Lung cancer screening with low-dose computed tomography: an analysis of the MEDCAC decision

Induced Demand in Cancer Diagnosis

Context: Supplier-induced demand (SID) is an essential concept in health economics related to the diagnosis of different types of cancer and related expenditures. The current review considered studies on induced demand in cancer diagnosis. Evidence Acquisition: This systematic review investigated the induced diagnosis of cancer in four well-known databases (Scopus, Science Direct, Web of Science, and PubMed) from January 1980 to July 2019 using the keywords “induced demand,” “cancer,” and “diagnosis”. References of the studies found through the original search were also considered for analysis. Results: No studies focused on SID in cancer diagnosis could be found, thus indicating a significant deficiency in the discussion of SID in cancer diagnosis studies. Therefore, the terms most relevant to the concept of SID in cancer diagnosis were examined. Finally, 24 factors were categorized into three groups: economic, socio-cultural, and structural. The majority of evidence for the probability of SID in cancer diagnosis is related to overdiagnosis or early diagnosis caused by unnecessary screening (57.14% of reviewed articles) and the neglect of clinical practice guidelines (42.8% of reviewed articles), mainly by diagnostic imaging. Conclusions: Research focused explicitly on SID in cancer diagnosis is needed. Moreover, economic, social, and structural reforms related to the factors that connect overuse, overdiagnosis, and unnecessary services to cancer diagnosis are required to control costs and harm and provide the best benefits to patients.

Lung cancer screening: latest developments and unanswered questions

The US National Lung Screening Trial showed that individuals randomly assigned to screening with low-dose CT scans had 20% lower lung cancer mortality than did those screened with conventional chest radiography. On the basis of a review of the literature and a modelling study, the US Preventive Services Task Force recommends annual screening for lung cancer for individuals aged 55-80 years who have a 30 pack-year smoking history and either currently smoke or quit smoking within the past 15 years. However, the balance between benefits and harms of lung cancer screening is still greatly debated. The large number of false-positive results and the potential for overdiagnosis are causes for concern. Some investigators suggest the ratio between benefits and harms could be improved through various means. Nevertheless, many questions remain with regard to the implementation of lung cancer screening. This paper highlights the latest developments in CT lung cancer screening and provides an overview of the main unanswered questions.

Prediction of potential drivers connecting different dysfunctional levels in lung adenocarcinoma via a protein-protein interaction network

Lung cancer is a serious disease that threatens an affected individual's life. Its pathogenesis has not yet to be fully described, thereby impeding the development of effective treatments and preventive measures. "Cancer driver" theory considers that tumor initiation can be associated with a number of specific mutations in genes called cancer driver genes. Four omics levels, namely, (1) methylation, (2) microRNA, (3) mutation, and (4) mRNA levels, are utilized to cluster cancer driver genes. In this study, the known dysfunctional genes of these four levels were used to identify novel driver genes of lung adenocarcinoma, a subtype of lung cancer. These genes could contribute to the initiation and progression of lung adenocarcinoma in at least two levels. First, random walk with restart algorithm was performed on a protein-protein interaction (PPI) network constructed with PPI information in STRING by using known dysfunctional genes as seed nodes for each level, thereby yielding four groups of possible genes. Second, these genes were further evaluated in a test strategy to exclude false positives and select the most important ones. Finally, after conducting an intersection operation in any two groups of genes, we obtained several inferred driver genes that contributed to the initiation of lung adenocarcinoma in at least two omics levels. Several genes from these groups could be confirmed according to recently published studies. The inferred genes reported in this study were also different from those described in a previous study, suggesting that they can be used as essential supplementary data for investigations on the initiation of lung adenocarcinoma. This article is part of a Special Issue entitled: Accelerating Precision Medicine through Genetic and Genomic Big Data Analysis edited by Yudong Cai & Tao Huang.

A supramolecular indicator displacement assay for acetyl amantadine, a proxy biomarker for spermidine/spermine N1-acetyltransferase (SSAT) activity

Acetyl amantadine (AcAm) is produced from amantadine (Am) in vivo upon catalysis by spermidine/spermine N1-acetyl transferase (SSAT). SSAT is a biomarker for multiple aggressive cancers, and the analysis of AcAm in urine has been promoted as a proxy measure for the early detection of cancer. We report here the development and optimization of cucurbit[7]uril–dye pair based indicator displacement assay (IDA) for the detection of AcAm in solution. In deionized water, using Rhodamine B as the dye, the limit of detection of AcAm was 0.087 μM with a linear response range from 0 to 1 μM. Using berberine as the dye, the limit of detection was 0.077 μM with the same range of linear response. Our efforts and difficulties in translating this assay to function in human urine are also described. We achieve a partial response of the berberine IDA to the presence of AcAm in urine that has undergone a simple PD-10 desalting step.

High-risk older smokers' perceptions, attitudes, and beliefs about lung cancer screening

The US Preventive Services Task Force recommends that smokers aged 55-80 should be screened annually with low-dose computed tomography (LDCT). This study identified demographics, smoking history, health risk perceptions, knowledge, and attitudes factors of older smokers (≥55 years) related to LDCT agreement. Using binary logistic regression, a predictive model of factors to explain LDCT agreement was produced. This is a cross-sectional, national, online survey of 338 older smokers (≥55 years) with a ≥30 pack-year smoking history. Over 82% of the sample believed that a person who continues to smoke after the age of 40 has at least a 25% chance of developing lung cancer and 77.3% would "agree to a LDCT today". Using chi-square analyses, six variables that were significant at the 0.10 level were selected for inclusion in model development. Four of the independent variables made a unique statistically significant contribution to the model: perceives accuracy of the LDCT as an important factor in the decision to have a LDCT scan; believes that early detection of LC will result in a good prognosis; believes that they are at high risk for lung cancer; and is not afraid of CT scans. Of note, only 10.9% believed that a negative CT scan result would mean that they could continue to smoke. Older smokers are aware of the risks of smoking, are interested in smoking cessation, and most are interested in and positive about LDCT. Cognitive aspects of participation in screening are key to increasing the uptake of lung cancer screening among high-risk smokers.

The 10 Pillars of Lung Cancer Screening: Rationale and Logistics of a Lung Cancer Screening Program

On the basis of the National Lung Screening Trial data released in 2011, the U.S. Preventive Services Task Force made lung cancer screening (LCS) with low-dose computed tomography (CT) a public health recommendation in 2013. The Centers for Medicare and Medicaid Services (CMS) currently reimburse LCS for asymptomatic individuals aged 55-77 years who have a tobacco smoking history of at least 30 pack-years and who are either currently smoking or had quit less than 15 years earlier. Commercial insurers reimburse the cost of LCS for individuals aged 55-80 years with the same smoking history. Effective care for the millions of Americans who qualify for LCS requires an organized step-wise approach. The 10-pillar model reflects the elements required to support a successful LCS program: eligibility, education, examination ordering, image acquisition, image review, communication, referral network, quality improvement, reimbursement, and research frontiers. Examination ordering can be coupled with decision support to ensure that only eligible individuals undergo LCS. Communication of results revolves around the Lung Imaging Reporting and Data System (Lung-RADS) from the American College of Radiology. Lung-RADS is a structured decision-oriented reporting system designed to minimize the rate of false-positive screening examination results. With nodule size and morphology as discriminators, Lung-RADS links nodule management pathways to the variety of nodules present on LCS CT studies. Tracking of patient outcomes is facilitated by a CMS-approved national registry maintained by the American College of Radiology. Online supplemental material is available for this article.

Screening for lung cancer: to be or not to be covered by medicare?

The National Lung Cancer Screening Trial (NLST) found a reduction in lung cancer mortality in high-risk patients aged 55 to 74 who were screened with low-dose computed tomography (LDCT) rather than chest x-ray. This reduction was 20% after 6.5 years and 16% after 7.5 years, with a 6.7% reduction in all-cause mortality after 6.5 years. The US Preventive Services Task Force recommended LDCT screening for people aged 55 to 80 who currently smoke or had quit within the last 15 years and who have a history of at least 30 pack-years of smoking. Advocates are urging Medicare to cover the cost of screening for that same targeted population, but the Medicare Evidence Development and Coverage Advisory Committee recommended against coverage, expressing their lack of confidence that the benefits would outweigh the risks for the Medicare patients likely to be screened. Data that support and refute the advocacy position regarding Medicare coverage for LDCT screening are presented. The likely benefits and risks for Medicare patients are discussed in the context of NLST data, other research findings, comparisons between NLST patients and Medicare patients of the same age and smoking histories, and Medicare policies.

Screening for Lung Cancer With Low-Dose Computed Tomography: Grand Rounds Discussion From the Beth Israel Deaconess Medical Center

In December 2013, the U.S. Preventive Services Task Force recommended screening for lung cancer with low-dose computed tomography (LDCT) for selected current and former smokers. The Task Force based the recommendation primarily on the results of the NLST (National Lung Screening Trial). In this trial, patients randomly assigned to LDCT screening for 3 years had lower rates of both lung cancer-specific mortality and all-cause mortality (relative risk reduction, 6.7% [95% CI, 1.2% to 13.6%]; absolute risk reduction, 0.46% [CI, 0% to 0.9%]). Clinicians and health systems confront questions and challenges as they begin to implement lung cancer screening. This paper summarizes a conference during which an internist and a radiologist discuss the application of the Task Force recommendation to an individual patient.