Screening High-Risk Populations for Lung Cancer: Guideline Recommendations

Roberts, Heidi C.; Walker-Dilks, Cindy; Sivjee, Khalil; Ung, Yee C.; Yasufuku, Kazuhiro; Hey, Amanda; Lewis, Nancy

doi:10.1097/jto.0b013e31829fd3d5

Cited by 66 publications

(35 citation statements)

References 13 publications

(19 reference statements)

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“…To our knowledge, only the United States has implemented lung cancer screening policies. Although the province of Ontario, Canada, recommends screening individuals at high risk for lung cancer through an organized program, no program has yet been established [5]. Cancer Care Ontario (the provincial cancer agency of Ontario) is currently evaluating the feasibility of implementing such a program [6].…”

Section: Introductionmentioning

confidence: 99%

Risk prediction models for selection of lung cancer screening candidates: A retrospective validation study

et al. 2017

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BackgroundSelection of candidates for lung cancer screening based on individual risk has been proposed as an alternative to criteria based on age and cumulative smoking exposure (pack-years). Nine previously established risk models were assessed for their ability to identify those most likely to develop or die from lung cancer. All models considered age and various aspects of smoking exposure (smoking status, smoking duration, cigarettes per day, pack-years smoked, time since smoking cessation) as risk predictors. In addition, some models considered factors such as gender, race, ethnicity, education, body mass index, chronic obstructive pulmonary disease, emphysema, personal history of cancer, personal history of pneumonia, and family history of lung cancer.Methods and findingsRetrospective analyses were performed on 53,452 National Lung Screening Trial (NLST) participants (1,925 lung cancer cases and 884 lung cancer deaths) and 80,672 Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) ever-smoking participants (1,463 lung cancer cases and 915 lung cancer deaths). Six-year lung cancer incidence and mortality risk predictions were assessed for (1) calibration (graphically) by comparing the agreement between the predicted and the observed risks, (2) discrimination (area under the receiver operating characteristic curve [AUC]) between individuals with and without lung cancer (death), and (3) clinical usefulness (net benefit in decision curve analysis) by identifying risk thresholds at which applying risk-based eligibility would improve lung cancer screening efficacy. To further assess performance, risk model sensitivities and specificities in the PLCO were compared to those based on the NLST eligibility criteria. Calibration was satisfactory, but discrimination ranged widely (AUCs from 0.61 to 0.81). The models outperformed the NLST eligibility criteria over a substantial range of risk thresholds in decision curve analysis, with a higher sensitivity for all models and a slightly higher specificity for some models. The PLCOm2012, Bach, and Two-Stage Clonal Expansion incidence models had the best overall performance, with AUCs >0.68 in the NLST and >0.77 in the PLCO. These three models had the highest sensitivity and specificity for predicting 6-y lung cancer incidence in the PLCO chest radiography arm, with sensitivities >79.8% and specificities >62.3%. In contrast, the NLST eligibility criteria yielded a sensitivity of 71.4% and a specificity of 62.2%. Limitations of this study include the lack of identification of optimal risk thresholds, as this requires additional information on the long-term benefits (e.g., life-years gained and mortality reduction) and harms (e.g., overdiagnosis) of risk-based screening strategies using these models. In addition, information on some predictor variables included in the risk prediction models was not available.ConclusionsSelection of individuals for lung cancer screening using individual risk is superior to selection criteria based on age and pack-years alone. T...

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Section: Introductionmentioning

confidence: 99%

Risk prediction models for selection of lung cancer screening candidates: A retrospective validation study

et al. 2017

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“…In a LDCT screening cohort in western China similar to participants in the NLST trial, Lei, et al found the number of risk factors of lung cancer was associated with increasing detection rate of asymtomatic lung cancer [32]. Providing a strict design and conduction, the benefits of LDCT screening in high-risk populations for lung cancer may overweigh those harms [33]. However, there is no high-quality evidence based on Chinese population to define the specific high-risk subpopulation as screening candidates.…”

Section: Discussionmentioning

confidence: 99%

Necessity of organized low-dose computed tomography screening for lung cancer: From epidemiologic comparisons between China and the Western nations

et al. 2016

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ObjectivesTo compare the proportion of stage I lung cancer and population mortality in China to those in U.S. and Europe where lung cancer screening by low-dose computed tomography (LDCT) has been already well practiced.MethodsThe proportions of stage I lung cancer in LDCT screening population in U.S. and Europe were retrieved from NLST and NELSON trials. The general proportion of stage I lung cancer in China was retrieved from a rapid meta-analysis, based on a literature search in the China National Knowledge Infrastructure database. The lung cancer mortality and prevalence of China, U.S. and Europe was retrieved from Globocan 2012 fact sheet. Mortality-to-prevalence ratio (MPR) was applied to compare the population survival outcome of lung cancer.ResultsThe estimated proportion of stage I lung cancer in China is merely 20.8% among hospital-based cross-sectional population, with relative ratios (RRs) being 2.40 (95% CI 2.18–2.65) and 2.98 (95% CI 2.62–3.38) compared by LDCT-screening population in U.S. and Europe trials, respectively. MPR of lung cancer is as high as 58.9% in China, with RRs being 0.46 (95% CI 0.31–0.67) and 0.58 (95% CI 0.39–0.85) compared by U.S. and Europe, respectively.ConclusionsBy the epidemiological inference, the LDCT mass screening might be associated with increasing stage I lung cancer and therefore improving population survival outcome. How to translate the experiences of lung cancer screening by LDCT from developed counties to China in a cost-effective manner needs to be further investigated.

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“…5 However, they caution that screening should be provided only in high-volume centres with enough expertise available to offer the appropriate follow-up care. 5 Smoking is still the cause of 90% of cases of lung cancer, and smoking cessation is still the most effective measure for decreasing the rates of death from the disease.…”

Section: Canada Does Not Have a Publicly Funded Screening Program Formentioning

confidence: 99%

Screening for lung cancer

Kennedy

Baerlocher

2014

CMAJ

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Screening High-Risk Populations for Lung Cancer: Guideline Recommendations

Abstract: The benefits of screening high-risk populations for lung cancer with LDCT outweigh the harms if screening is implemented in a strictly controlled manner.

Cited by 66 publications

References 13 publications

Risk prediction models for selection of lung cancer screening candidates: A retrospective validation study

Risk prediction models for selection of lung cancer screening candidates: A retrospective validation study

Necessity of organized low-dose computed tomography screening for lung cancer: From epidemiologic comparisons between China and the Western nations

Screening for lung cancer

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