Lung Cancer Screening

Wood, Douglas E.; Eapen, George A.; Ettinger, David S.; Hou, Lifang; Jackman, David M.; Kazerooni, Ella A.; Klippenstein, Donald; Lackner, Rudy P.; Leard, Lorriana E.; Leung, Ann N.; Massion, Pierre P.; Meyers, Bryan F.; Munden, Reginald F.; Otterson, Gregory A.; Peairs, Kimberly S.; Pipavath, Sudhakar; Pratt-Pozo, Christie; Reddy, Chakravarthy; Reid, Mary E.; Rotter, A; Schabath, Matthew B.; Sequist, Lecia V.; Tong, Betty C.; Travis, William D.; Unger, Michael; Yang, Stephen C.

doi:10.6004/jnccn.2012.0022

Cited by 214 publications

(147 citation statements)

References 168 publications

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“…In 2011, the National Lung Screening Trial (NLST) demonstrated a 20% relative reduction in lung cancer mortality with annual low-dose chest computed tomography (LDCT) scans in asymptomatic current and former heavy smokers between the ages of 55 and 74 years (2). In light of these results, computed tomography (CT) lung cancer screening of high-risk individuals has been recommended by many organizations and guidelines and it is now covered by both private insurers and Medicare (3)(4)(5)(6)(7).…”

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confidence: 99%

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

et al. 2016

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Rationale: To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown.Objectives: To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations.Methods: This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities. Measurements and Main Results:The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policyrecommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived).Conclusions: Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.

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confidence: 99%

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

et al. 2016

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“…These include the American College of Chest Physicians, the American Cancer Society, the American Association of Thoracic Surgery, and the National Comprehensive Cancer Network [17,18]. More recently, the United States Preventative Services Task Force (USPSTF) has developed a draft recommendation (Grade B) for CT lung cancer screening of high-risk patients (those 55 to 79 years old with 30-pack/years or greater history of smoking) (http:// www.uspreventativeservicetaskforce.org/draftrec.htm).…”

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confidence: 99%

Lung cancer screening: current status

McLoud

2013

Radiol med

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Lung cancer remains the leading cause of death from malignancy with approximately 1.3 million deaths occurring world wide per year [1]. Approximately 70 % of cases have incurable disease at presentation which is either widely metastatic or locally advanced [1]. The overall 5-year survival still remains very low at only 14 % [1]. Lung cancer, however, which is detected early in its course, demonstrates much better survival data. Survival in non-small-cell lung cancer Stage I is greater than 70 % and small peripheral less than 1 cm lung cancers have survival rates of greater than 80 % [2]. The rationale for screening is, therefore, obvious. Diagnosis of lung cancer early in preclinical stages has a higher cure rate and, therefore, high-risk asymptomatic individuals are likely to benefit from screening.The introduction of helical and subsequently multidetector CT in the 1990s led to a number of feasibility studies in which CT was used as a screening tool for the detection of early asymptomatic lung cancer. Observational single arm trials were conducted for several years in many countries including the United States, Japan, and Europe [3][4][5][6][7][8]. These studies established the sensitivity of low-dose CT for early lung cancer detection. These trials also tested algorithms for diagnostic workup and demonstrated a reduction in the incidence of advanced non-small-cell lung cancer with screening. A high percentage (84-93 %) was Stage I lung cancers [3][4][5]. They also produced somewhat similar results. They demonstrated that detection of earlystage lung cancer was higher than that reported previously with standard chest radiography [9] but that the false positive rate was at least three times that of standard radiographs. In regard to diagnostic algorithms, these studies provided evidence that peripheral nodules greater than 8-10 mm in size required further investigation because of the high likelihood of lung cancer. Such investigations included further imaging with PET-CT, percutaneous biopsy or resection and often led to invasive procedures. Smaller nodules (\8 mm diameter) could be managed with CT follow-up to determine interval growth indicating the likelihood of malignancy.These single arm feasibility and observational studies provided compelling evidence of the effectiveness of helical and MDCT as a screening tool for early detection of lung cancer. However, they were not sufficient to determine screening effectiveness because they were not able to assess the influence of CT screening on lung cancer mortality. Only randomized controlled trials can determine effectiveness of screening where the end point must be a decrease in mortality in the screened group as compared to a non-screened control.Subsequently, several prospective randomized controlled trials were undertaken both in the United States and Europe. These included the National Lung Cancer Screening Trial (NLST) in the United States [10] and the Nelson Trial and others in Europe [11][12][13][14][15]. The results of the NLST trial were published in 2...

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“…In the United States, the American Cancer Society and several other national advisory bodies have recommended lung cancer screening to individuals who meet the NLST eligibility criterion (38)(39)(40). The U.S. Preventive Services Task force recommended the same criterion for screening, but with a wider age range (55-79 years; ref.…”

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confidence: 99%

Selecting High-Risk Individuals for Lung Cancer Screening: A Prospective Evaluation of Existing Risk Models and Eligibility Criteria in the German EPIC Cohort

Hüsing

Sookthai

et al. 2015

Cancer Prevention Research

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Lung cancer risk prediction models are considered more accurate than the eligibility criteria based on age and smoking in identification of high-risk individuals for screening. We externally validated four lung cancer risk prediction models (Bach, Spitz, LLP, and PLCO M2012 ) among 20,700 ever smokers in the EPIC-Germany cohort. High-risk subjects were identified using the eligibility criteria applied in clinical trials (NELSON/ LUSI, DLCST, ITALUNG, DANTE, and NLST) and the four risk prediction models. Sensitivity, specificity, and positive predictive value (PPV) were calculated based on the lung cancers diagnosed in the first 5 years of follow-up. Decision curve analysis was performed to compare net benefits. The number of high-risk subjects identified by the eligibility criteria ranged from 3,409 (NELSON/LUSI) to 1,458 (NLST). Among the eligibility criteria, the DLCST produced the highest sensitivity (64.13%), whereas the NLST produced the highest specificity (93.13%) and PPV (2.88%). The PLCO M2012 model showed the best performance in external validation (C-index: 0.81; 95% CI, 0.76-0.86; E/O: 1.03; 95% CI, 0.87-1.23) and the highest sensitivity, specificity, and PPV, but the superiority over the Bach model and the LLP model was modest. All the models but the Spitz model showed greater net benefit over the full range of risk estimates than the eligibility criteria. We concluded that all of the lung cancer risk prediction models apart from the Spitz model have a similar accuracy to identify high-risk individuals for screening, but in general outperform the eligibility criteria used in the screening trials. Cancer Prev Res; 8(9);

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Lung Cancer Screening

Cited by 214 publications

References 168 publications

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

Lung cancer screening: current status

Selecting High-Risk Individuals for Lung Cancer Screening: A Prospective Evaluation of Existing Risk Models and Eligibility Criteria in the German EPIC Cohort

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