Assessing the Impact of Incidental Findings in a Lung Cancer Screening Study by Using Low-dose Computed Tomography

Kucharczyk, Michael Jonathan; Menezes, Ravi; McGregor, Alexander; Paul, Narinder; Roberts, Heidi C.

doi:10.1016/j.carj.2010.02.008

Cited by 90 publications

(71 citation statements)

References 29 publications

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“…This proportion is consistent with our results. In addition, technological advancements in imaging modalities and various screening programs have increased the prevalence of incidental findings of malignancies, which in turn increases the number of referrals of patients for palliative radiation [28,29].…”

Section: Discussionmentioning

confidence: 99%

Comparing baseline symptom severity and demographics over two time periods in an outpatient palliative radiotherapy clinic

Khan

Kwong

Nguyen

et al. 2011

Support Care Cancer

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There have been statistically significant lower scores in the severity of the majority of symptoms as scored by the latter patient cohort; however, whether this difference in magnitude is clinically significant is debatable. The reason for referral and demographics in patients sent for palliative radiotherapy has changed over a 10-year period. This may be a reflection of the changes in systemic therapies and improvements in supportive care for patients with advanced cancer.

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Section: Discussionmentioning

confidence: 99%

Comparing baseline symptom severity and demographics over two time periods in an outpatient palliative radiotherapy clinic

Khan

Kwong

Nguyen

et al. 2011

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“…We note that only the effect of including costs and consequences of incidental findings would be indeterminate. Although it is probable that incidental findings would generate additional work-up and imaging costs (studies in both Canada 108 and Italy 109 have reported costs equivalent to around £9 per participant), it is equally likely that the earlier diagnosis of these non-cancer conditions could potentially generate compensating outcome gains.…”

Section: Uk Lung Cancer Screening Evaluation Modelmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

229

231

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BackgroundLung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects.ObjectivesTo (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening.DesignA pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years).SettingThoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire.ParticipantsIndividuals aged 50–75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres.InterventionsA thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria.Main outcome measuresPopulation-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling.ResultsA total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality.ConclusionsThe UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60–75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols.Future workThe UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch–Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation.Trial registrationCurrent Controlled Trials ISRCTN78513845.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.

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“…There is no reliable information on the costs of managing potentially significant incidental findings; however, 2 recent studies of lung cancer screening with CT in Italy and Canada reported radiologic costs of $129 21 and $95 22 per finding. In a study of incidental findings in CT colonography in the United States, total medical costs were about $1600 per finding, only about one third of which was due to radiologic imaging.…”

Section: Methodsmentioning

confidence: 99%

Computed Tomography Screening for Lung Cancer in the National Lung Screening Trial

Black¹

2015

Journal of Thoracic Imaging

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The National Lung Screening Trial (NLST) demonstrated that screening with low-dose CT versus chest radiography reduced lung cancer mortality by 16% to 20%. More recently, a cost-effectiveness analysis (CEA) of CT screening for lung cancer versus no screening in the NLST was performed. The CEA conformed to the reference-case recommendations of the US Panel on Cost-Effectiveness in Health and Medicine, including the use of the societal perspective and an annual discount rate of 3%. The CEA was based on several important assumptions. In this paper, I review the methods and assumptions used to obtain the base case estimate of $81,000 per quality-adjusted life-year gained. In addition, I show how this estimate varied widely among different subsets and when some of the base case assumptions were changed and speculate on the cost-effectiveness of CT screening for lung cancer outside the NLST.

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Assessing the Impact of Incidental Findings in a Lung Cancer Screening Study by Using Low-dose Computed Tomography

Cited by 90 publications

References 29 publications

Comparing baseline symptom severity and demographics over two time periods in an outpatient palliative radiotherapy clinic

Comparing baseline symptom severity and demographics over two time periods in an outpatient palliative radiotherapy clinic

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Computed Tomography Screening for Lung Cancer in the National Lung Screening Trial

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