Trends in Subpopulations at High Risk for Lung Cancer

Abstract

Introduction Two thirds of newly diagnosed lung cancer patients in the U.S. would not meet the current USPSTF (United States Preventive Services Task Force) screening criteria, suggesting a need for amendment to the high-risk definition. To provide evidence of additional high-risk subpopulations and estimated gains and losses, we conducted a two-step study using three cohorts. Methods Two prospective cohorts are comprised of 5988 primary lung cancer patients diagnosed between 1997-2011 (Hospital) and 850 defined-community residents (Community); the retrospective cohort is the Olmsted County population (Minnesota, USA) followed for 28 years (1984-2011). Subgroups of lung cancer patients who might have been identified using additional determinates were estimated and compared between Community and Hospital cohorts. Findings were supported by indirect comparative projections of two ratios: benefit to harm and cost to effectiveness. Results Former cigarette smokers with 30 or more pack-years and 15-30 quit-years age 55-80 formed the largest subgroup not meeting the current screening criteria, constituting 12% of the hospital cohort and 17% of community cohort. Using the expanded criteria suggested by our study may add 19% more CT examinations for detecting 16% more cases when comparing to the USPSTF criteria. Meanwhile, the increases of false positive, over-diagnosed and radiation-related lung cancer death are 0.6%, 0.1%, and 4.0%, respectively. Conclusions Current USPSTF screening criteria exclude many patients at high risk for lung cancer. Individuals who are under 81 years, had 30 or more pack-year smoking history, and had quit for 15-30 years may significantly increase the number of non-over diagnosis screen-detected lung cancers, does not significantly add false positive cases, saves more lives, yet with an acceptable amount of elevated scan exposure and cost.

Neutrophil‐to‐lymphocyte ratio and risk of lung cancer mortality in a low‐risk population: A cohort study

“…Lung cancer screening with low‐dose computed tomography targeting high‐risk ever‐smokers has been widely adopted in the United States based on a 20% reduction in mortality from lung cancer among high‐risk individuals using National Lung Screening Trial inclusion criteria, which comprise age and smoking history . However, approximately two‐thirds of newly diagnosed lung cancer patients reportedly fail to meet the U.S. Preventive Services Task Force high‐risk criteria . Moreover, epidemiological studies have reported that an estimated 10–25% of lung cancers occur in never‐smokers, and the proportion of lung cancer in never‐smokers has been increasing over time .…”

“…3 However, approximately two-thirds of newly diagnosed lung cancer patients reportedly fail to meet the U.S. Preventive Services Task Force high-risk criteria. 4 Moreover, epidemiological studies have reported that an estimated 10-25% of lung cancers occur in never-smokers, and the proportion of lung cancer in never-smokers has been increasing over time. 5,6 This highlights a need to identify additional subpopulations at increased risk for lung cancer among low-risk populations and never-smokers while considering factors other than smoking and aging.…”

Trends in smoking among secondary school and high school students in Poland, 2009 and 2011

“…For a long time, adverse symptoms of chronic poisoning in heavy smokers had not been apparent. Scientific research focused especially on cardiology and oncology has demonstrated a strong connection between smoking and disease incidence of the cardiovascular system and cancer [4][5][6][7]. The World Health Organization (WHO), in collaboration with governmental and nongovernmental organizations, have taken many steps for countering the tobacco epidemic.…”

Early detection of lung cancer

“…The primary group that this adds comprises those who smoked 30 pack-years but have quit 15 or more years ago and remain at high risk for lung cancer. In a retrospective cohort of patients who were diagnosed with lung cancer, Yang et al suggest that expanding the criteria of screening to include those who quit smoking 15–30 years ago would have the potential to include 16% more of those who got cancer with acceptable cost and minimal harm 36 .…”