL-M, DL-H).
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Affiliation(s)
- C Franck
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - A Snoeckx
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - M Spinhoven
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - H El Addouli
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - S Nicolay
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - A Van Hoyweghen
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - P Deak
- GE Healthcare, Glattbrugg, Switzerland
| | - F Zanca
- Palindromo Consulting, Leuven, Belgium
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149
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Desai A, Prasad V. Low-Dose Computed Tomographic Screening for Lung Cancer: Time to Implement or Unresolved Questions? J Gen Intern Med 2021; 36:3202-3204. [PMID: 33904047 PMCID: PMC8481428 DOI: 10.1007/s11606-021-06806-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/03/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Aakash Desai
- Department of Internal Medicine, University of Connecticut, Farmington, CT, USA
| | - Vinay Prasad
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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150
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Jani C, Marshall DC, Singh H, Goodall R, Shalhoub J, Al Omari O, Salciccioli JD, Thomson CC. Lung cancer mortality in Europe and the USA between 2000 and 2017: an observational analysis. ERJ Open Res 2021; 7:00311-2021. [PMID: 34988220 PMCID: PMC8711085 DOI: 10.1183/23120541.00311-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/27/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The lung is the most common site for cancer and has the highest worldwide cancer-related mortality. Our study reports and compares trends in lung cancer mortality in the USA and 26 European countries. STUDY DESIGN AND METHODS Lung cancer mortality data were extracted for males and females for each of the years 2000-2017 from the World Health Organization (WHO) Mortality and the Centers for Disease Control and Prevention (CDC) WONDER databases. Lung cancer mortality trends were compared using Joinpoint regression analysis, and male-to-female mortality ratios were calculated. RESULTS Down-trending lung cancer mortality rates were observed in males in all countries except Cyprus and Portugal between 2000 and 2017. In females, increasing mortality rates were observed in 22 of the 27 countries analysed. Latvia had the highest estimated annual percentage change (EAPC) in male mortality (-9.6%) between 2013 and 2015. In the USA, EAPCs were -5.1% for males and -4.2% for females between 2014 and 2017. All countries had an overall decrease in the ratio of male-to-female lung cancer mortality. The most recent observation of median male-to-female mortality was 2.26 (IQR 1.92-4.05). The countries with the greatest current sex disparity in lung cancer mortality were Lithuania (5.51) and Latvia (5.00). CONCLUSION Between 2000 and 2017, lung cancer mortality rates were decreasing for males in Europe and the USA, whereas increasing lung cancer mortality rates were generally observed in females. There is a persistent but decreasing sex-mortality gap, with men having persistently greater lung cancer mortality but with rates decreasing faster than women.
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Affiliation(s)
- Chinmay Jani
- Dept of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Harpreet Singh
- Dept of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard Goodall
- Dept of Surgery and Cancer, Imperial College of London, London, UK
| | - Joseph Shalhoub
- Dept of Surgery and Cancer, Imperial College of London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Omar Al Omari
- Dept of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Justin D. Salciccioli
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
- These authors contributed equally
| | - Carey C. Thomson
- Dept of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA
- These authors contributed equally
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