Lung cancer screening feasibility in Australia

Marshall, Henry; Bowman, Rayleen V.; Ayres, J.; Crossin, Jane; Lau, Melanie; Slaughter, R.; Redmond, S.; Passmore, Linda; McCaul, Elizabeth; Courtney, Deborah; Leong, Steven; Windsor, Morgan; Zimmerman, P. V.; Yang, Ian A.; Fong, Kwun M.

doi:10.1183/09031936.00208714

Cited by 25 publications

(26 citation statements)

References 15 publications

(10 reference statements)

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“…by the Pan-Canadian Early Detection of Lung Cancer (Brock University) Model 6 (PanCan model) for baseline scan nodules, may have a role in management 7 but requires further validation in multiple populations. This article reports the prevalence, incidence and long-term follow-up of SSNs detected in a low-dose CT lung cancer screening cohort 8,9 based on the National Lung Screening Trial protocols and investigates the utility of the PanCan model in stratifying risk in baseline SSNs.…”

Section: Introductionmentioning

confidence: 99%

Screen-detected subsolid pulmonary nodules: long-term follow-up and application of the PanCan lung cancer risk prediction model

Zhao

Marshall

Yang

et al. 2016

BJR

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Zhao and Marshall contributed equally.Objective: To report the long-term follow-up of subsolid nodules (SSNs) detected in participants of a prospective low-dose CT lung cancer screening cohort, and to investigate the utility of the PanCan model in stratifying risk in baseline SSNs. Methods: Participants underwent a baseline scan, two annual incidence scans and further follow-up scans for the detected nodules. All SSNs underwent a minimum of 2 years of follow-up (unless resolved or resected). Risk of malignancy was estimated using the PanCan model; discrimination [area under the receiver-operating characteristic curve (AUC)] and calibration (HosmerLemeshow goodness-of-fit test) were assessed. The Mann-Whitney U-Wilcoxon test was used to compare estimated risk between groups. Results: 70 SSNs were detected in 41 (16.0%) out of 256 total participants. Median follow-up period was 25.5 months (range 2.0-74.0 months). 29 (41.4%) SSNs were transient. Five (7.1%) SSNs were resected, all found to be Stage I lung adenocarcinoma, including one SSN stable in size for 3.0 years before growth was detected. The PanCan model had good discrimination for the 52 baseline SSNs (AUC 5 0.89; 95% confidence interval 0.76-1); the HosmerLemeshow goodness-of-fit test was non-significant (p 5 0.27). Estimated risk was significantly higher in the baseline SSNs found to be cancer vs those not found to be cancer after 2-6 years of follow-up (p , 0.01). Conclusion: Our findings support a long-term follow-up approach for screen-detected SSNs for 3 years or longer. The PanCan model appeared discriminatory and well calibrated in this cohort. Advances in knowledge:The PanCan model may have utility in identifying low-risk SSNs which could be followed with less frequent CT scans.

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Section: Introductionmentioning

confidence: 99%

Screen-detected subsolid pulmonary nodules: long-term follow-up and application of the PanCan lung cancer risk prediction model

Zhao

Marshall

Yang

et al. 2016

BJR

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“…Of 256 participants who received a baseline screening CT, 171 (66.8%) were men, median age 64.5 years, 47% current or recent smokers (quit within prior 6 months), median 55 pack‐years smoking history, 184 (72%) married, 46 (18%) with a history of lung cancer in a first degree relative and 119 (46%) had some level of tertiary education (e.g. college, university or post‐graduate).…”

Section: Resultsmentioning

confidence: 99%

“…Participants had to have FEV1 >50% predicted and in general good health with an absence of CT scans within the previous 2 years. Participants received three screening scans and were followed‐up for 5 years . Nodule management was based on NLST‐ACRIN using 2D measurement (axial image).…”

Section: Introductionmentioning

confidence: 99%

Cost of screening for lung cancer in Australia

Marshall

Finn

Bowman

et al. 2019

Internal Medicine Journal

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Background Lung cancer screening can reduce lung cancer mortality. Australian cost estimates are important to inform policy but remain uncertain. Aim To describe the first direct medical costs associated with lung cancer screening in Australia. Methods Single‐centre prospective screening cohort. Healthy volunteers (age 60–74 years, current or former smokers quit <15 years prior to enrolment, ≥30 pack‐years exposure) underwent baseline and two annual incidence computed tomography (CT) screening scans. Health status and healthcare usage data were collated for 5 years. The main outcome measures were: rates of lung cancer; individual healthcare resource use derived from multiple data sources adjusted to 2018 Australian Medicare Benefits Schedule values. Results A total of 256, 239, 233 participants was screened at each round respectively; 12 participants were diagnosed with lung cancer during screening and 2 during follow‐up: 9 underwent surgery, 4 received concurrent chemoradiation, 1 received palliative chemotherapy. One surgical case died from lymphoma 1407 days after diagnosis, all other surgical cases survived >5 years. Non‐surgical median survival post‐diagnosis was 654 days. Gross trial cost was Australian dollar (AU$) 965 665 (AU$397 396 CT scans; AU$29 303 false‐positive scan work‐up; AU$96 340 true‐positive scan workup; AU$336 914 lung cancer treatment; AU$104 712 lung cancer follow‐up post‐treatment). Average total direct medical cost per participant was AU$3 768. Average direct cost of surgery was AU$22 659; average non‐surgical cost was AU$47 395 (radiotherapy, chemotherapy, palliative care). Conclusions Advanced cancer cost more to treat and had worse survival than early cancer. Screening costs are similar to international studies and suggest that lung cancer early detection could limit treatment costs and improve outcomes.

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“…Participant eligibility and recruitment have been described elsewhere 11 12. Two hundred and fifty-six healthy current or former smokers (171 men; 85 women) aged 60–74 years were enrolled in a LDCT screening study; median age 64.5 years; median pack-years of smoking 55 and 47% current smokers.…”

Section: Methodsmentioning

confidence: 99%

“…Participants received baseline scans (T 0 ) and up to two annual incidence scans (T 1 and T 2 ) using a 64-detector helical CT based on NLST protocols. Criteria for scan positivity, based on NLST, were any nodule ≥4 mm diameter (baseline scan) and any new or growing nodule (incidence scan) 11 12. Indeterminate nodules underwent 2 years radiological follow-up.…”

Section: Methodsmentioning

confidence: 99%