Organized Lung Cancer Screening Pilot: Informing a Province-Wide Program in Ontario, Canada

Darling, Gail; Tammemägi, Martin C.; Schmidt, Heidi; Buchanan, Daniel; Leung, Yvonne; McGarry, Caitlin; Rabeneck, Linda

doi:10.1016/j.athoracsur.2020.07.051

Cited by 49 publications

(41 citation statements)

References 11 publications

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“…While many challenges remain, various trials and pilot studies are underway to evaluate the performance and feasibility of implementing risk‐based lung cancer screening in practice, such as the International Lung Screening Trial (ILST), SUMMIT, the Manchester Lung Health Check, Ontario Health‐Cancer Care Ontario's High Risk Lung Cancer Screening Program and 4‐IN‐THE‐LUNG‐RUN 108,121,123,163,164 . It is expected that these studies will provide answers to many of the remaining challenges; as well as discover new opportunities for further risk‐stratification.…”

Section: Discussionmentioning

confidence: 99%

“…In the Ontario Health-Cancer Care Ontario pilot, risk-assessment and shared-decision making was facilitated through patient navigators, who guided individual persons from the recruitment phase up to the referral to diagnostic assessment. 108 Participant satisfaction surveys found that the vast majority of participants had high or very high satisfaction with this process, with a programme retention rate of almost 85%. A pilot programme aimed at underserved communities in Centinela Valley, California, similarly found that participants responded positively to the availability and support from personalised patient navigators.…”

Section: Individual Invitation and Risk-communication Strategiesmentioning

confidence: 99%

“…Although the overall uptake rate was higher than those found in other pilots and implementation studies in the United Kingdom (53% compared to 9%‐14%), no differences were found between the standard and tailored approaches. In the Ontario Health‐Cancer Care Ontario pilot, risk‐assessment and shared‐decision making was facilitated through patient navigators, who guided individual persons from the recruitment phase up to the referral to diagnostic assessment 108 . Participant satisfaction surveys found that the vast majority of participants had high or very high satisfaction with this process, with a programme retention rate of almost 85%.…”

Section: Individual Invitation and Risk‐communication Strategiesmentioning

confidence: 99%

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Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Haaf

Aalst

Koning

et al. 2021

Intl Journal of Cancer

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Randomised clinical trials have shown the efficacy of computed tomography lung cancer screening, initiating discussions on whether and how to implement population-based screening programs. Due to smoking behaviour being the primary risk-factor for lung cancer and part of the criteria for determining screening eligibility, lung cancer screening is inherently risk-based. In fact, the selection of high-risk individuals has been shown to be essential in implementing lung cancer screening in a cost-effective manner. Furthermore, studies have shown that further riskstratification may improve screening efficiency, allow personalisation of the screening interval and reduce health disparities. However, implementing risk-based lung cancer screening programs also requires overcoming a number of challenges. There are indications that risk-based approaches can negatively influence the trade-off between individual benefits and harms if not applied thoughtfully. Large-scale implementation of targeted, risk-based screening programs has been limited thus far. Consequently, questions remain on how to efficiently identify and invite high-risk individuals from the general population. Finally, while risk-based approaches may increase screening program efficiency, efficiency should be balanced with the overall impact of the screening program. In this review, we will address the opportunities and challenges in applying risk-stratification in different aspects of lung cancer screening programs, as well as the balance between screening program efficiency and impact. K E Y W O R D S lung cancer screening, personalised screening, risk-based screening Abbreviations: 4-IN-THE-LUNG-RUN, (Towards INdividually tailored INvitations screening INtervals and INtegrated co-morbidity reducing strategies in lung cancer screening) implementation trial; AUC, area under the receiver operating characteristic curve; BMI, body mass index; bioMILD, the Plasma microRNA Profiling as First Line Screening Test for Lung Cancer Detection: a

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Section: Discussionmentioning

confidence: 99%

Section: Individual Invitation and Risk-communication Strategiesmentioning

confidence: 99%

Section: Individual Invitation and Risk‐communication Strategiesmentioning

confidence: 99%

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Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Haaf

Aalst

Koning

et al. 2021

Intl Journal of Cancer

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“…In addition, evidence from "real world" data is quickly accumulating which also supports risk prediction model implementation. [9][10][11] Here, we provide additional "real world" evidence and reveal that the PLCOm2012 risk prediction model at a greater than or equal to 1%/6-year risk threshold seems to effectively eliminate race disparity in lung cancer screening.…”

Section: Discussionmentioning

confidence: 85%

Brief Report: Risk Prediction Model Versus United States Preventive Services Task Force 2020 Draft Lung Cancer Screening Eligibility Criteria—Reducing Race Disparities

Pasquinelli

Tammemägi

Kovitz

et al. 2021

JTO Clinical and Research Reports

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Introduction: Eligibility criteria for lung cancer screening based solely on age and smoking history are less sensitive than validated risk prediction models. The U.S. Preventive Services Task Force (USPSTF) has proposed new guidelines to improve the sensitivity for selecting high-risk individuals and to decrease race disparity. In this retrospective study, termed the Chicago Race Eligibility for Screening Cohort, we compare the sensitivity of the proposed USPSTF2020 criteria versus the PLCOm2012 risk prediction model for selecting a racially diverse lung cancer population with a smoking history for lung cancer screening. Methods: This Chicago Race Eligibility for ScreeningCohort study applies the PLCOm2012 model with a risk threshold of 1.0%/6 years and the USPSTF2020 criteria (age 50-80 y, pack-years 20 y, quit-years 15 y) to 883 individuals with a smoking history diagnosed with having lung cancer.Results: The PLCOm2012 was more sensitive than the USPSTF2020 overall (79.1% versus 68.6%, p < 0.0001) in White (81.5% versus 75.4%, p ¼ 0.029) and in African American (82.8% versus 70.6% p < 0.0001) individuals. Of the total cohort, 254 (28.8%) would not have qualified owing to less than 20 pack-years, quit-time of more than 15 years, and age less than 50 years. Of these 254 cases, 40% would have qualified by the PLCOm2012 model. For the 20 pack-year criterion, of the 497 African American individuals, 19.3% did not meet this criterion, and of these, an additional 31.3% would have qualified by the PLCOm2012 model (p ¼ 0.002).Conclusions: Although more sensitive than USPSTF2013, the proposed USPSTF2020 draft guidelines still have a race disparity in eligibility for screening. This study provides "real world" evidence that use of the PLCOm2012 risk prediction model eliminates this race disparity.

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“…Essential core elements of a CTLS program include a program navigator and a reliable database for nodule/patient monitoring. 48,82 A multidisciplinary steering committee facilitates the management of a program that involves multiple specialties. Other aspects for particular attention include the following.…”

Section: Key Issues and Components Of Successful Lung Screening Programsmentioning

confidence: 99%

Lung Screening Benefits and Challenges: A Review of The Data and Outline for Implementation

Sands

Tammemägi

Couraud

et al. 2021

Journal of Thoracic Oncology

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Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for almost a fifth of all cancerrelated deaths. Annual computed tomographic lung cancer screening (CTLS) detects lung cancer at earlier stages and reduces lung cancer-related mortality among high-risk individuals. Many medical organizations, including the U.S. Preventive Services Task Force, recommend annual CTLS in high-risk populations. However, fewer than 5% of individuals worldwide at high risk for lung cancer have undergone screening. In large part, this is owing to delayed implementation of CTLS in many countries throughout the world. Factors contributing to low uptake in countries with longstanding CTLS endorsement, such as the United States, include lack of patient and clinician awareness of current recommendations in favor of CTLS and clinician concerns about CTLS-related radiation exposure, false-positive results, overdiagnosis, and cost. This review of the literature serves to address these concerns by evaluating the potential risks and benefits of CTLS. Review of key components of a lung screening program, along with an updated shared decision aid, provides guidance for program development and optimization. Review of studies evaluating the population considered "high-risk" is included as this may affect future guidelines within the United States and other countries considering lung screening implementation.

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Organized Lung Cancer Screening Pilot: Informing a Province-Wide Program in Ontario, Canada

Cited by 49 publications

References 11 publications

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Brief Report: Risk Prediction Model Versus United States Preventive Services Task Force 2020 Draft Lung Cancer Screening Eligibility Criteria—Reducing Race Disparities

Lung Screening Benefits and Challenges: A Review of The Data and Outline for Implementation

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