CT Screening for Lung Cancer: Diagnoses Resulting from the New York Early Lung Cancer Action Project

Henschke, Claudia I.; Yankelevitz, David F.; McCauley, Dorothy I.; Rifkin, Matthew D.; Fiore, E; Austin, John; Pearson, Gregory; Shiau, Maria C.; Kopel, Samuel; Klippenstein, Donald; Litwin, Alan; Loud, Peter A.; Kohman, Leslie J.; Scalzetti, Ernest M.; Khan, Arfa; Shah, Rakesh; Mendelson, David S.; Heelan, Robert T.; Ginsberg, Michelle S.; Matalon, Terence A.S.; Wiernik, Peter H.; Altorki, Nasser K.; Farooqi, Ali; Faustini, Yolanda; Libby, Daniel M.; Miettinen, Olli S.; Ostroff, Jamie S.; Pasmantier, Mark; Reeves, Anthony P.; Smith, James P.; Vazquez, Madeline F.; Yip, Rowena; Agnello, Kimberly K.; Kramer, Arin; Hess, Judith; Carter, Darryl; Brambilla, Elizabeth; Gazdar, Adi F.; Noguchi, Masayuki; Travis, William D.

doi:10.1148/radiol.2431060467

Cited by 97 publications

(14 citation statements)

References 23 publications

(22 reference statements)

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“…Due to the substantial survival advantage to early detection, there have been extensive efforts to detect lung cancer at an early stage. The Early Lung Cancer Action Project (ELCAP) [5] and the National Lung Cancer Screening Trial (NLST) [4] are prospective studies that screened symptom-free high-risk smokers using low dose computed tomography (CT) and preliminary results show increased ability to detect early stage, potentially curable lesions [3]. The NLST was stopped early in November of 2010 after the preliminary data revealed a 20.3% decrease in lung cancer deaths in the CT screening arm of the trial [4], [6].…”

Section: Introductionmentioning

confidence: 99%

Serum microRNA Biomarkers for Detection of Non-Small Cell Lung Cancer

et al. 2012

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Non small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality world-wide and the majority of cases are diagnosed at late stages of disease. There is currently no cost-effective screening test for NSCLC, and the development of such a test is a public health imperative. Recent studies have suggested that chest computed tomography screening of patients at high risk of lung cancer can increase survival from disease, however, the cost effectiveness of such screening has not been established. In this Phase I/II biomarker study we examined the feasibility of using serum miRNA as biomarkers of NSCLC using RT-qPCR to examine the expression of 180 miRNAs in sera from 30 treatment naive NSCLC patients and 20 healthy controls. Receiver operating characteristic curves (ROC) and area under the curve were used to identify differentially expressed miRNA pairs that could distinguish NSCLC from healthy controls. Selected miRNA candidates were further validated in sera from an additional 55 NSCLC patients and 75 healthy controls. Examination of miRNA expression levels in serum from a multi-institutional cohort of 50 subjects (30 NSCLC patients and 20 healthy controls) identified differentially expressed miRNAs. A combination of two differentially expressed miRNAs miR-15b and miR-27b, was able to discriminate NSCLC from healthy controls with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100% in the training set. Upon further testing on additional 130 subjects (55 NSCLC and 75 healthy controls), this miRNA pair predicted NSCLC with a specificity of 84% (95% CI 0.73–0.91), sensitivity of 100% (95% CI; 0.93–1.0), NPV of 100%, and PPV of 82%. These data provide evidence that serum miRNAs have the potential to be sensitive, cost-effective biomarkers for the early detection of NSCLC. Further testing in a Phase III biomarker study in is necessary for validation of these results.

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Section: Introductionmentioning

confidence: 99%

Serum microRNA Biomarkers for Detection of Non-Small Cell Lung Cancer

et al. 2012

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“…Costs included all follow-up from suspicious nodules identified in screening; in the first year of screening, 21% of participants required follow-up LDCT scan or biopsy for a positive result (nodules larger than five millimeters in diameter) and in subsequent years, positive results from screening dropped to 7% (see Exhibit 1 and the Appendix in [7] for detailed decision trees). These values were based on the New York ELCAP [30] and personal communication with the ELCAP lead investigator (Claudia Henschke, December 6, 2010). They are slightly higher than those reported in the New York ELCAP (14% at baseline and 6% at follow-up) [30] and I-ELCAP studies (16% at baseline) [31] and slightly lower than the 27% at baseline reported by the NLST, though NLST defined a positive result as greater than four, rather than five, millimeters in diameter [10].…”

Section: Methodsmentioning

confidence: 99%

A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions

et al. 2013

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BackgroundA 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT) screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50–64) at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program.Methods and FindingsThe current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs) gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses.ConclusionsThe findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50–64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations.

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“…We compared the SF-36v2 data from the lung cancer survivor sample to a cohort of current smokers and former smokers who had completed the SF-12v2 at the time of enrollment in a large, low dose helical computer tomography (CT scan) lung screening trial conducted in the New York metropolitan region [16] equivalent to the geographic catchment area of the comprehensive cancer center treating the lung cancer survivors. We chose this novel comparison group because these individuals were similar to our survivor population in terms of demographic characteristics (older) and smoking history, except for not having been diagnosed and treated for NSCLC.…”

Section: Methodsmentioning

confidence: 99%

“…We examined demographic, medical, and psychological correlates of HQOL. In contrast to other cross-sectional studies that compared HQOL to the general population, we compared HQOL (SF-36v2) scores from lung cancer survivors with a comparison sample of older adults who had enrolled in a lung screening trial [16] and who had screened negative for lung cancer. Use of this matched comparison sample allowed us to better control for demographic, tobacco-related, and comorbidity variables that can influence interpretation of HQOL outcomes.…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life among early-stage, non-small cell, lung cancer survivors

et al. 2011

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Background Limited data are available about the physical and mental functioning of individuals diagnosed and treated for early stage lung cancer. To develop post-treatment guidelines and targeted resources for the growing number of lung cancer survivors, clinically relevant information about longer-term health-related quality of life (HQOL) is needed. The current study examines lung cancer survivors' HQOL and identifies associations between HQOL and demographic, disease and psychosocial risk factors. Methods A total of 359 individuals diagnosed and surgically treated for Stage IA or IB non-small cell lung cancer completed a post-treatment survey via mail or telephone that included the SF-36v2 as well as demographic, medical, psychological and physical symptom indices. To better understand the impact of lung cancer treatment, we examined age- and gender-adjusted differences in HQOL as compared to a demographically matched sample of older adults, most with a significant smoking history, who participated in a lung cancer screening trial. Risk factors for impairments in HQOL were also identified. Results Compared to the screening sample, lung cancer survivors reported lower physical health scores, but did not differ in terms of mental health status. Dyspnea and distressed mood were most associated with HQOL impairments. Conclusions Early stage lung cancer survivors are likely to experience mild impairment in physical functioning. They may benefit from management of distressed mood and referral to physical activity and pulmonary rehabilitation programs to promote HQOL outcomes.

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CT Screening for Lung Cancer: Diagnoses Resulting from the New York Early Lung Cancer Action Project

Abstract: The NY-ELCAP regimen of screening revealed that annual CT screening for lung cancer resulted in identification of a high proportion of patients with early-stage disease.

Cited by 97 publications

References 23 publications

Serum microRNA Biomarkers for Detection of Non-Small Cell Lung Cancer

Serum microRNA Biomarkers for Detection of Non-Small Cell Lung Cancer

A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions

Health-related quality of life among early-stage, non-small cell, lung cancer survivors

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