The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries

Saul, Eduardo Edelman; Guerra, Raquel Bezerra; Saul, Michelle; Silva, Laércio Lopes da; Aleixo, Gabriel F. P.; Matuda, Raquel M. K.; Lopes, Gilberto

doi:10.1038/s43018-020-00142-z

Cited by 34 publications

(22 citation statements)

References 130 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It remains unclear how effective and relevant Western guidelines are for Asian countries, especially those with low and middle income. The lack of qualified providers, low availability of surgery and radiotherapy services, and poor access to and affordability of up-to-date treatments remain a prevailing concern for lung cancer care in low-income and middleincome countries (LMICs) compared with high-income countries (HICs) 8 9. Moreover, universal healthcare and health insurance mechanisms are still in the development phase in many Asian countries and LMICs.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the majority of guidelines were developed in Western countries, considering country-specific resources and healthcare mechanisms, and associated with effective referral systems governed by policies 8. It is unlikely that guidelines developed for Western health systems can be fully effective in poorly resourced health systems,8 9 which require different definitions, measurements and guidelines for timely care compatible with their available resources and the strength of their health systems 10…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Defining timeliness in care for patients with lung cancer: a scoping review

et al. 2022

View full text Add to dashboard Cite

ObjectivesEarly diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer.MethodsThis scoping review was guided by the methodological framework for scoping reviews by Arksey and O’Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles.ResultsA total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure.ConclusionThis review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Defining timeliness in care for patients with lung cancer: a scoping review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The results revealed that 58.6% of the screening-detected cases were in the early stages (IA and IB). At the 10-year follow-up, the reduction in LC mortality was 24% and 33% among men and a small sample of women, respectively [19].…”

Section: Guidelines For Early Detection Of Lung Cancermentioning

confidence: 93%

Early Diagnosis of Lung Cancer in the United Arab Emirates: Challenges and Strategic Recommendations

Al-Shamsi

Jaffar

Mahboub

et al. 2021

Clinics and Practice

View full text Add to dashboard Cite

In the United Arab Emirates (UAE), lung cancer (LC) was the third leading cause of deaths due to cancer in 2017. Around 80% of the patients in the UAE are diagnosed at a late stage, rendering the treatment less effective in improving survival outcomes. Lack of awareness of disease symptomatology, deficient screening initiatives, misdiagnosis, and delayed referral to the specialist are contributing factors for delayed diagnosis. Effective screening at a primary care setting can be crucial for early diagnosis, referral to specialists, and enhancing patient outcomes. It is important to establish screening and referral guidelines through which each suspected case can be identified and provided timely intervention. Although the international screening and referral pathway framework are comprehensive, several regional barriers need to be addressed before they can be adapted at the national level. A group of LC experts from the UAE deliberated on issues like delayed diagnosis of LC and strategic recommendations for overcoming the challenges. The discussion was based on the review of the published evidence, international and regional guidelines for screening and early diagnosis of LC. Herein, we present a guideline, endorsed by the esteemed panel of experts, for aiding early diagnosis and optimizing the management of LC in the UAE.

show abstract

“…Lung cancer (LC) accounts for up to 18.4% of all cancer-related deaths worldwide [1,2]. Up to 70% of patients suffer from advanced disease-either locally advanced (stage IIIC) or metastatic (stage IV)-at the time of diagnosis, limiting curative options [3,4]. LC secondary prevention (i.e., early detection) by means of low-dose computed tomography (LDCT) has been proven effective by several LC screening (LCS) trials, showing a 20-30% mortality reduction in high-risk subjects [1,[5][6][7].…”

Section: Introductionmentioning

confidence: 99%

A Low-Dose CT-Based Radiomic Model to Improve Characterization and Screening Recall Intervals of Indeterminate Prevalent Pulmonary Nodules

et al. 2021

View full text Add to dashboard Cite

Lung cancer (LC) is currently one of the main causes of cancer-related deaths worldwide. Low-dose computed tomography (LDCT) of the chest has been proven effective in secondary prevention (i.e., early detection) of LC by several trials. In this work, we investigated the potential impact of radiomics on indeterminate prevalent pulmonary nodule (PN) characterization and risk stratification in subjects undergoing LDCT-based LC screening. As a proof-of-concept for radiomic analyses, the first aim of our study was to assess whether indeterminate PNs could be automatically classified by an LDCT radiomic classifier as solid or sub-solid (first-level classification), and in particular for sub-solid lesions, as non-solid versus part-solid (second-level classification). The second aim of the study was to assess whether an LCDT radiomic classifier could automatically predict PN risk of malignancy, and thus optimize LDCT recall timing in screening programs. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, positive predictive value, negative predictive value, sensitivity, and specificity. The experimental results showed that an LDCT radiomic machine learning classifier can achieve excellent performance for characterization of screen-detected PNs (mean AUC of 0.89 ± 0.02 and 0.80 ± 0.18 on the blinded test dataset for the first-level and second-level classifiers, respectively), providing quantitative information to support clinical management. Our study showed that a radiomic classifier could be used to optimize LDCT recall for indeterminate PNs. According to the performance of such a classifier on the blinded test dataset, within the first 6 months, 46% of the malignant PNs and 38% of the benign ones were identified, improving early detection of LC by doubling the current detection rate of malignant nodules from 23% to 46% at a low cost of false positives. In conclusion, we showed the high potential of LDCT-based radiomics for improving the characterization and optimizing screening recall intervals of indeterminate PNs.

show abstract

The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries

Cited by 34 publications

References 130 publications

Defining timeliness in care for patients with lung cancer: a scoping review

Defining timeliness in care for patients with lung cancer: a scoping review

Early Diagnosis of Lung Cancer in the United Arab Emirates: Challenges and Strategic Recommendations

A Low-Dose CT-Based Radiomic Model to Improve Characterization and Screening Recall Intervals of Indeterminate Prevalent Pulmonary Nodules

Contact Info

Product

Resources

About