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Tieu V, MacDowell S, Tibi S, Ventayen B, Agarwal M. Identifying Populations at Risk for Lung Cancer Mortality from the National Health and Nutrition Examination Survey (2001-2018) Using the 2021 USPSTF Screening Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:781. [PMID: 38929027 PMCID: PMC11203664 DOI: 10.3390/ijerph21060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Lung cancer (LC) is the leading cause of cancer mortality in the United States. To combat this predicament, early screening and critically assessing its risk factors remain crucial. The aim of this study was to identify the value of specific factors from the National Health and Nutrition Examination Survey (NHANES) from 2001-2018, as they relate to lung cancer mortality in the US Preventive Services Task Force (USPSTF)-eligible population. A total of 3545 adults who met USPSTF criteria were extracted from 81,595 NHANES participants. The LC Death Risk Assessment Tool was used to calculate the number of deaths per 1000 individuals. The Mann-Whitney U test and one-way ANOVA determined the statistical significance of the factors involved in LC mortality. Male sex, African and Hispanic ethnicity, lower education attainment, and secondhand exposure to cigarette smoke correlated with an increased risk of LC mortality. Additionally, the factor of emotional support from NHANES data was analyzed and did not show any benefit to reducing risk. By identifying individuals at high-risk, preventative measures can be maximized to produce the best possible outcome.
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Mimae T, Okada M. Asian Perspective on Lung Cancer Screening. Thorac Surg Clin 2023; 33:385-400. [PMID: 37806741 DOI: 10.1016/j.thorsurg.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in Japan and worldwide. Early detection of lung cancer is an important strategy for decreasing mortality. Advances in diagnostic imaging have made it possible to detect lung cancer at an early stage in medical practice. Conversely, screening of asymptomatic healthy populations is recommended only when the evidence shows the benefits of regular intervention. Due to a variety of evidence and racial differences, screening methods vary from country to country. This article focused on the perspective of lung cancer screening in Japan.
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Affiliation(s)
- Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Madani MH, Riess JW, Brown LM, Cooke DT, Guo HH. Imaging of lung cancer. Curr Probl Cancer 2023:100966. [PMID: 37316337 DOI: 10.1016/j.currproblcancer.2023.100966] [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: 02/21/2023] [Revised: 04/29/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality globally. Imaging is essential in the screening, diagnosis, staging, response assessment, and surveillance of patients with lung cancer. Subtypes of lung cancer can have distinguishing imaging appearances. The most frequently used imaging modalities include chest radiography, computed tomography, magnetic resonance imaging, and positron emission tomography. Artificial intelligence algorithms and radiomics are emerging technologies with potential applications in lung cancer imaging.
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Affiliation(s)
- Mohammad H Madani
- Department of Radiology, University of California, Davis, Sacramento, CA.
| | - Jonathan W Riess
- Division of Hematology/Oncology, Department of Internal Medicine, UC Davis Medical Center, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Lisa M Brown
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, CA
| | - David T Cooke
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, CA
| | - H Henry Guo
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
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4
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Hochhegger B, Pasini R, Roncally Carvalho A, Rodrigues R, Altmayer S, Kayat Bittencourt L, Marchiori E, Forghani R. Artificial Intelligence for Cardiothoracic Imaging: Overview of Current and Emerging Applications. Semin Roentgenol 2023; 58:184-195. [PMID: 37087139 DOI: 10.1053/j.ro.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/07/2023]
Abstract
Artificial intelligence algorithms can learn by assimilating information from large datasets in order to decipher complex associations, identify previously undiscovered pathophysiological states, and construct prediction models. There has been tremendous interest and increased incorporation of artificial intelligence into various industries, including healthcare. As a result, there has been an exponential rise in the number of research articles and industry participants producing models intended for a variety of applications in medical imaging, which can be challenging to navigate for radiologists. In thoracic imaging, multiple applications are being evaluated for chest radiography and computed tomography and include applications for lung nodule evaluation and cancer imaging, quantifying diffuse lung disorders, and cardiac imaging, to name a few. This review aims to provide an overview of current clinical AI models, focusing on the most common clinical applications of AI in cardiothoracic imaging.
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Olazagasti C, Seetharamu N, Kohn N, Steiger D. Implementing physician education to increase lung cancer screening uptake. Lung Cancer Manag 2023; 11:LMT55. [PMID: 37122495 PMCID: PMC10135441 DOI: 10.2217/lmt-2022-0008] [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: 07/01/2022] [Accepted: 10/12/2022] [Indexed: 05/02/2023] Open
Abstract
Aim Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. The US Preventive Services Task Force and National Comprehensive Cancer Network recommend annual low-dose computed tomography (LDCT) for eligible adults. We conducted a study to assess physician LDCT referral patterns. Methods The study was divided into a pre-, intervention, and post-intervention periods. The intervention was a LC screening educational series. We evaluated rates of LDCT screening referrals during pre- and post-intervention periods. Results In the pre-intervention period, 75 patients fulfilled US Preventive Services Task Force and/or National Comprehensive Cancer Network criteria and 27% underwent LDCT. In the post-intervention period, 135 patients fulfilled either screening criteria of whom 61.5% underwent LDCT. Conclusion In our study, educational lectures improved compliance significantly and should be used as tool for primary care providers to effectively increase LDCT screening referrals.
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Affiliation(s)
- Coral Olazagasti
- Division of Medical Oncology at Sylvester Comprehensive Cancer Center at The University of Miami Miller School of Medicine, FL 33136, USA
- Author for correspondence:
| | - Nagashree Seetharamu
- Division of Hematology-Oncology at Zucker School of Medicine @ Hofstra/Northwell Health New Hyde Park, NY 11042, USA
| | - Nina Kohn
- Department of Biostatistics at Feinstein Institute for Medical Research Great Neck, NY 11021, USA
| | - David Steiger
- Division of Pulmonary & Critical Care at Icahn School of Medicine at Mount Sinai New York, NY 10029, USA
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6
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Abstract
Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer deaths by early detection. The United States Preventive Services Task Force recommends lung cancer screening with LDCT in adults of age 50 years to 80 years who have at least a 20 pack-year smoking history and are currently smoking or have quit within the past 15 years. The implementation of a lung-cancer-screening program is complex. High-quality screening requires the involvement of a multidisciplinary team. The aim of a screening program is to find balance between mortality reduction and avoiding potential harms related to false-positive findings, overdiagnosis, invasive procedures, and radiation exposure. Components and processes of a high-quality lung-cancer-screening program include the identification of eligible individuals, shared decision-making, performing and reporting LDCT results, management of screen-detected lung nodules and non-nodule findings, smoking cessation, ensuring adherence, data collection, and quality improvement.
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Affiliation(s)
- Humberto K Choi
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue Mail Code A90, Cleveland, OH 44195, USA.
| | - Peter J Mazzone
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue Mail Code A90, Cleveland, OH 44195, USA
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7
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Artificial Intelligence in Lung Cancer Imaging: Unfolding the Future. Diagnostics (Basel) 2022; 12:diagnostics12112644. [PMID: 36359485 PMCID: PMC9689810 DOI: 10.3390/diagnostics12112644] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/30/2022] Open
Abstract
Lung cancer is one of the malignancies with higher morbidity and mortality. Imaging plays an essential role in each phase of lung cancer management, from detection to assessment of response to treatment. The development of imaging-based artificial intelligence (AI) models has the potential to play a key role in early detection and customized treatment planning. Computer-aided detection of lung nodules in screening programs has revolutionized the early detection of the disease. Moreover, the possibility to use AI approaches to identify patients at risk of developing lung cancer during their life can help a more targeted screening program. The combination of imaging features and clinical and laboratory data through AI models is giving promising results in the prediction of patients’ outcomes, response to specific therapies, and risk for toxic reaction development. In this review, we provide an overview of the main imaging AI-based tools in lung cancer imaging, including automated lesion detection, characterization, segmentation, prediction of outcome, and treatment response to provide radiologists and clinicians with the foundation for these applications in a clinical scenario.
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Parekh A, Deokar K, Verma M, Singhal S, Bhatt ML, Katoch CDS. The 50-Year Journey of Lung Cancer Screening: A Narrative Review. Cureus 2022; 14:e29381. [PMID: 36304365 PMCID: PMC9585290 DOI: 10.7759/cureus.29381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Early diagnosis and treatment are associated with better outcomes in oncology. We reviewed the existing literature using the search terms “low dose computed tomography” and “lung cancer screening” for systematic reviews, metanalyses, and randomized as well as non-randomized clinical trials in PubMed from January 1, 1963 to April 30, 2022. The studies were heterogeneous and included people with different age groups, smoking histories, and other specific risk scores for lung cancer screening. Based on the available evidence, almost all the guidelines recommend screening for lung cancer by annual low dose CT (LDCT) in populations over 50 to 55 years of age, who are either current smokers or have left smoking less than 15 years back with more than 20 to 30 pack-years of smoking. “LDCT screening” can reduce lung cancer mortality if carried out judiciously in countries with adequate resources and infrastructure.
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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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Chiu HY, Chao HS, Chen YM. Application of Artificial Intelligence in Lung Cancer. Cancers (Basel) 2022; 14:cancers14061370. [PMID: 35326521 PMCID: PMC8946647 DOI: 10.3390/cancers14061370] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Lung cancer is the leading cause of malignancy-related mortality worldwide. AI has the potential to help to treat lung cancer from detection, diagnosis and decision making to prognosis prediction. AI could reduce the labor work of LDCT, CXR, and pathology slides reading. AI as a second reader in LDCT and CXR reading reduces the effort of radiologists and increases the accuracy of nodule detection. Introducing AI to WSI in digital pathology increases the Kappa value of the pathologist and help to predict molecular phenotypes with radiomics and H&E staining. By extracting radiomics from image data and WSI from the histopathology field, clinicians could use AI to predict tumor properties such as gene mutation and PD-L1 expression. Furthermore, AI could help clinicians in decision-making by predicting treatment response, side effects, and prognosis prediction in medical treatment, surgery, and radiotherapy. Integrating AI in the future clinical workflow would be promising. Abstract Lung cancer is the leading cause of malignancy-related mortality worldwide due to its heterogeneous features and diagnosis at a late stage. Artificial intelligence (AI) is good at handling a large volume of computational and repeated labor work and is suitable for assisting doctors in analyzing image-dominant diseases like lung cancer. Scientists have shown long-standing efforts to apply AI in lung cancer screening via CXR and chest CT since the 1960s. Several grand challenges were held to find the best AI model. Currently, the FDA have approved several AI programs in CXR and chest CT reading, which enables AI systems to take part in lung cancer detection. Following the success of AI application in the radiology field, AI was applied to digitalized whole slide imaging (WSI) annotation. Integrating with more information, like demographics and clinical data, the AI systems could play a role in decision-making by classifying EGFR mutations and PD-L1 expression. AI systems also help clinicians to estimate the patient’s prognosis by predicting drug response, the tumor recurrence rate after surgery, radiotherapy response, and side effects. Though there are still some obstacles, deploying AI systems in the clinical workflow is vital for the foreseeable future.
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Affiliation(s)
- Hwa-Yen Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-Y.C.); (Y.-M.C.)
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Internal Medicine, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu 310, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Heng-Sheng Chao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-Y.C.); (Y.-M.C.)
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-28712121
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-Y.C.); (Y.-M.C.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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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: 2] [Impact Index Per Article: 1.0] [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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12
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Olazagasti C, Ehrlich M, Kohn N, Aviles K, Hoilett A, Seetharamu N. Missed Opportunities? An Observational Analysis of Lung Cancer Screening Utilization Amongst Patients With Lung Cancer. Cancer Control 2022; 29:10732748221077959. [PMID: 35157547 PMCID: PMC8848039 DOI: 10.1177/10732748221077959] [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] [Indexed: 12/03/2022] Open
Abstract
Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. The U.S. Preventive Services Task Force (USPSTF) and National Comprehensive Cancer Network (NCCN) recommend annual low-dose CT chest (LDCT) for LC screening in high-risk adults who meet appropriate criteria, which primarily focus on age and smoking history. Despite this, screening rates remain low and patients with LC are typically diagnosed at a later stage. We conducted a single-center retrospective analysis of patients with an established diagnosis of lung cancer to evaluate if screening guidelines were appropriately followed before the cancer diagnosis. Patients diagnosed with LC between 2016 and 2019 were included in the analysis. Charts were reviewed for demographics, detailed smoking history, as well as histology and stage of LC. Associations between categorical factors and screening were examined using the chi-square test. Associations between continuous and ordinal factors and screening were examined using the Mann–Whitney test. A total of 530 charts were reviewed, of which 52% met NCCN criteria and 35% met USPSTF criteria. Only 4.0% and 4.8% of patients who met NCCN and USPSTF criteria, respectively, underwent screening. There was a significant association between staging at diagnosis and screening with LDCT. All the patients who had screening CT scans were diagnosed at localized stages of lung cancer in both NCCN and USPSTF groups compared to 49.1% and 48% in eligible subjects that did not undergo screening, respectively. Our study showed that despite established guidelines for LC screening and insurance coverage, a vast majority of screening-eligible LC patients have never had LDCT. We found that patients who underwent screening as per guidelines were diagnosed at earlier stages of the disease. Ongoing efforts to increase awareness and adherence to LC screening guidelines are needed to improve early detection and reduce LC mortality.
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Affiliation(s)
- Coral Olazagasti
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, 33315University of Miami, Miami, FL, USA
| | - Matthew Ehrlich
- 21611New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Nina Kohn
- Department of Biostatistics, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Karen Aviles
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
| | - Aldane Hoilett
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
| | - Nagashree Seetharamu
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
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13
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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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14
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Fan Y, Su Z, Wei M, Liang H, Jiang Y, Li X, Meng Z, Wang Y, Pan H, Song J, Qiao Y, Zhou Q. Long-term Lung Cancer Risk Associated with Sputum Atypia: A 27-Year Follow-up Study of an Occupational Lung Screening Cohort in Yunnan, China. Cancer Epidemiol Biomarkers Prev 2021; 30:2122-2129. [PMID: 34446474 DOI: 10.1158/1055-9965.epi-21-0339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/12/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sputum cytologic atypia is associated with increased lung cancer risk. However, little is known about the long-term magnitude and temporal trend of this risk. METHODS An extended follow-up was conducted in a prospective screening cohort among occupational tin miners in Yunnan, China. Sputum samples were collected prospectively at baseline and 7 annual screenings since enrollment. The associations between sputum cytologic results from baseline screening, the first 4 consecutive rounds of sputum screening, and lung cancer risk were analyzed by time-varying covariate Cox regression model. RESULTS A moderate or worse cytologic result was associated with a significantly increased lung cancer risk. This relative hazard significantly decreased over time. Compared with negative screening results, the adjusted hazard ratios of baseline-moderate or worse atypia, at least one moderate or worse atypia in the first 4 consecutive screening rounds during the first 10 years of follow-up were 3.11 [95% confidence interval (CI): 2.37-4.07], 3.25 (95% CI: 2.33-4.54) respectively. This association was stronger for persistent atypia (adjusted hazard ratio = 17.55, 95% CI: 8.32-37.03); atypia identified in the recent screening rounds (adjusted HR = 4.14, 95% CI: 2.70-6.35), and those were old in age, had higher level of smoking, occupational radon, and arsenic exposure. In terms of histology, this increased risk was significant for squamous cell carcinoma and small cell lung cancer. CONCLUSIONS Although decreasing over time, an increased lung cancer risk concerning moderate or worse sputum atypia can continue at least for 10 years. IMPACT Sputum atypia might be helpful for identifying high-risk individuals for screening, surveillance, or chemoprevention of lung cancer.
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Affiliation(s)
- Yaguang Fan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Medical University General Hospital, Tianjin, China
| | - Zheng Su
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengna Wei
- Breast Cancer Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hao Liang
- Lung Cancer Center, Lung Cancer Institute, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong Jiang
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuebing Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongli Pan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinzhao Song
- Department of Mechanical Engineering & Applied Mechanics, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Youlin Qiao
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. .,Center of Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghua Zhou
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Medical University General Hospital, Tianjin, China. .,Lung Cancer Center, Lung Cancer Institute, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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15
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Si H, Du D, Li W, Li Q, Li J, Zhao D, Li L, Tang B. Sputum-Based Tumor Fluid Biopsy: Isolation and High-Throughput Single-Cell Analysis of Exfoliated Tumor Cells for Lung Cancer Diagnosis. Anal Chem 2021; 93:10477-10486. [PMID: 34292723 DOI: 10.1021/acs.analchem.1c00833] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Timely and effective diagnosis is of great significance for improving the survival rate of lung cancer patients. Although histopathology is the main diagnostic tool among the existing methods for lung cancer diagnosis, it is not suitable for high-risk groups, early lung cancer patients, patients with advanced-stage disease, and other situations wherein tumor tissues cannot be obtained. In view of this, we proposed an innovative lung cancer diagnosis method employing for the first time a microfluidic technology for high-efficiency isolation and high-throughput single-cell analysis of exfoliated tumor cells (ETCs) in sputum. This method fully combines the advantages of traditional sputum cytology and microfluidic technology and realizes the diagnosis of lung cancer by using a small amount of repeatable ETCs instead of the tumor tissue. This method is expected to provide a practical strategy for the non-invasive detection of lung cancer patients and lung cancer screening for high-risk groups.
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Affiliation(s)
- Haibin Si
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, P. R. China
| | - Dexin Du
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, P. R. China
| | - Wenbo Li
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, P. R. China
| | - Qingling Li
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, P. R. China
| | - Jingxin Li
- Department of Physiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan 250012, P. R. China
| | - Dongbo Zhao
- Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, P. R. China
| | - Lu Li
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, P. R. China
| | - Bo Tang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, P. R. China
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16
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Li M, Cai Q, Ma JW, Zhang L, Henschke CI. The 100 most cited articles on lung cancer screening: a bibliometric analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:787. [PMID: 34268400 PMCID: PMC8246190 DOI: 10.21037/atm-20-3199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/15/2020] [Indexed: 12/21/2022]
Abstract
Background The number of citations of an article reflects its impact on the scientific community. The aim of this study was to identify and characterize the 100 most cited articles on lung cancer screening. Methods The 100 most cited articles on lung cancer screening published in all scientific journals were identified using the Web of Science database. Relevant data, including the number of citations, publication year, publishing journal and impact factor (IF), authorship and country of origin, article type and study design, screening modality, and main topic, were collected and analyzed. Results The 100 most cited articles were all English and published between 1973 and 2017, with 81 published after 2000. The mean number of citations was 292.90 (range 100–3,910). Sixty articles originated from the United States. These articles were published in 32 journals; there was a statistically significant positive correlation between journal IF and the number of citations (r=0.238, P=0.018). Seventy-nine articles were original research of which 37.9% were about results from randomized controlled trials (RCTs). The most common screening modalities in these articles were low-dose computed tomography (LDCT) (n=78), followed by chest X-ray radiography (CXR) and sputum cytology (n=11). The most common topic in these articles was screening test effectiveness. Conclusions Our study presents a detailed list and analysis of the 100 most cited articles published about lung cancer screening which provides insight into the historical developments and key contributions in this field.
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Affiliation(s)
- Meng Li
- 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.,Department of Radiology, Mount Sinai Health System, New York, NY, USA
| | - Qiang Cai
- Department of Radiology, Mount Sinai Health System, New York, NY, USA.,Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jing-Wen Ma
- 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
| | - Li Zhang
- 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.,Department of Radiology, Mount Sinai Health System, New York, NY, USA
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17
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Bou Akl I, K Zgheib N, Matar M, Mukherji D, Bardus M, Nasr R. Primary care and pulmonary physicians' knowledge and practice concerning screening for lung cancer in Lebanon, a middle-income country. Cancer Med 2021; 10:2877-2884. [PMID: 33742559 PMCID: PMC8026943 DOI: 10.1002/cam4.3816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background Screening for lung cancer with low‐dose computed tomography (LDCT) was shown to reduce lung cancer incidence and overall mortality, and it has been recently included in international guidelines. Despite the rising burden of lung cancer in low and middle‐income countries (LMICs) such as Lebanon, little is known about what primary care physicians or pulmonologists know and think about LDCT as a screening procedure for lung cancer, and if they recommend it. Objectives Evaluate the knowledge about LDCT and implementation of international guidelines for lung cancer screening among Lebanese primary care physicians (PCPs) and pulmonary specialists. Methodology PCPs and PUs based in Lebanon were surveyed concerning knowledge and practices related to lung cancer screening by self‐administered paper questionnaires. Results 73.8% of PCPs and 60.7% of pulmonary specialists recognized LDCT as an effective tool for lung cancer screening, with 63.6% of PCPs and 71% of pulmonary specialists having used it for screening. However, only 23.4% of PCPs and 14.5% of pulmonary specialists recognized the eligibility criteria for screening. Chest X‐ray was recognized as ineffective by only 55.8% of PCPs and 40.7% of pulmonary specialists; indeed, 30.2% of PCPs and 46% of pulmonary specialists continue using it for screening. The majority have initiated a discussion about the risks and benefits of lung cancer screening. Conclusion PCPs and pulmonary specialists are initiating discussions and ordering LDCT for lung cancer screening. However, a significant proportion of both specialties are still using a non‐recommended screening tool (chest x‐ray); only few PCPs and pulmonary specialists recognized the population at risk for which screening is recommended. Targeted provider education is needed to close the knowledge gap and promote proper implementation of guidelines for lung cancer screening.
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Affiliation(s)
- Imad Bou Akl
- Division of Pulmonary, Department of Internal Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Nathalie K Zgheib
- Department of Pharmacology and Toxicology, American University of Beirut Faculty of Medicine, Beirut, Lebanon.,Cancer Prevention and Control Program, Naef K. Basile Cancer Institute, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Maroun Matar
- Division of Pulmonary, Department of Internal Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Deborah Mukherji
- Cancer Prevention and Control Program, Naef K. Basile Cancer Institute, American University of Beirut, Faculty of Medicine, Beirut, Lebanon.,Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Marco Bardus
- Cancer Prevention and Control Program, Naef K. Basile Cancer Institute, American University of Beirut, Faculty of Medicine, Beirut, Lebanon.,Department of Health Promotion and Community Health, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
| | - Rihab Nasr
- Cancer Prevention and Control Program, Naef K. Basile Cancer Institute, American University of Beirut, Faculty of Medicine, Beirut, Lebanon.,Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut Faculty of Medicine, Beirut, Lebanon
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18
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Abstract
BACKGROUND Screening for lung cancer has used chest radiography (CR), low dose computed tomography (LDCT) and sputum cytology (SC). Estimates of the lead time (LT), i.e., the time interval from detection of lung cancer by screening to the development of symptoms, have been derived from longitudinal studies of populations at risk, tumor doubling time (DT), the ratio between its prevalence at the first round of screening and its annual incidence during follow-up, and by probability modeling derived from the results of screening trials. OBJECTIVE To review and update the estimates of LT of lung cancer. METHODS A non-systematic search of the literature for estimates of LT and screening trials. Search of the reference sections of the retrieved papers for additional relevant studies. Calculation of LTs derived from these studies. RESULTS LT since detection by CR was 0.8-1.1 years if derived from longitudinal studies; 0.6-2.1 years if derived from prevalence / incidence ratios; 0.2 years if derived from the average tumor DT; and 0.2-1.0 if derived from probability modeling. LT since detection by LDCT was 1.1-3.5 if derived from prevalence / incidence ratios; 3.9 if derived from DT; and 0.9 if derived from probability modeling. LT since detection of squamous cell cancer by SC in persons with normal CR was 1.3-1.5 if derived from prevalence/incidence ratios; and 2.1 years if derived from the DT of squamous cell cancer. CONCLUSIONS Most estimates of the LT yield values of 0.2-1.5 years for detection by CR; of 0.9-3.5 years for detection by LDCT; and about 2 years or less for detection of squamous cell cancer by SC in persons with normal CR. The heterogeneity of the screening trials and methods of derivation may account for the variability of LT estimates.
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Affiliation(s)
- Jochanan Benbassat
- Department of Medicine (retired), Hadassah Medical Center, PO Box 3894, 91037, Jerusalem, Israel.
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19
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Artificial Intelligence Tools for Refining Lung Cancer Screening. J Clin Med 2020; 9:jcm9123860. [PMID: 33261057 PMCID: PMC7760157 DOI: 10.3390/jcm9123860] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022] Open
Abstract
Nearly one-quarter of all cancer deaths worldwide are due to lung cancer, making this disease the leading cause of cancer death among both men and women. The most important determinant of survival in lung cancer is the disease stage at diagnosis, thus developing an effective screening method for early diagnosis has been a long-term goal in lung cancer care. In the last decade, and based on the results of large clinical trials, lung cancer screening programs using low-dose computer tomography (LDCT) in high-risk individuals have been implemented in some clinical settings, however, this method has various limitations, especially a high false-positive rate which eventually results in a number of unnecessary diagnostic and therapeutic interventions among the screened subjects. By using complex algorithms and software, artificial intelligence (AI) is capable to emulate human cognition in the analysis, interpretation, and comprehension of complicated data and currently, it is being successfully applied in various healthcare settings. Taking advantage of the ability of AI to quantify information from images, and its superior capability in recognizing complex patterns in images compared to humans, AI has the potential to aid clinicians in the interpretation of LDCT images obtained in the setting of lung cancer screening. In the last decade, several AI models aimed to improve lung cancer detection have been reported. Some algorithms performed equal or even outperformed experienced radiologists in distinguishing benign from malign lung nodules and some of those models improved diagnostic accuracy and decreased the false-positive rate. Here, we discuss recent publications in which AI algorithms are utilized to assess chest computer tomography (CT) scans imaging obtaining in the setting of lung cancer screening.
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20
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Abstract
Lung cancer is the leading cause of US cancer-related deaths. Lung cancer screening with a low radiation dose chest computed tomography scan is now standard of care for a high-risk eligible population. It is imperative for clinicians and surgeons to evaluate the trade-offs of benefits and harms, including the identification of many benign lung nodules, overdiagnosis, and complications. Integration of smoking cessation interventions augments the clinical benefits of screening. Screening programs must develop strategies to manage screening-detected findings to minimize potential harms. Further research should focus on how to improve patient selection, minimize harms, and facilitate access to screening.
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Affiliation(s)
- Humberto K Choi
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Peter J Mazzone
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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21
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Roncarati R, Lupini L, Miotto E, Saccenti E, Mascetti S, Morandi L, Bassi C, Rasio D, Callegari E, Conti V, Rinaldi R, Lanza G, Gafà R, Papi A, Frassoldati A, Sabbioni S, Ravenna F, Casoni GL, Negrini M. Molecular testing on bronchial washings for the diagnosis and predictive assessment of lung cancer. Mol Oncol 2020; 14:2163-2175. [PMID: 32441866 PMCID: PMC7463327 DOI: 10.1002/1878-0261.12713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022] Open
Abstract
Cytopathological analyses of bronchial washings (BWs) collected during fibre‐optic bronchoscopy are often inconclusive for lung cancer diagnosis. To address this issue, we assessed the suitability of conducting molecular analyses on BWs, with the aim to improve the diagnosis and outcome prediction of lung cancer. The methylation status of RASSF1A, CDH1, DLC1 and PRPH was analysed in BW samples from 91 lung cancer patients and 31 controls, using a novel two‐colour droplet digital methylation‐specific PCR (ddMSP) technique. Mutations in ALK, BRAF, EGFR, ERBB2, KRAS, MAP2K1, MET, NRAS, PIK3CA, ROS1 and TP53 and gene fusions of ALK, RET and ROS1 were also investigated, using next‐generation sequencing on 73 lung cancer patients and 14 tumour‐free individuals. Our four‐gene methylation panel had significant diagnostic power, with 97% sensitivity and 74% specificity (relative risk, 7.3; odds ratio, 6.1; 95% confidence interval, 12.7–127). In contrast, gene mutation analysis had a remarkable value for predictive, but not for diagnostic, purposes. Actionable mutations in EGFR, HER2 and ROS1 as well as in other cancer genes (KRAS, PIK3CA and TP53) were detected. Concordance with gene mutations uncovered in tumour biopsies was higher than 90%. In addition, bronchial‐washing analyses permitted complete patient coverage and the detection of additional actionable mutations. In conclusion, BWs are a useful material on which to perform molecular tests based on gene panels: aberrant gene methylation and mutation analyses could be performed as approaches accompanying current diagnostic and predictive assays during the initial workup phase. This study establishes the grounds for further prospective investigation.
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Affiliation(s)
- Roberta Roncarati
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy.,CNR, Institute of Genetics and Biomedical Research, National Research Council of Italy, Milano, Italy
| | - Laura Lupini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Elena Miotto
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Elena Saccenti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Susanna Mascetti
- Azienda Ospedaliero-Universitaria di Ferrara, Division of Respiratory Endoscopy, S. Anna Hospital, Cona, Italy
| | - Luca Morandi
- Azienda Ospedaliero-Universitaria di Ferrara, Division of Respiratory Endoscopy, S. Anna Hospital, Cona, Italy
| | - Cristian Bassi
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy.,Laboratorio per le Tecnologie delle Terapie Avanzate, Tecnopolo, University of Ferrara, Italy
| | - Debora Rasio
- Department of Clinical and Molecular Medicine, Sant' Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Elisa Callegari
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Valentina Conti
- Pneumology Division, State Hospital, San Marino, Republic of San Marino
| | - Rosa Rinaldi
- Division of Anatomic Pathology, Carlo Poma Hospital, Mantova, Italy
| | - Giovanni Lanza
- Azienda Ospedaliero-Universitaria di Ferrara, Division of Anatomic Pathology, S. Anna Hospital, Cona, Italy.,Department of Medical Sciences, University of Ferrara, Italy
| | - Roberta Gafà
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy.,Azienda Ospedaliero-Universitaria di Ferrara, Division of Anatomic Pathology, S. Anna Hospital, Cona, Italy
| | - Alberto Papi
- Azienda Ospedaliero-Universitaria di Ferrara, Division of Respiratory Endoscopy, S. Anna Hospital, Cona, Italy.,Department of Medical Sciences, University of Ferrara, Italy
| | - Antonio Frassoldati
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy.,Azienda Ospedaliero-Universitaria di Ferrara, Medical Oncology Unit, S. Anna Hospital, Cona, Italy
| | - Silvia Sabbioni
- Laboratorio per le Tecnologie delle Terapie Avanzate, Tecnopolo, University of Ferrara, Italy.,Department of Life Sciences and Biotechnology, University of Ferrara, Italy
| | - Franco Ravenna
- Division of Pneumology and Intensive Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - Gian L Casoni
- Azienda Ospedaliero-Universitaria di Ferrara, Division of Respiratory Endoscopy, S. Anna Hospital, Cona, Italy
| | - Massimo Negrini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy.,Laboratorio per le Tecnologie delle Terapie Avanzate, Tecnopolo, University of Ferrara, Italy
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22
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Olazagasti C, Bernabe C, Seetharamu N. Lung cancer screening guidelines are clear but are they being followed? Lung Cancer Manag 2020; 9:LMT35. [PMID: 33318756 PMCID: PMC7724650 DOI: 10.2217/lmt-2020-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Coral Olazagasti
- Department of Medicine, Division of Hematology & Medical Oncology, Barbara & Donald Zucker School of Medicine at Hofstra/Northwell Health Hempstead, NY 11549, USA
| | - Carolina Bernabe
- Division of Hematology & Medical Oncology at Essen Medical Associates, Bronx, NY 10452, USA
| | - Nagashree Seetharamu
- Department of Medicine, Division of Hematology & Medical Oncology, Barbara & Donald Zucker School of Medicine at Hofstra/Northwell Health Hempstead, NY 11549, USA
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23
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Balata H, Evison M, Sharman A, Crosbie P, Booton R. CT screening for lung cancer: Are we ready to implement in Europe? Lung Cancer 2019; 134:25-33. [PMID: 31319989 DOI: 10.1016/j.lungcan.2019.05.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/12/2019] [Accepted: 05/26/2019] [Indexed: 12/23/2022]
Abstract
Lung cancer screening with low-dose CT (LDCT) is already available in certain parts of the world, such as the United States, but not yet in Europe. The recently published European position statement on lung cancer screening has recommended planning for implementation of screening to start within 18-months [1]. Pilot European programmes are already underway, primarily in the United Kingdom (UK), delivering lung cancer screening to their local populations. This review article acknowledges the evidence base for LDCT screening and will discuss the challenges that still need to be overcome in an attempt to answer the question: are we ready to implement in Europe?
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Affiliation(s)
- Haval Balata
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health University of Manchester, Manchester, UK.
| | - Matthew Evison
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - Philip Crosbie
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
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24
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Arenberg D. Update on screening for lung cancer. Transl Lung Cancer Res 2019; 8:S77-S87. [PMID: 31211108 PMCID: PMC6546631 DOI: 10.21037/tlcr.2019.03.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022]
Abstract
As the leading cause of cancer related death world wide, lung cancer is responsible for an enormous amount of suffering and disability. Detection of disease when it is surgically curable is associated with far greater odds of cure, and therefore it is a disease for which mass screening of high-risk populations has significant potential benefit. Starting in 2011, with the publication of the National Lung Screening Trial from United States (U.S.), mass screening programs have emerged throughout the U.S., as well as in other countries. More recently, large European screening trials have confirmed the potential mortality benefit of lung cancer screening. This invited non-systematic review paper covers the trial that data justify mass-screening, for lung cancer and proposes strategies for maximizing benefits and minimizing harms in the context of a mass public health lung cancer screening program.
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Affiliation(s)
- Douglas Arenberg
- Division of Pulmonary & Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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25
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Shankar A, Saini D, Dubey A, Roy S, Bharati SJ, Singh N, Khanna M, Prasad CP, Singh M, Kumar S, Sirohi B, Seth T, Rinki M, Mohan A, Guleria R, Rath GK. Feasibility of lung cancer screening in developing countries: challenges, opportunities and way forward. Transl Lung Cancer Res 2019; 8:S106-S121. [PMID: 31211111 DOI: 10.21037/tlcr.2019.03.03] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer is the leading cause of all cancer deaths worldwide, comprising 18.4% of all cancer deaths. Low-dose computed tomography (LDCT) has shown mortality benefit in various trials and now a standard tool for lung cancer screening. Most researches have been carried out in developed countries where lung cancer incidence and mortality is very high. There is an increasing trend in lung cancer incidence in developing countries attributed to tobacco smoking and various environmental and occupational risk factors. Implementation of lung cancer screening is challenging, so organised lung cancer screening is practically non-existent. There are numerous challenges in implementing such programs ranging from infrastructure, trained human resources, referral algorithm to cost and psychological trauma due to over-diagnosis. Pulmonary tuberculosis and other chest infections are important issues to be addressed while planning for lung cancer screening in developing countries. Burden of these diseases is very high and can lead to over-diagnosis in view of cut off of lung nodule size in various studies. Assessment of high risk cases for lung cancer is difficult as various forms of smoking make quantification non-uniform and difficult. Lung cancer screening targets only high risk population unlike screening programs for other cancers where entire population is targeted. There is a need of lung cancer screening for high risk cases as it saves life. Tobacco control and smoking cessation remain the most important long term intervention to decrease morbidity and mortality from lung cancer in developing countries. There is no sufficient evidence supporting the introduction of population-based screening for lung cancer in public health services.
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Affiliation(s)
- Abhishek Shankar
- Preventive Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Deepak Saini
- Indian Society of Clinical Oncology, Delhi, India
| | - Anusha Dubey
- Indian Society of Clinical Oncology, Delhi, India
| | - Shubham Roy
- Indian Society of Clinical Oncology, Delhi, India
| | - Sachidanand Jee Bharati
- Oncoanaesthesia and Palliative Medicine, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Navneet Singh
- Pulmonary Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Chandra Prakash Prasad
- Medical Oncology (Lab), Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Mayank Singh
- Medical Oncology (Lab), Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Sunil Kumar
- Surgical Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Bhawna Sirohi
- Medical Oncology, Max Institute of Cancer Care, Delhi, India
| | - Tulika Seth
- Clinical Hematology, All India Institute of Medical Sciences, Delhi, India
| | - Minakshi Rinki
- Biotechnology, Swami Shraddhanand College, Delhi University, Delhi, India
| | - Anant Mohan
- Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, Delhi, India
| | - Randeep Guleria
- Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, Delhi, India
| | - Goura Kishor Rath
- Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
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26
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Huo J, Hong YR, Bian J, Guo Y, Wilkie DJ, Mainous AG. Low Rates of Patient-Reported Physician–Patient Discussion about Lung Cancer Screening among Current Smokers: Data from Health Information National Trends Survey. Cancer Epidemiol Biomarkers Prev 2019; 28:963-973. [DOI: 10.1158/1055-9965.epi-18-0629] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/16/2018] [Accepted: 01/30/2019] [Indexed: 11/16/2022] Open
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27
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Donnelly EF, Kazerooni EA, Lee E, Henry TS, Boiselle PM, Crabtree TD, Iannettoni MD, Johnson GB, Laroia AT, Maldonado F, Olsen KM, Shim K, Sirajuddin A, Wu CC, Kanne JP. ACR Appropriateness Criteria ® Lung Cancer Screening. J Am Coll Radiol 2019; 15:S341-S346. [PMID: 30392603 DOI: 10.1016/j.jacr.2018.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 02/04/2023]
Abstract
Lung cancer remains the leading cause of cancer death in both men and women. Smoking is the single greatest risk factor for the development of lung cancer. For patients between the age of 55 and 80 with 30 or more pack years smoking history who currently smoke or who have quit within the last 15 years should undergo lung cancer screening with low-dose CT. In patients who do not meet these criteria but who have additional risk factors for lung cancer, lung cancer screening with low-dose CT is controversial but may be appropriate. Imaging is not recommended for lung cancer screening of patient younger than 50 years of age or patients older than 80 years of age or patients of any age with less than 20 packs per year history of smoking and no additional risk factor (ie, radon exposure, occupational exposure, cancer history, family history of lung cancer, history of COPD, or history of pulmonary fibrosis). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Edwin F Donnelly
- Panel Chair, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Elizabeth Lee
- Research Author, University of Michigan Health System, Ann Arbor, Michigan
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Phillip M Boiselle
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Traves D Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; The Society of Thoracic Surgeons
| | - Mark D Iannettoni
- University of Iowa, Iowa City, Iowa; The Society of Thoracic Surgeons
| | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Kyungran Shim
- John H. Stroger Jr Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | | | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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28
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Jatoi I, Anderson WF, Miller AB, Brawley OW. The history of cancer screening. Curr Probl Surg 2019; 56:138-163. [PMID: 30922446 DOI: 10.1067/j.cpsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology, Dale H. Dorn Endowed Chair in Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - William F Anderson
- National Institutes of Health/National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MA
| | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Otis W Brawley
- Michael Bloomberg Distinguished Professor of Oncology and Public Health, Johns Hopkins University, Baltimore, MA
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29
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Parker CS, Siracuse CG, Litle VR. Identifying lung cancer in patients with active pulmonary tuberculosis. J Thorac Dis 2018; 10:S3392-S3397. [PMID: 30505526 DOI: 10.21037/jtd.2018.07.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The diagnosis of lung cancer can be delayed in patients with a history of infection with pulmonary tuberculosis that present with new lesions on chest imaging, due to a high initial index of suspicion for mycobacterium tuberculosis complex rather than malignancy. This may lead to diagnosis of malignancy at a more advanced stage of the disease with subsequent increased morbidity and mortality. We reviewed the current literature to evaluate various methods of differentiating between a diagnosis of lung cancer and tuberculosis including radiography, computerized tomography (CT), positron emission tomography (PET) and various biological markers. We included only papers published in English. Based on current data, we recommend that patients established as high risk, according to the American Association of Thoracic Surgery, patients with age greater than or equal to 55 years and a smoking history of greater than or equal to 30 pack years, should be assessed with CT for underlying malignancy prior to beginning tuberculosis treatment, even in the presence of a clinical or microbiologic diagnosis of tuberculosis. In patients with equivocal CT findings, we recommend examination of tumor markers miR128, miR210, miR126 along with CEA, if these tests are at the clinician's disposal.
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Affiliation(s)
- Cassandra S Parker
- Department of Surgery, Rhode Island Hospital, Brown University, Rhode Island, USA
| | | | - Virginia R Litle
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, USA
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30
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Raez LE, Nogueira A, Santos ES, dos Santos RS, Franceschini J, Ron DA, Block M, Yamaguchi N, Rolfo C. Challenges in Lung Cancer Screening in Latin America. J Glob Oncol 2018; 4:1-10. [PMID: 30241252 PMCID: PMC6223408 DOI: 10.1200/jgo.17.00040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is the deadliest cancer worldwide and is of particular concern for Latin America. Its rising incidence in this area of the world poses myriad challenges for the region's economies, which are already struggling with limited resources to meet the health care needs of low- and middle-income populations. In this environment, we are concerned that regional governments are relatively unaware of the pressing need to implement effective strategies for the near future. Low-dose chest computed tomography (LDCT) for screening, and routine use of minimally invasive techniques for diagnosis and staging remain uncommon. According to results of the National Lung Screening Trial, LDCT lung cancer screening provided a 20% relative reduction in mortality rates among at-risk individuals. Nevertheless, this issue is still a matter of debate, particularly in developing countries, and it is not fully embraced in developing countries. The aim of this article is to provide an overview of what the standard of care is for lung cancer computed tomography screening around the world and to aid understanding of the challenges and potential solutions that can help with the implementation of LDCT in Latin America.
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Affiliation(s)
- Luis E. Raez
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Amanda Nogueira
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Edgardo S. Santos
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ricardo Sales dos Santos
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Juliana Franceschini
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - David Arias Ron
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mark Block
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nise Yamaguchi
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christian Rolfo
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
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31
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Abstract
Lung cancer is a global health burden and is among the most common and deadliest of all malignancies worldwide. The goal of screening programs is to detect tumors in earlier, curable stages, consequently reducing disease-specific mortality. The issue of screening has great relevance to thoracic surgeons, who should play a leading role in the debate over screening and its consequences. The burden is on thoracic surgeons to work in a multidisciplinary setting to guide and treat these patients safely and responsibly, ensuring low morbidity and mortality of potential diagnostic or therapeutic interventions.
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Affiliation(s)
- Brendon M Stiles
- Division of Thoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Bradley Pua
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Nasser K Altorki
- Division of Thoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA.
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32
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Gilbert CR, Ely R, Fathi JT, Louie BE, Wilshire CL, Modin H, Aye RW, Farivar AS, Vallières E, Gorden JA. The economic impact of a nurse practitioner–directed lung cancer screening, incidental pulmonary nodule, and tobacco-cessation clinic. J Thorac Cardiovasc Surg 2018; 155:416-424. [DOI: 10.1016/j.jtcvs.2017.07.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/08/2017] [Accepted: 07/15/2017] [Indexed: 11/16/2022]
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33
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Abstract
PURPOSE OF REVIEW Lung cancer screening with low-dose chest computed tomography is now recommended for high-risk individuals by the US Preventive Services Task Force. This recommendation was informed by several randomized controlled trials, the largest of which, the National Lung Screening Trial, demonstrated a 20% relative reduction in lung cancer mortality with annual low-dose chest computed tomography compared with chest radiography. RECENT FINDINGS The benefit of lung cancer screening must be balanced against potential harms, including a high false-positive rate with consequent further evaluative studies and invasive testing. It is critical that harms be minimized as screening generalizes to the broad community. Informed decision making between providers and patients should include individualized risk assessment, a discussion of both potential benefit and harm, and tobacco treatment. Given the multiple components required for high quality, screening should ideally occur in the context of a multidisciplinary program. SUMMARY We are in the early days of lung cancer screening, still with much to learn. Ongoing studies are necessary to refine the definition of a positive screen and develop better methods of distinguishing between true positive and false-positive results. Novel approaches, including the development of multicomponent lung cancer biomarkers, will likely inform and improve our future screening practice.
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34
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Su D, Feng L, Jiang Y, Wang Y. [Effect of Scanning and Reconstruction Parameters on Three Dimensional Volume and CT Value Measurement of Pulmonary Nodules: A Phantom Study]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:562-567. [PMID: 28855040 PMCID: PMC5973003 DOI: 10.3779/j.issn.1009-3419.2017.08.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
具有表皮生长因子受体(epidermal growth factor receptor, EGFR)敏感突变的非小细胞肺癌患者对酪氨酸激酶抑制剂(tyrosine kinase inhibitors, TKIs)具有良好反应,但是即使存在相同突变,不同患者对TKIs的反应也不一致。推测突变分子含量的不同是TKIs反应不一的部分原因,具有更高EGFR突变“丰度”的肿瘤患者可能从TKIs中获益更多。EGFR突变可根据检测方法敏感性的不同,定量检测突变分子比例以及突变蛋白表达等进行半定量或定量检测。EGFR突变丰度可能有助于反映肿瘤异质性,评估疾病进程,预测TKIs药物敏感性,早期发现耐药,具有重要的临床意义。
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Affiliation(s)
- Datong Su
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lei Feng
- Department of Radiology, Tianjin Xiqing Hospital, Tianjin 300000, China
| | - Yingjian Jiang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ying Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
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35
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Blandin Knight S, Crosbie PA, Balata H, Chudziak J, Hussell T, Dive C. Progress and prospects of early detection in lung cancer. Open Biol 2017; 7:170070. [PMID: 28878044 PMCID: PMC5627048 DOI: 10.1098/rsob.170070] [Citation(s) in RCA: 460] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/27/2017] [Indexed: 12/14/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related death in the world. It is broadly divided into small cell (SCLC, approx. 15% cases) and non-small cell lung cancer (NSCLC, approx. 85% cases). The main histological subtypes of NSCLC are adenocarcinoma and squamous cell carcinoma, with the presence of specific DNA mutations allowing further molecular stratification. If identified at an early stage, surgical resection of NSCLC offers a favourable prognosis, with published case series reporting 5-year survival rates of up to 70% for small, localized tumours (stage I). However, most patients (approx. 75%) have advanced disease at the time of diagnosis (stage III/IV) and despite significant developments in the oncological management of late stage lung cancer over recent years, survival remains poor. In 2014, the UK Office for National Statistics reported that patients diagnosed with distant metastatic disease (stage IV) had a 1-year survival rate of just 15-19% compared with 81-85% for stage I.
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MESH Headings
- Adenocarcinoma/diagnostic imaging
- Adenocarcinoma/genetics
- Adenocarcinoma/mortality
- Adenocarcinoma/surgery
- Adenocarcinoma of Lung
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Bronchoscopy/methods
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/surgery
- Circulating Tumor DNA/blood
- Circulating Tumor DNA/genetics
- Early Detection of Cancer/methods
- Humans
- Liquid Biopsy/methods
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Lung Neoplasms/surgery
- Neoplasm Staging
- Neoplastic Cells, Circulating/metabolism
- Neoplastic Cells, Circulating/pathology
- Prognosis
- Radiography
- Small Cell Lung Carcinoma/diagnostic imaging
- Small Cell Lung Carcinoma/genetics
- Small Cell Lung Carcinoma/mortality
- Small Cell Lung Carcinoma/surgery
- Survival Analysis
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Affiliation(s)
- Sean Blandin Knight
- North West Lung Centre, University Hospital South Manchester, Manchester, UK
| | - Phil A Crosbie
- North West Lung Centre, University Hospital South Manchester, Manchester, UK
- Cancer Research UK Lung Cancer Centre of Excellence at Manchester and University College London, UK
| | - Haval Balata
- North West Lung Centre, University Hospital South Manchester, Manchester, UK
| | - Jakub Chudziak
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - Tracy Hussell
- Manchester Collaborative Centre for Inflammation Research, University of Manchester, Manchester, UK
| | - Caroline Dive
- Cancer Research UK Lung Cancer Centre of Excellence at Manchester and University College London, UK
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
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36
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Xia W, Yu X, Mao Q, Xia W, Wang A, Dong G, Chen B, Ma W, Xu L, Jiang F. Improvement of survival for non-small cell lung cancer over time. Onco Targets Ther 2017; 10:4295-4303. [PMID: 28919778 PMCID: PMC5587133 DOI: 10.2147/ott.s145036] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the main histological subtype of lung cancer, which is the leading cause of cancer death. It is unclear whether the improved survival seen at high-volume centers applies to the general population and, more importantly, whether the improvement in lung cancer survival was just a consequence of improved screening work. Data from the Surveillance, Epidemiology, and End Results (SEER) registry was used to identify 405,580 patients with NSCLC diagnosed from 1988 to 2008. The patients were divided into four groups according to the year of diagnosis. Trends of clinical characteristics were analyzed to reflect the progress of screening work. Five-year relative survivals in various subgroups were compared. The results indicated that proportion of aged, advanced, and non-surgical patients increased, whereas patients with lymph node metastasis and high histology grade decreased. Improvements in all stages of NSCLC patients were demonstrated, with relatively more significant gains for patients with localized and regional disease. After potentially curative surgical resection, remarkable improvements were observed in both cohorts with time (surgical: 52.00%–63.00%; non-surgical: 6.10%–13.50%). Specifically, patients who underwent pneumonectomy, lobectomy/bilobectomy, and partial/wedge/segmental resection all presented better survival rates. Our SEER analysis demonstrated improvements among patients in all stages of NSCLC that were deemed attributable to improved therapy and medical care for NSCLC rather than improved screening work.
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Affiliation(s)
- Wenjie Xia
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province.,The Fourth Clinical College of Nanjing Medical University
| | - Xinnian Yu
- Department of Chemotherapy, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province
| | - Qixing Mao
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province.,The Fourth Clinical College of Nanjing Medical University
| | - Wenying Xia
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Anpeng Wang
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province.,The Fourth Clinical College of Nanjing Medical University
| | - Gaochao Dong
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province
| | - Bing Chen
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province.,The Fourth Clinical College of Nanjing Medical University
| | - Weidong Ma
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province.,The Fourth Clinical College of Nanjing Medical University
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province
| | - Feng Jiang
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province
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37
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Fintelmann FJ, Bernheim A, McLoud TC. Brief History of Lung Cancer Screening Including the National Lung Screening Trial. Semin Roentgenol 2017; 52:125-128. [PMID: 28734392 DOI: 10.1053/j.ro.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Adam Bernheim
- Department of Radiology, Emory University Hospital, Atlanta, GA
| | - Theresa C McLoud
- Department of Radiology, Massachusetts General Hospital, Boston, MA
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38
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A review of lung cancer screening and the role of computer-aided detection. Clin Radiol 2017; 72:433-442. [DOI: 10.1016/j.crad.2017.01.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 12/14/2016] [Accepted: 01/04/2017] [Indexed: 12/26/2022]
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39
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Vachani A, Sequist LV, Spira A. AJRCCM: 100-Year Anniversary. The Shifting Landscape for Lung Cancer: Past, Present, and Future. Am J Respir Crit Care Med 2017; 195:1150-1160. [PMID: 28459327 PMCID: PMC5439022 DOI: 10.1164/rccm.201702-0433ci] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 12/13/2022] Open
Abstract
The past century has witnessed a transformative shift in lung cancer from a rare reportable disease to the leading cause of cancer death among men and women worldwide. This historic shift reflects the increase in tobacco consumption worldwide, spurring public health efforts over the past several decades directed at tobacco cessation and control. Although most lung cancers are still diagnosed at a late stage, there have been significant advances in screening high-risk smokers, diagnostic modalities, and chemopreventive approaches. Improvements in surgery and radiation are advancing our ability to manage early-stage disease, particularly among patients considered unfit for traditional open resection. Arguably, the most dramatic progress has occurred on the therapeutic side, with the development of targeted and immune-based therapy over the past decade. This article reviews the major shifts in the lung cancer landscape over the past 100 years. Although many ongoing clinical challenges remain, this review will also highlight emerging molecular and imaging-based approaches that represent opportunities to transform the prevention, early detection, and treatment of lung cancer in the years ahead.
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Affiliation(s)
- Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lecia V. Sequist
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Avrum Spira
- Section of Computational Biomedicine, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
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Sateia HF, Choi Y, Stewart RW, Peairs KS. Screening for lung cancer. Semin Oncol 2017; 44:74-82. [PMID: 28395767 DOI: 10.1053/j.seminoncol.2017.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/23/2016] [Accepted: 02/06/2017] [Indexed: 12/17/2022]
Abstract
This review will comprise a general overview of the epidemiology of lung cancer, as well as lung cancer risk factors, screening modalities, current guideline recommendations for screening, and our approach to lung cancer screening.
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Affiliation(s)
- Heather F Sateia
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD.
| | - Youngjee Choi
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Rosalyn W Stewart
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Kimberly S Peairs
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Ağababaoğlu İ, Önen A, Demir AB, Aktaş S, Altun Z, Ersöz H, Şanlı A, Özdemir N, Akkoçlu A. Chaperonin (HSP60) and annexin-2 are candidate biomarkers for non-small cell lung carcinoma. Medicine (Baltimore) 2017; 96:e5903. [PMID: 28178129 PMCID: PMC5312986 DOI: 10.1097/md.0000000000005903] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lung cancer is responsible of 12.4% and 17.6% of all newly diagnosed cancer cases and mortality due to cancer, respectively, and 5-year survival rate despite all improved treatment options is 15%. This survival rate reaches 66% in the Stage 1 and surgically treated patients. Early diagnosis which could not be definitely and commonly achieved yet is extremely critical in obtaining high survival rate in this disease. For this reason; proteomic differences were evaluated using matrix assisted laser desorption ionization (MALDI) mass spectrometry in the subgroups of lung adenocarcinoma and squamous cell carcinoma. METHODS Fresh tissue samples of 36 malignant cases involving 83.3% (n = 30) men and 16.7% (n = 6) women patients were distributed into 2 groups as early and end stage lung cancer and each group were composed of subgroups including 18 squamous cell carcinoma (9 early stage cases, 9 end stage cases) and 18 adenocarcinoma cases (9 early stage cases, 9 end stage cases). The fresh tissues obtained from the tumoral and matched normal sites after surgical intervention. The differences in protein expression levels were determined by comparing proteomic changes in each patient. RESULTS In the subgroups of advanced stage adenocarcinoma; tumoral tissue revealed differences in expression of 2 proteins compared with normal parenchymal tissue. Of those; difference in protein expression in heat shock protein 60 (HSP60) was found statistically significant (P = 0.0001). Subgroups of early and advanced stage squamos cell carcinoma have differed in certain 20 protein expression of normal tissue and diseased squamos cell carcinoma. Of those, increased protein expression level of only annexin-2 protein was found statistically significant (P = 0.002). No significant difference was detected in early and advanced stage protein expressions of the tumoral tissues in the subgroups of adenocarcinoma and squamous cell carcinoma. CONCLUSIONS We conclude that with respect to early diagnosis of lung cancer that HSP60 and annexin-2 proteins are the important biomarkers in the subgroups of adenocarcinoma and squamous cell carcinoma. We also consider that these 2 proteins are molecules which may provide critical contribution in evaluation of prognosis, metastatic potential, response to treatment, and in establishment of differential diagnosis between adenocarcinoma and squamous cell carcinoma.
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Affiliation(s)
| | - Ahmet Önen
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Ayşe Banu Demir
- Department of Medical Biology, Izmir University of Economics Faculty of Medicine
| | - Safiye Aktaş
- Department of Basic Oncology, Dokuz Eylül University Institute of Oncology
| | - Zekiye Altun
- Department of Basic Oncology, Dokuz Eylül University Institute of Oncology
| | - Hasan Ersöz
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Aydın Şanlı
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Nezih Özdemir
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Atila Akkoçlu
- Department of Chest Diseases, Dokuz Eylül University Medicine School, İzmir, Turkey
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Abstract
Background Randomized trials evaluating new cancer screening technologies may underestimate the efficacy of screening to reduce cancer mortality if study participants are noncompliant. Participants may fail to comply with the screening itself or fail to obtain appropriate diagnostic follow-up and treatment. Noncompliance with screening has drawn wide attention, but little attention has been paid to noncompliance with diagnostic follow-up and treatment. Purpose To examine the importance of noncompliance with screening, follow-up, and treatment in cancer screening trials. Methods The unique problems associated with noncompliance in screening trials are described and provide an example illustrating the potential impact of noncompliance in a screening trial. I discuss issues that arise with measurement of follow-up and therapeutic noncompliance, and the benefit of collecting information on health system and participant characteristics associated with noncompliance. Results The estimate of the efficacy of a screening program on cancer mortality can be adjusted for screening, follow-up, and treatment noncompliance. Noncompliance needs to be measured in a rigorous, systematic manner across all arms of the trial. Information on health system and participant characteristics associated with compliance may also be incorporated into statistical models to estimate screening effects with full compliance, plan interventions to increase compliance, and extrapolate results of screening trials from one population to another. Limitations Measuring compliance with follow-up and treatment can be difficult when these occur outside the trial, and when there is variation among providers in follow-up and treatment practices. Conclusions Noncompliance may alter the estimate of a screening effect on cancer mortality in clinical trials. It is possible to adjust screening efficacy estimates for noncompliance using existing statistical techniques. It is important that data describing compliance with screening, follow-up, and treatment are collected as part of standard data collection in cancer screening trials. Clinical Trials 2007; 4: 341—349. http://ctj.sagepub.com
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Affiliation(s)
- Ilana F Gareen
- Center for Statistical Sciences and the Department of Community Health, Brown University School of Medicine, Providence, RI 02912, USA.
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Abstract
The results of the National Lung Screening Trial (NLST) have provided the medical community and American public with considerable optimism about the potential to reduce lung cancer mortality with imaging-based screening. Designed as a randomized trial, the NLST has provided the first evidence of screening benefit by showing a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality with low dose helical computed tomography (LDCT) screening relative to chest X-ray. The major harms of LDCT screening include the potential for radiation-induced carcinogenesis; high false-positivity rates in individuals without lung cancer, and overdiagnosis. Following the results of the NLST, the National Comprehensive Cancer Network (NCCN) published the first of multiple lung cancer screening guidelines under development by major medical organizations. These recommendations amalgamated screening cohorts, practices, interpretations, and diagnostic follow-up based on the NLST and other published studies to provide guidance for the implementation of LDCT screening. There are major areas of opportunity to optimize implementation. These include standardizing practices in the screening setting, optimizing risk profiles for screening and for managing diagnostic evaluation in individuals with indeterminate nodules, developing interdisciplinary screening programs in conjunction with smoking cessation, and approaching all stakeholders systematically to ensure the broadest education and dissemination of screening benefits relative to risks. The incorporation of validated biomarkers of risk and preclinical lung cancer can substantially enhance the effectiveness screening programs.
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Affiliation(s)
- Christine D Berg
- From the Early Detection Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiothoracic Surgery, University of Washington, Seattle, WA
| | - Denise R Aberle
- From the Early Detection Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiothoracic Surgery, University of Washington, Seattle, WA
| | - Douglas E Wood
- From the Early Detection Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiothoracic Surgery, University of Washington, Seattle, WA
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Ruparel M, Quaife SL, Navani N, Wardle J, Janes SM, Baldwin DR. Pulmonary nodules and CT screening: the past, present and future. Thorax 2016; 71:367-75. [PMID: 26921304 PMCID: PMC4819623 DOI: 10.1136/thoraxjnl-2015-208107] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
Lung cancer screening has come a long way since the early studies with chest X-ray. Advancing technology and progress in the processing of images have enabled low dose CT to be tried and tested, and evidence suggests its use can result in a significant mortality benefit. There are several issues that need refining in order to successfully implement screening in the UK and elsewhere. Some countries have started patchy implementation of screening and there is increased recognition that the appropriate management of pulmonary nodules is crucial to optimise benefits of early detection, while reducing harm caused by inappropriate medical intervention. This review summarises and differentiates the many recent guidelines on pulmonary nodule management, discusses screening activity in other countries and exposes the present barriers to implementation in the UK.
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Affiliation(s)
- M Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - S L Quaife
- Health Behaviour Research Centre, University College London, London, UK
| | - N Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - J Wardle
- Health Behaviour Research Centre, University College London, London, UK
| | - S M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - D R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, UK
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The evidence for low-dose CT screening of lung cancer. Clin Imaging 2016; 40:288-95. [DOI: 10.1016/j.clinimag.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/03/2015] [Indexed: 02/03/2023]
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Li ZY, Luo L, Hu YH, Chen H, Den YK, Tang L, Liu B, Liu D, Zhang XY. Lung cancer screening: a systematic review of clinical practice guidelines. Int J Clin Pract 2016; 70:20-30. [PMID: 26538377 DOI: 10.1111/ijcp.12744] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer screening using low-dose computed tomography presents an exciting development for high-risk individuals. Several expert bodies and governments have recently issued and updated their clinical practice guidelines (CPGs) for lung cancer screening. We evaluate the CPGs and compare and contrast the recommendations between them. METHODS We searched seven databases (MEDLINE, EMBASE, TRIP, NGC, SIGN, GIN, CMA Infobase) to find CPGs, and used the appraisal of guidelines for research and evaluation instrument (AGREE-II) to evaluate them. We also assessed the recommendations within each CPG. RESULTS Of the eight CPGs included, four guidelines were regarded as high in quality (60%) based on rigour of development and effectively targeting 4-5 of the six domains according to the AGREE-II criteria. Most CPGs' recommendations for the lung cancer screening of high-risk individuals, the associated screening parameters and the benefit vs. harm of screening were consistent. However, there is still variation among the CPGs reviewed in this study. CONCLUSIONS The qualities of the selected CPGs vary and there is potential to improve the qualities among and between each. Specifically, more evidence is needed to support the recommendations such as a larger cohort of high-risk participants, and further analysis of the lung cancer screening interval, the benefit vs. harm of lung cancer screening, the timing and rigour of follow-up and availability of effective treatments.
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Affiliation(s)
- Z Y Li
- Department of Thoracic Surgery, Guizhou Province People's Hospital, Guiyang, China
| | - L Luo
- Department of Research and Education, Guizhou Province People's Hospital, Guiyang, China
| | - Y H Hu
- Department of Research and Education, Guizhou Province People's Hospital, Guiyang, China
| | - H Chen
- Department of Research and Education, Guizhou Province People's Hospital, Guiyang, China
| | - Y K Den
- Department of Research and Education, Guizhou Province People's Hospital, Guiyang, China
| | - L Tang
- Department of Medical Imaging, Guizhou Province People's Hospital, Guiyang, China
| | - B Liu
- Department of Thoracic Surgery, Guizhou Province People's Hospital, Guiyang, China
| | - D Liu
- Department of Thoracic Surgery, Guizhou Province People's Hospital, Guiyang, China
| | - X Y Zhang
- Department of Respiratory Medicine, Guizhou Province People's Hospital, Guiyang, China
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Abstract
Lung cancer is the leading cause of cancer mortality in the United States and worldwide. Since lung cancer outcomes are dependent on stage at diagnosis with early disease resulting in longer survival, the goal of screening is to capture lung cancer in its early stages when it can be treated and cured. Multiple studies have evaluated the use of chest X-ray (CXR) with or without sputum cytologic examination for lung cancer screening, but none has demonstrated a mortality benefit. In contrast, the multicenter National Lung Screening Trial (NLST) from the United States found a 20 % reduction in lung cancer mortality following three consecutive screenings with low-dose computed tomography (LDCT) in high-risk current and former smokers. Data from European trials are not yet available. In addition to a mortality benefit, lung cancer screening with LDCT also offers a unique opportunity to promote smoking cessation and abstinence and may lead to the diagnoses of treatable chronic diseases, thus decreasing the overall disease burden. The risks of lung cancer screening include overdiagnosis, radiation exposure, and false-positive results leading to unnecessary testing and possible patient anxiety and distress. However, the reduction in lung cancer mortality is a benefit that outweighs the risks and major health organizations currently recommend lung cancer screening using age, smoking history, and quit time criteria derived from the NLST. Although more research is needed to clearly define and understand the application and utility of lung cancer screening in the general population, current data support that lung cancer screening is effective and should be offered to eligible beneficiaries.
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Sharma D, Newman TG, Aronow WS. Lung cancer screening: history, current perspectives, and future directions. Arch Med Sci 2015; 11:1033-43. [PMID: 26528348 PMCID: PMC4624749 DOI: 10.5114/aoms.2015.54859] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/07/2013] [Accepted: 09/11/2013] [Indexed: 12/19/2022] Open
Abstract
Lung cancer has remained the leading cause of death worldwide among all cancers. The dismal 5-year survival rate of 16% is in part due to the lack of symptoms during early stages and lack of an effective screening test until recently. Chest X-ray and sputum cytology were studied extensively as potential screening tests for lung cancer and were conclusively proven to be of no value. Subsequently, a number of studies compared computed tomography (CT) with the chest X-ray. These studies did identify lung cancer in earlier stages. However, they were not designed to prove a reduction in mortality. Later trials have focused on low-dose CT (LDCT) as a screening tool. The largest US trial - the National Lung Screening Trial (NLST) - enrolled approximately 54,000 patients and revealed a 20% reduction in mortality. While a role for LDCT in lung cancer screening has been established, the issues of high false positive rates, radiation risk, and cost effectiveness still need to be addressed. The guidelines of the international organizations that now include LDCT in lung cancer screening are reviewed. Other methods that may improve earlier detection such as positron emission tomography, autofluorescence bronchoscopy, and molecular biomarkers are also discussed.
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Affiliation(s)
- Divakar Sharma
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Thomas G. Newman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Wilbert S. Aronow
- Divisions of Cardiology, and Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla NY, USA
- Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla NY, USA
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Beek EJRV, Mirsadraee S, Murchison JT. Lung cancer screening: Computed tomography or chest radiographs? World J Radiol 2015; 7:189-193. [PMID: 26339461 PMCID: PMC4553249 DOI: 10.4329/wjr.v7.i8.189] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/29/2015] [Accepted: 05/28/2015] [Indexed: 02/06/2023] Open
Abstract
Worldwide, lung cancer is the leading cause of mortality due to malignancy. The vast majority of cases of lung cancer are smoking related and the most effective way of reducing lung cancer incidence and mortality is by smoking cessation. In the Western world, smoking cessation policies have met with limited success. The other major means of reducing lung cancer deaths is to diagnose cases at an earlier more treatable stage employing screening programmes using chest radiographs or low dose computed tomography. In many countries smoking is still on the increase, and the sheer scale of the problem limits the affordability of such screening programmes. This short review article will evaluate the current evidence and potential areas of research which may benefit policy making across the world.
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