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Bhardwaj M, Schöttker B, Holleczek B, Benner A, Schrotz-King P, Brenner H. Potential of Inflammatory Protein Signatures for Enhanced Selection of People for Lung Cancer Screening. Cancers (Basel) 2022; 14:2146. [PMID: 35565275 PMCID: PMC9103423 DOI: 10.3390/cancers14092146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 12/10/2022] Open
Abstract
Randomized trials have demonstrated a substantial reduction in lung cancer (LC) mortality by screening heavy smokers with low-dose computed tomography (LDCT). The aim of this study was to assess if and to what extent blood-based inflammatory protein biomarkers might enhance selection of those at highest risk for LC screening. Ever smoking participants were chosen from 9940 participants, aged 50-75 years, who were followed up with respect to LC incidence for 17 years in a prospective population-based cohort study conducted in Saarland, Germany. Using proximity extension assay, 92 inflammation protein biomarkers were measured in baseline plasma samples of ever smoking participants, including 172 incident LC cases and 285 randomly selected participants free of LC. Smoothly clipped absolute deviation (SCAD) penalized regression with 0.632+ bootstrap for correction of overoptimism was applied to derive an inflammation protein biomarker score (INS) and a combined INS-pack-years score in a training set, and algorithms were further evaluated in an independent validation set. Furthermore, the performances of nine LC risk prediction models individually and in combination with inflammatory plasma protein biomarkers for predicting LC incidence were comparatively evaluated. The combined INS-pack-years score predicted LC incidence with area under the curves (AUCs) of 0.811 and 0.782 in the training and the validation sets, respectively. The addition of inflammatory plasma protein biomarkers to established nine LC risk models increased the AUCs up to 0.121 and 0.070 among ever smoking participants from training and validation sets, respectively. Our results suggest that inflammatory protein biomarkers may have potential to improve the selection of people for LC screening and thereby enhance screening efficiency.
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Affiliation(s)
- Megha Bhardwaj
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (B.S.); (H.B.)
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (B.S.); (H.B.)
- Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, 69115 Heidelberg, Germany
| | - Bernd Holleczek
- Saarland Cancer Registry, Präsident-Baltz-Strasse 5, 66119 Saarbrücken, Germany;
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Petra Schrotz-King
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (B.S.); (H.B.)
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, 69115 Heidelberg, Germany
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Comparative effect of different strategies for the screening of lung cancer: a systematic review and network meta-analysis. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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PERROTTA F, D’AGNANO V, SCIALÒ F, KOMICI K, ALLOCCA V, NUCERA F, SALVI R, STELLA GM, BIANCO A. Evolving concepts in COPD and lung cancer: a narrative review. Minerva Med 2022; 113:436-448. [DOI: 10.23736/s0026-4806.22.07962-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Finamore P, Tanese L, Longo F, De Stefano D, Pedone C, Angelici L, Agabiti N, Cascini S, Davoli M, Zobel BB, Incalzi RA, Crucitti P. The additional value of lung cancer screening program in identifying unrecognized diseases. BMC Pulm Med 2022; 22:48. [PMID: 35101007 PMCID: PMC8802423 DOI: 10.1186/s12890-022-01826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background A systematic examination of low-dose CT (LDCT) scan, beside lung nodules, may disclose the presence of undiagnosed diseases, improving the efficacy and the cost/efficacy of these programs. The study was aimed at evaluating the association between LDCT scan findings and non-oncologic and oncologic diseases. Methods The LDCT scan of participants to the “Un Respiro per la vita”® lung cancer screening program were checked and abnormal findings, beside lung nodules, recorded. First admission to the acute care because of cardiovascular (CD), respiratory (RD) and oncological diseases (OD) in the following three years were retrieved. The association of LDCT scan abnormal findings with CD, RD and OD was assessed through univariable and multivariable logistic regression models. Results Mean age of 746 participants was 62 years (SD:5), 62% were male. 11 (1.5%) received a diagnosis of lung cancer. 16.1% participants were admitted to the acute care in the following three years: 8.6% for CD, 4.3% for RD and 5.2% for OD. Valve calcification (OR 2.02, p:0.02) and mucus plugs (OR 3.37, p:0.04) were positively associated with CD, while sub-pleural fibrosis had a protective role (OR 0.47, p:0.01). Lung nodules > 8 mm (OR 5.54, p: < 0.01), tracheal deviation (OR 6.04, p:0.01) and mucus plugs (OR 4.00, p:0.04) were positively associated with OD admissions. Centrilobular emphysema OR for RD admissions was 1.97 (p:0.06). Conclusions The observed association between selected LDCT findings and ensuing CD, RD and OD suggests that the information potential of LCDT goes beyond the screening of lung cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01826-1.
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Affiliation(s)
- Panaiotis Finamore
- Unit of Geriatrics, Department of Medicine and Surgery, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Luigi Tanese
- Unit of Imaging Center, Department of Medicine and Surgery, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Filippo Longo
- Unit of Thoracic Surgery, Department of Medicine and Surgery, Campus Bio-Medico University and Teaching Hospital, Rome, Italy.
| | - Domenico De Stefano
- Unit of Imaging Center, Department of Medicine and Surgery, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Claudio Pedone
- Unit of Geriatrics, Department of Medicine and Surgery, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Laura Angelici
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, ASL Roma 1, Rome, Italy
| | - Nera Agabiti
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, ASL Roma 1, Rome, Italy
| | - Silvia Cascini
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, ASL Roma 1, Rome, Italy
| | - Marina Davoli
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, ASL Roma 1, Rome, Italy
| | - Bruno Beomonte Zobel
- Unit of Imaging Center, Department of Medicine and Surgery, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine and Surgery, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Pierfilippo Crucitti
- Unit of Thoracic Surgery, Department of Medicine and Surgery, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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Cloud-Based Lung Tumor Detection and Stage Classification Using Deep Learning Techniques. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4185835. [PMID: 35047635 PMCID: PMC8763490 DOI: 10.1155/2022/4185835] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 02/01/2023]
Abstract
Artificial intelligence (AI), Internet of Things (IoT), and the cloud computing have recently become widely used in the healthcare sector, which aid in better decision-making for a radiologist. PET imaging or positron emission tomography is one of the most reliable approaches for a radiologist to diagnosing many cancers, including lung tumor. In this work, we proposed stage classification of lung tumor which is a more challenging task in computer-aided diagnosis. As a result, a modified computer-aided diagnosis is being considered as a way to reduce the heavy workloads and second opinion to radiologists. In this paper, we present a strategy for classifying and validating different stages of lung tumor progression, as well as a deep neural model and data collection using cloud system for categorizing phases of pulmonary illness. The proposed system presents a Cloud-based Lung Tumor Detector and Stage Classifier (Cloud-LTDSC) as a hybrid technique for PET/CT images. The proposed Cloud-LTDSC initially developed the active contour model as lung tumor segmentation, and multilayer convolutional neural network (M-CNN) for classifying different stages of lung cancer has been modelled and validated with standard benchmark images. The performance of the presented technique is evaluated using a benchmark image LIDC-IDRI dataset of 50 low doses and also utilized the lung CT DICOM images. Compared with existing techniques in the literature, our proposed method achieved good result for the performance metrics accuracy, recall, and precision evaluated. Under numerous aspects, our proposed approach produces superior outcomes on all of the applied dataset images. Furthermore, the experimental result achieves an average lung tumor stage classification accuracy of 97%-99.1% and an average of 98.6% which is significantly higher than the other existing techniques.
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Kian W, Zemel M, Levitas D, Alguayn W, Remilah AA, Rahman NA, Peled N. Lung cancer screening: a critical appraisal. Curr Opin Oncol 2022; 34:36-43. [PMID: 34652284 DOI: 10.1097/cco.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The recently published large-scale NELSON trial showed a reduction in lung cancer (LC) mortality with the use of low-dose computed tomography (LDCT) in high-risk patients. This is the first such European-based trial to mirror the results of the US National Lung Screening Trial (NLST). The NLST was responsible for nationwide implementation of LC screening protocols which has shown a decrease in LC mortality. However, the implementation of such screening in Europe has been challenging. With the findings from the NELSON trial, implementation of LC screening throughout Europe should once again be evaluated. RECENT FINDINGS This review article further elaborates on the advantages of LDCT in LC screening. It also discusses promising future approaches that can supplement the current LC screening guidelines. SUMMARY Implementation of LC screening with LDCT should again be evaluated throughout Europe as it could substantially decrease LC-related mortality.
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Affiliation(s)
- Waleed Kian
- The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem
| | - Melanie Zemel
- Medical School for International Health, Ben-Gurion University of the Negev
| | - Dina Levitas
- The Legacy Heritage Center & Dr Larry Norton Institute, Soroka Medical Center & Ben-Gurion University of the Negev
| | - Wafeek Alguayn
- Thoracic Surgery Department, Soroka Medical Center, Be'er Sheva
| | - Areen A Remilah
- The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem
| | - Nader Abdel Rahman
- Interventional Pulmonology and Bronchoscopy, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nir Peled
- The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem
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Hsu HS, Chiang XH, Hsu HH, Chen JS, Hsu CP. Low-dose computed tomography screening, follow-up, and management of lung nodules – An expert consensus statement from Taiwan. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_114_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Field JK, Vulkan D, Davies MP, Baldwin DR, Brain KE, Devaraj A, Eisen T, Gosney J, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MK, Rassl DM, Rintoul RC, Screaton NJ, Wald NJ, Weller D, Whynes DK, Williamson PR, Yadegarfar G, Gabe R, Duffy SW. Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100179. [PMID: 34806061 PMCID: PMC8589726 DOI: 10.1016/j.lanepe.2021.100179] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial. METHODS From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50-75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence. FINDINGS 1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1-7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41-1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76-0.92) from nine eligible trials. INTERPRETATION The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups. FUNDING NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.
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Affiliation(s)
- John K. Field
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Daniel Vulkan
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael P.A. Davies
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Kate E. Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, and National Heart and Lung Institute, Imperial College, London, UK
| | - Tim Eisen
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - John Gosney
- Department of Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Beverley A. Green
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - John A. Holemans
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Keith M. Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Kate J. Lifford
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Fiona E. McRonald
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Arjun Nair
- Department of Radiology, University College, London Hospital, London, UK
| | - Richard D. Page
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Doris M. Rassl
- Department of Pathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Robert C. Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J. Screaton
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J. Wald
- Faculty of Population Health Sciences, University College London, London, UK
| | - David Weller
- School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK
| | - David K. Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | | | - Gasham Yadegarfar
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Rhian Gabe
- Center for Evaluation and Methods, Wolfson Institute of Population Health. Queen Mary University of London, London, UK
| | - Stephen W. Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest 2021; 160:e427-e494. [PMID: 34270968 PMCID: PMC8727886 DOI: 10.1016/j.chest.2021.06.063] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. METHODS Approved panelists reviewed previously developed key questions using the Population, Intervention, Comparator, Outcome format to address the benefit and harms of low-dose CT screening, and key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analyses were performed when enough evidence was available. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached. RESULTS The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in seven graded recommendations and nine ungraded consensus statements. CONCLUSIONS Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance.
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Affiliation(s)
| | | | | | - Tanner J Caverly
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA; Boston University School of Medicine, Boston, MA
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Leleu O, Basille D, Auquier M, Clarot C, Hoguet E, Baud M, Lenel S, Milleron B, Berna P, Jounieaux V. Results of Second Round Lung Cancer Screening by Low-Dose CT scan - French Cohort Study (DEP-KP80). Clin Lung Cancer 2021; 23:e54-e59. [PMID: 34764039 DOI: 10.1016/j.cllc.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Over the last few years, lung cancer screening by low-dose CT scan has demonstrated a decrease in lung cancer mortality. While this method has been in use since 2013 in the United States of America, no European country has yet implemented a systematic screening program. We hereby report the results from the second round of screening from a French cohort study. PATIENTS AND METHODS DEP KP80 is a prospective study evaluating lung cancer screening by means of three low-dose computer tomography (CT) scans at 1-year intervals in 1,307 participants, aged 55 to 74 years old, all smokers or former smokers, having quit within the last 15 years, with over 30 pack years. The results of the first round demonstrated it was possible to conduct effective screening in real-life situations. RESULTS Participation was lower in this second round than in the first (35.3% vs. 73.1%, P < .001). The rate of negative results was significantly higher and that of undetermined results lower than those produced in the first round. Overall, 75% of cancers revealed were Stage 1 and 87.5% benefitted from surgical treatment. The incidence of cancer in the second round was 2.43%. CONCLUSION As with the first round, the results of this second round confirm the feasibility and efficacy of lung cancer screening. The lower participation rate for this second round is proof of the need to improve awareness among participants and healthcare professionals of the relevance of committing to an annual screening program.
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Affiliation(s)
- Olivier Leleu
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France.
| | | | | | - Caroline Clarot
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France
| | - Estelle Hoguet
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France
| | - Mickael Baud
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France
| | - Sabrina Lenel
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France
| | - Bernard Milleron
- Intergroupe francophone de cancérologie thoracique (IFCT), Paris, France
| | - Pascal Berna
- Department of Thoracic surgery, CHU Amiens, Amiens, France
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Ekman S, Horvat P, Rosenlund M, Kejs AM, Patel D, Juarez-Garcia A, Lacoin L, Daumont MJ, Penrod JR, Brustugun OT, Sørensen JB. Epidemiology and Survival Outcomes for Patients With NSCLC in Scandinavia in the Preimmunotherapy Era: A SCAN-LEAF Retrospective Analysis From the I-O Optimise Initiative. JTO Clin Res Rep 2021; 2:100165. [PMID: 34590017 PMCID: PMC8474201 DOI: 10.1016/j.jtocrr.2021.100165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/18/2021] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction SCAN-LEAF, part of the I-O Optimise initiative, is a retrospective, longitudinal study investigating the epidemiology, clinical care, and outcomes for patients with NSCLC in Scandinavia. We report overall survival (OS) trends for patients diagnosed with NSCLC in Sweden and Denmark between 2005 and 2015. Methods Swedish and Danish cohorts were established by linking national registries. Data on all adults diagnosed with incident NSCLC from January 1, 2005, to December 31, 2015, were included. For temporal analyses of OS trends, patients were stratified by TNM stage and histology. Results Between 2005 and 2015, a total of 30,067 and 31,939 patients from Sweden and Denmark, respectively, were diagnosed with NSCLC; the most common histological subtype was nonsquamous cell carcinoma (56.9% and 53.0%) and 48.4% and 51.6% were diagnosed at stage IV. Over the study period, significant improvements in short-term survival (1 y) were observed for patients with nonsquamous cell carcinoma in both countries, regardless of disease stage at diagnosis; however, improvements in longer-term survival (5 y) were limited to patients with stage I and II disease only. Conversely, among patients with squamous cell histology, improvements in short-term survival were only observed for stage I disease in Sweden and stage IIIA disease in Denmark, while significant improvements in longer-term survival were seen only for stage IIIA NSCLC in both countries. Conclusions Despite some survival improvements between 2005 and 2015, an unmet need remains for patients with advanced NSCLC, particularly those with squamous cell histology. Future analyses will evaluate the impact of newer treatments on OS in NSCLC.
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Affiliation(s)
- Simon Ekman
- Thoracic Oncology Center, Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Pia Horvat
- Real-World Evidence Solutions, IQVIA, London, United Kingdom
| | - Mats Rosenlund
- Real-World & Analytics Solutions, IQVIA, Solna, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anne Mette Kejs
- Real-World & Analytics Solutions, IQVIA, Copenhagen, Denmark
| | - Dony Patel
- Real-World Evidence Solutions, IQVIA, London, United Kingdom
| | - Ariadna Juarez-Garcia
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Uxbridge, United Kingdom
| | | | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-L'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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Goldfarb DG, Zeig‐Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Kahn AR, Qiao B, Schymura MJ, Webber MP, Dasaro CR, Lucchini RG, Todd AC, Prezant DJ, Hall CB, Boffetta P. Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study. Am J Ind Med 2021; 64:815-826. [PMID: 34288025 PMCID: PMC8515734 DOI: 10.1002/ajim.23278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated. METHODS This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016. RESULTS From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64-0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58-0.72). The cancer-specific HR was 0.94 (95% CI = 0.78-1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. CONCLUSIONS WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.
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Affiliation(s)
- David G. Goldfarb
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Environmental, Occupational and Geospatial Health SciencesCity University of New York Graduate School of Public Health and Health PolicyNew YorkNew YorkUSA
| | - Rachel Zeig‐Owens
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Dana Kristjansson
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Department of Genetics and BioinformaticsNorwegian Institute of Public HealthOsloNorway
- Center of Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Jiehui Li
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Robert M. Brackbill
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Mark R. Farfel
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - James E. Cone
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Amy R. Kahn
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Baozhen Qiao
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Maria J. Schymura
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Mayris P. Webber
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David J. Prezant
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Charles B. Hall
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Paolo Boffetta
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew YorkUSA
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
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63
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Inoue K, Hsu W, Arah OA, Prosper AE, Aberle DR, Bui AAT. Generalizability and Transportability of the National Lung Screening Trial Data: Extending Trial Results to Different Populations. Cancer Epidemiol Biomarkers Prev 2021; 30:2227-2234. [PMID: 34548326 DOI: 10.1158/1055-9965.epi-21-0585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/14/2021] [Accepted: 09/09/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Randomized controlled trials (RCT) play a central role in evidence-based healthcare. However, the clinical and policy implications of implementing RCTs in clinical practice are difficult to predict as the studied population is often different from the target population where results are being applied. This study illustrates the concepts of generalizability and transportability, demonstrating their utility in interpreting results from the National Lung Screening Trial (NLST). METHODS Using inverse-odds weighting, we demonstrate how generalizability and transportability techniques can be used to extrapolate treatment effect from (i) a subset of NLST to the entire NLST population and from (ii) the entire NLST to different target populations. RESULTS Our generalizability analysis revealed that lung cancer mortality reduction by LDCT screening across the entire NLST [16% (95% confidence interval [CI]: 4-24)] could have been estimated using a smaller subset of NLST participants. Using transportability analysis, we showed that populations with a higher prevalence of females and current smokers had a greater reduction in lung cancer mortality with LDCT screening [e.g., 27% (95% CI, 11-37) for the population with 80% females and 80% current smokers] than those with lower prevalence of females and current smokers. CONCLUSIONS This article illustrates how generalizability and transportability methods extend estimation of RCTs' utility beyond trial participants, to external populations of interest, including those that more closely mirror real-world populations. IMPACT Generalizability and transportability approaches can be used to quantify treatment effects for populations of interest, which may be used to design future trials or adjust lung cancer screening eligibility criteria.
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Affiliation(s)
- Kosuke Inoue
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California.,Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - William Hsu
- Medical & Imaging Informatics Group, Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California. .,Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California.,Department of Bioengineering, UCLA Samueli School of Engineering, Los Angeles, California
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California.,Department of Statistics, UCLA College of Letters and Science, Los Angeles, California.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ashley E Prosper
- Medical & Imaging Informatics Group, Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California.,Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Denise R Aberle
- Medical & Imaging Informatics Group, Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California.,Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California.,Department of Bioengineering, UCLA Samueli School of Engineering, Los Angeles, California
| | - Alex A T Bui
- Medical & Imaging Informatics Group, Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California.,Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California
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64
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Kerpel-Fronius A, Tammemägi M, Cavic M, Henschke C, Jiang L, Kazerooni E, Lee CT, Ventura L, Yang D, Lam S, Huber RM. Screening for Lung Cancer in Individuals Who Never Smoked: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report. J Thorac Oncol 2021; 17:56-66. [PMID: 34455065 DOI: 10.1016/j.jtho.2021.07.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022]
Abstract
Screening with low-dose computed tomography of high-risk individuals with a smoking history reduces lung cancer mortality. Current screening guidelines and eligibility criteria can miss more than 50% of lung cancers, and in some geographic areas, such as East Asia, a large proportion of the missed lung cancers are in never-smokers. Although randomized trials revealed the benefits of screening for people who smoke, these trials generally excluded never-smokers. Thus, the feasibility and effectiveness of lung cancer screening of individuals who never smoked are uncertain. Several known and suspected risk factors for lung cancers in never-smokers such as exposure to secondhand smoke, occupational carcinogens, radon, air pollution, and pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung diseases, and intrinsic factors, such as age, are well noted. In this regard, knowledge of risk factors may make possible quantification and prediction of lung cancer risk in never smokers. It is worth considering if and how never smokers could be included in population-based screening programs. As the implementation of these programs is challenging in many countries owing to multiple factors and the epidemiologic differences by global regions, these issues will need to be evaluated in each country taking into account various factors, including accuracy of risk assessment and cost-effectiveness of screening in never smokers. This report aims to outline current knowledge on risk factors for lung cancer in never smokers to propose research strategies for this topic and initiate a broader discussion on lung cancer screening of never smokers. Similar considerations can be made in current and ex-smokers, which do not fulfill the current screening inclusion criteria, but otherwise are at increased risk. Although screening of never smokers may in the future be effectively conducted, current evidence to support widespread implementation of this practice is lacking.
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Affiliation(s)
- Anna Kerpel-Fronius
- Országos Korányi Pulmonológiai Intézet, National Korányi Institute for Pulmonology, Budapest, Hungary.
| | - Martin Tammemägi
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Milena Cavic
- Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Claudia Henschke
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Long Jiang
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Ella Kazerooni
- Division of Cardiothoracic Radiology and Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Choon-Taek Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Internal Medicine and Respiratory Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Luigi Ventura
- Thoracic Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Dawei Yang
- Department of Pulmonary Medicine and Critical Care, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Stephen Lam
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V Thoracic Oncology Centre Munich University of Munich-Campus Innenstadt Munich, Germany, member of the German Center for Lung Research (DZL - CPC-M)
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65
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Validating Methylated HOXA9 in Bronchial Lavage as a Diagnostic Tool in Patients Suspected of Lung Cancer. Cancers (Basel) 2021; 13:cancers13164223. [PMID: 34439376 PMCID: PMC8393370 DOI: 10.3390/cancers13164223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 01/05/2023] Open
Abstract
Diagnosing lung cancer requires invasive procedures with high risk of complications. Methylated tumor DNA in bronchial lavage has previously shown potential as a diagnostic biomarker. We aimed to develop and validate methylated HOXA9 in bronchial lavage as a diagnostic biomarker of lung cancer. Participants were referred on suspicion of lung cancer. Ten mL lavage fluid was collected at bronchoscopy for analysis of methylated HOXA9 based on droplet digital PCR according to our previously published method. HOXA9 status was compared with the final diagnosis. The Discovery and Validation cohorts consisted of 101 and 95 consecutively enrolled participants, respectively. In the discovery cohort, the sensitivity and specificity were 73.1% (95% CI 60.9-83.2%) and 85.3% (95% CI 68.9-95.0%), respectively. In the validation cohort, the values were 80.0% (95% CI 66.3-90.0%) and 75.6% (95% CI 60.5-87.1%), respectively. A multiple logistic regression model including age, smoking status, and methylated HOXA9 status resulted in an AUC of 84.9% (95% CI 77.3-92.4%) and 85.9% (95% CI 78.4-93.4%) for the Discovery and Validation cohorts, respectively. Methylated HOXA9 in bronchial lavage holds potential as a supplementary tool in the diagnosis of lung cancer with a clinically relevant sensitivity and specificity. It remained significant when adjusting for age and smoking status.
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66
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Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report - Executive Summary. Chest 2021; 160:1959-1980. [PMID: 34270965 DOI: 10.1016/j.chest.2021.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part due to the results of the National Lung Screening Trial. Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, as well as increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. METHODS Approved panelists reviewed previously developed key questions using the PICO (population, intervention, comparator, and outcome) format to address the benefit and harms of low-dose CT screening, as well as key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the GRADE approach. Meta-analyses were performed where appropriate. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and un-graded statements were drafted, voted on, and revised until consensus was reached. RESULTS The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in 7 graded recommendations and 9 ungraded consensus statements. CONCLUSIONS Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen detected findings, and the effectiveness of smoking cessation interventions, can impact this balance.
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Affiliation(s)
| | | | | | - Tanner J Caverly
- Ann Arbor VA Center for Clinical Management Research and University of Michigan Medical School , Madison, WI
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA
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67
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Taksler GB, Peterse EFP, Willems I, Ten Haaf K, Jansen EEL, de Kok IMCM, van Ravesteyn NT, de Koning HJ, Lansdorp-Vogelaar I. Modeling Strategies to Optimize Cancer Screening in USPSTF Guideline-Noncompliant Women. JAMA Oncol 2021; 7:885-894. [PMID: 33914025 DOI: 10.1001/jamaoncol.2021.0952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance In 2018, only half of US women obtained all evidence-based cancer screenings. This proportion may have declined during the COVID-19 pandemic because of social distancing, high-risk factors, and fear. Objective To evaluate optimal screening strategies in women who obtain some, but not all, US Preventive Services Task Force (USPSTF)-recommended cancer screenings. Design, Setting, and Participants This modeling study was conducted from January 31, 2017, to July 20, 2020, and used 4 validated mathematical models from the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network using data from 20 million simulated women born in 1965 in the US. Interventions Forty-five screening strategies were modeled that combined breast, cervical, colorectal, and/or lung cancer (LC) screenings; restricted to 1, 2, 3 or 4 screenings per year; or all eligible screenings once every 5 years. Main Outcomes and Measures Modeled life-years gained from restricted cancer screenings as a fraction of those attainable from full compliance with USPSTF recommendations (maximum benefits). Results were stratified by LC screening eligibility (LC-eligible/ineligible). We repeated the analysis with 2018 adherence rates, evaluating the increase in adherence required for restricted screenings to have the same population benefit as USPSTF recommendations. Results This modeling study of 20 million simulated US women found that it was possible to reduce screening intensity to 1 carefully chosen test per year in women who were ineligible for LC screening and 2 tests per year in eligible women while maintaining 94% or more of the maximum benefits. Highly ranked strategies screened for various cancers, but less often than recommended by the USPSTF. For example, among LC-ineligible women who obtained just 1 screening per year, the optimal strategy frequently delayed breast and cervical cancer screenings by 1 year and skipped 3 mammograms entirely. Among LC-eligible women, LC screening was essential; strategies omitting it provided 25% or less of the maximum benefits. The top-ranked strategy restricted to 2 screenings per year was annual LC screening and alternating fecal immunochemical test with mammography (skipping mammograms when due for cervical cancer screening, 97% of maximum benefits). If adherence in a population of LC-eligible women obtaining 2 screenings per year were to increase by 1% to 2% (depending on the screening test), this model suggests that it would achieve the same benefit as USPSTF recommendations at 2018 adherence rates. Conclusions and Relevance This modeling study of 45 cancer screening strategies suggests that women who are noncompliant with cancer screening guidelines may be able to reduce USPSTF-recommended screening intensity with minimal reduction in overall benefits.
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Affiliation(s)
- Glen B Taksler
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.,Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, Ohio
| | - Elisabeth F P Peterse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Isarah Willems
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erik E L Jansen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Abstract
PURPOSE OF REVIEW Lung cancer remains the leading cause of cancer-related death in the United States, with poor overall 5-year survival. Early detection and diagnosis are key to survival as demonstrated in lung cancer screening trials. However, with increasing implementation of screening guidelines and use of computed tomography, there has been a sharp rise in the incidence of indeterminate pulmonary nodules (IPNs). Risk stratification of IPNs, particularly those in the intermediate-risk category, remains challenging in clinical practice. Individual risk factors, imaging characteristics, biomarkers, and prediction models are currently used to assist in risk stratifying patients, but such strategies remain suboptimal. This review focuses on established risk stratification methods, current areas of research, and future directions. RECENT FINDINGS The multitude of yearly incidental and screening-detected IPNs, its management-related healthcare costs, and risk of invasive procedures provides a strong rationale for risk stratification efforts. The development of new molecular and imaging biomarkers to discriminate benign from malignant lung nodules shows great promise. Yet, risk stratification methods need integration into the diagnostic workflow and await validation in prospective, biomarker-driven clinical trials. SUMMARY Novel biomarkers and new imaging analysis, including radiomics and deep-learning methods, have been developed to optimize the risk stratification of IPNs. While promising, additional validation and clinical studies are needed before they can be part of routine clinical practice.
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Affiliation(s)
- Rafael Paez
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center
| | - Michael N Kammer
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center
- Department of Chemistry, Vanderbilt University
| | - Pierre Massion
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center
- Cancer Early Detection and Prevention Initiative, Vanderbilt-Ingram Cancer Center
- Pulmonary and Critical Care Section, Medical Service, Tennessee Valley Healthcare System, Nashville Campus, Nashville, Tennessee, USA
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69
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Rankin NM, McWilliams A, Marshall HM. Lung cancer screening implementation: Complexities and priorities. Respirology 2021; 25 Suppl 2:5-23. [PMID: 33200529 DOI: 10.1111/resp.13963] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
Lung cancer is the number one cause of cancer death worldwide. The benefits of lung cancer screening to reduce mortality and detect early-stage disease are no longer in any doubt based on the results of two landmark trials using LDCT. Lung cancer screening has been implemented in the US and South Korea and is under consideration by other communities. Successful translation of demonstrated research outcomes into the routine clinical setting requires careful implementation and co-ordinated input from multiple stakeholders. Implementation aspects may be specific to different healthcare settings. Important knowledge gaps remain, which must be addressed in order to optimize screening benefits and minimize screening harms. Lung cancer screening differs from all other cancer screening programmes as lung cancer risk is driven by smoking, a highly stigmatized behaviour. Stigma, along with other factors, can impact smokers' engagement with screening, meaning that smokers are generally 'hard to reach'. This review considers critical points along the patient journey. The first steps include selecting a risk threshold at which to screen, successfully engaging the target population and maximizing screening uptake. We review barriers to smoker engagement in lung and other cancer screening programmes. Recruitment strategies used in trials and real-world (clinical) programmes and associated screening uptake are reviewed. To aid cross-study comparisons, we propose a standardized nomenclature for recording and calculating recruitment outcomes. Once participants have engaged with the screening programme, we discuss programme components that are critical to maximize net benefit. A whole-of-programme approach is required including a standardized and multidisciplinary approach to pulmonary nodule management, incorporating probabilistic nodule risk assessment and longitudinal volumetric analysis, to reduce unnecessary downstream investigations and surgery; the integration of smoking cessation; and identification and intervention for other tobacco related diseases, such as coronary artery calcification and chronic obstructive pulmonary disease. National support, integrated with tobacco control programmes, and with appropriate funding, accreditation, data collection, quality assurance and reporting mechanisms will enhance lung cancer screening programme success and reduce the risks associated with opportunistic, ad hoc screening. Finally, implementation research must play a greater role in informing policy change about targeted LDCT screening programmes.
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Affiliation(s)
- Nicole M Rankin
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Thoracic Tumour Collaborative of Western Australia, Western Australia Cancer and Palliative Care Network, Perth, WA, Australia
| | - Henry M Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.,The University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
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Hunger T, Wanka-Pail E, Brix G, Griebel J. Lung Cancer Screening with Low-Dose CT in Smokers: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11061040. [PMID: 34198856 PMCID: PMC8228723 DOI: 10.3390/diagnostics11061040] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
Lung cancer continues to be one of the main causes of cancer death in Europe. Low-dose computed tomography (LDCT) has shown high potential for screening of lung cancer in smokers, most recently in two European trials. The aim of this review was to assess lung cancer screening of smokers by LDCT with respect to clinical effectiveness, radiological procedures, quality of life, and changes in smoking behavior. We searched electronic databases in April 2020 for publications of randomized controlled trials (RCT) reporting on lung cancer and overall mortality, lung cancer morbidity, and harms of LDCT screening. A meta-analysis was performed to estimate effects on mortality. Forty-three publications on 10 RCTs were included. The meta-analysis of eight studies showed a statistically significant relative reduction of lung cancer mortality of 12% in the screening group (risk ratio = 0.88; 95% CI: 0.79-0.97). Between 4% and 24% of screening-LDCT scans were classified as positive, and 84-96% of them turned out to be false positive. The risk of overdiagnosis was estimated between 19% and 69% of diagnosed lung cancers. Lung cancer screening can reduce disease-specific mortality in (former) smokers when stringent requirements and quality standards for performance are met.
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Passiglia F, Cinquini M, Bertolaccini L, Del Re M, Facchinetti F, Ferrara R, Franchina T, Larici AR, Malapelle U, Menis J, Passaro A, Pilotto S, Ramella S, Rossi G, Trisolini R, Novello S. Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis. J Clin Oncol 2021; 39:2574-2585. [PMID: 34236916 DOI: 10.1200/jco.20.02574] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This meta-analysis aims to combine and analyze randomized clinical trials comparing computed tomography lung screening (CTLS) versus either no screening (NS) or chest x-ray (CXR) in subjects with cigarette smoking history, to provide a precise and reliable estimation of the benefits and harms associated with CTLS. MATERIALS AND METHODS Data from all published randomized trials comparing CTLS versus either NS or CXR in a highly tobacco-exposed population were collected, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses by comparator (NS or CXR) were performed. Pooled risk ratio (RR) and relative 95% CIs were calculated for dichotomous outcomes. The certainty of the evidence was assessed using the GRADE approach. RESULTS Nine eligible trials (88,497 patients) were included. Pooled analysis showed that CTLS is associated with: a significant reduction of lung cancer-related mortality (overall RR, 0.87; 95% CI, 0.78 to 0.98; NS RR, 0.80; 95% CI, 0.69 to 0.92); a significant increase of early-stage tumors diagnosis (overall RR, 2.84; 95% CI 1.76 to 4.58; NS RR, 3.33; 95% CI, 2.27 to 4.89; CXR RR, 1.52; 95% CI, 1.04 to 2.23); a significant decrease of late-stage tumors diagnosis (overall RR, 0.75; 95% CI, 0.68 to 0.83; NS RR, 0.67; 95% CI, 0.56 to 0.80); a significant increase of resectability rate (NS RR, 2.57; 95% CI, 1.76 to 3.74); a nonsignificant reduction of all-cause mortality (overall RR, 0.99; 95% CI, 0.94 to 1.05); and a significant increase of overdiagnosis rate (NS, 38%; 95% CI, 14 to 63). The analysis of lung cancer-related mortality by sex revealed nonsignificant differences between men and women (P = .21; I-squared = 33.6%). CONCLUSION Despite there still being uncertainty about overdiagnosis estimate, this meta-analysis suggested that the CTLS benefits outweigh harms, in subjects with cigarette smoking history, ultimately supporting the systematic implementation of lung cancer screening worldwide.
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Affiliation(s)
- Francesco Passiglia
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano (TO), Italy
| | - Michela Cinquini
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Francesco Facchinetti
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Roberto Ferrara
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tindara Franchina
- Department of Human Pathology "G. Barresi," University of Messina, Messina, Italy
| | - Anna R Larici
- Sacro Cuore Catholic University, Policlinico A. Gemelli Foundation, Rome, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples "Federico II," Naples, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Pilotto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Giulio Rossi
- Pathologic Anatomy, Azienda USL della Romagna, S. Maria delle Croci Hospital of Ravenna and Degli Infermi Hospital of Rimini, Rimini, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Novello
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano (TO), Italy
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Serum Metabolite Profiles in Participants of Lung Cancer Screening Study; Comparison of Two Independent Cohorts. Cancers (Basel) 2021; 13:cancers13112714. [PMID: 34072693 PMCID: PMC8198431 DOI: 10.3390/cancers13112714] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022] Open
Abstract
Serum metabolome is a promising source of molecular biomarkers that could support early detection of lung cancer in screening programs based on low-dose computed tomography. Several panels of metabolites that differentiate lung cancer patients and healthy individuals were reported, yet none of them were validated in the population at high-risk of developing cancer. Here we analyzed serum metabolome profiles in participants of two lung cancer screening studies: MOLTEST-BIS (Poland, n = 369) and SMAC-1 (Italy, n = 93). Three groups of screening participants were included: lung cancer patients, individuals with benign pulmonary nodules, and those without any lung alterations. Concentrations of about 400 metabolites (lipids, amino acids, and biogenic amines) were measured by a mass spectrometry-based approach. We observed a reduced level of lipids, in particular cholesteryl esters, in sera of cancer patients from both studies. Despite several specific compounds showing significant differences between cancer patients and healthy controls within each study, only a few cancer-related features were common when both cohorts were compared, which included a reduced concentration of lysophosphatidylcholine LPC (18:0). Moreover, serum metabolome profiles in both noncancer groups were similar, and differences between cancer patients and both groups of healthy participants were comparable. Large heterogeneity in levels of specific metabolites was observed, both within and between cohorts, which markedly impaired the accuracy of classification models: The overall AUC values of three-state classifiers were 0.60 and 0.51 for the test (MOLTEST) and validation (SMAC) cohorts, respectively. Therefore, a hypothetical metabolite-based biomarker for early detection of lung cancer would require adjustment to lifestyle-related confounding factors that putatively affect the composition of serum metabolome.
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Venkadesh KV, Setio AAA, Schreuder A, Scholten ET, Chung K, W Wille MM, Saghir Z, van Ginneken B, Prokop M, Jacobs C. Deep Learning for Malignancy Risk Estimation of Pulmonary Nodules Detected at Low-Dose Screening CT. Radiology 2021; 300:438-447. [PMID: 34003056 DOI: 10.1148/radiol.2021204433] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Accurate estimation of the malignancy risk of pulmonary nodules at chest CT is crucial for optimizing management in lung cancer screening. Purpose To develop and validate a deep learning (DL) algorithm for malignancy risk estimation of pulmonary nodules detected at screening CT. Materials and Methods In this retrospective study, the DL algorithm was developed with 16 077 nodules (1249 malignant) collected -between 2002 and 2004 from the National Lung Screening Trial. External validation was performed in the following three -cohorts -collected between 2004 and 2010 from the Danish Lung Cancer Screening Trial: a full cohort containing all 883 nodules (65 -malignant) and two cancer-enriched cohorts with size matching (175 nodules, 59 malignant) and without size matching (177 -nodules, 59 malignant) of benign nodules selected at random. Algorithm performance was measured by using the area under the receiver operating characteristic curve (AUC) and compared with that of the Pan-Canadian Early Detection of Lung Cancer (PanCan) model in the full cohort and a group of 11 clinicians composed of four thoracic radiologists, five radiology residents, and two pulmonologists in the cancer-enriched cohorts. Results The DL algorithm significantly outperformed the PanCan model in the full cohort (AUC, 0.93 [95% CI: 0.89, 0.96] vs 0.90 [95% CI: 0.86, 0.93]; P = .046). The algorithm performed comparably to thoracic radiologists in cancer-enriched cohorts with both random benign nodules (AUC, 0.96 [95% CI: 0.93, 0.99] vs 0.90 [95% CI: 0.81, 0.98]; P = .11) and size-matched benign nodules (AUC, 0.86 [95% CI: 0.80, 0.91] vs 0.82 [95% CI: 0.74, 0.89]; P = .26). Conclusion The deep learning algorithm showed excellent performance, comparable to thoracic radiologists, for malignancy risk estimation of pulmonary nodules detected at screening CT. This algorithm has the potential to provide reliable and reproducible malignancy risk scores for clinicians, which may help optimize management in lung cancer screening. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Tammemägi in this issue.
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Affiliation(s)
- Kiran Vaidhya Venkadesh
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Arnaud A A Setio
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Anton Schreuder
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Ernst T Scholten
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Kaman Chung
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Mathilde M W Wille
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Zaigham Saghir
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Bram van Ginneken
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Mathias Prokop
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Colin Jacobs
- From the Department of Medical Imaging, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands (K.V.V., A.A.A.S., A.S., E.T.S., K.C., B.v.G., M.P., C.J.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
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Ten Haaf K, van der Aalst CM, de Koning HJ, Kaaks R, Tammemägi MC. Personalising lung cancer screening: An overview of risk-stratification opportunities and challenges. Int J Cancer 2021; 149:250-263. [PMID: 33783822 PMCID: PMC8251929 DOI: 10.1002/ijc.33578] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022]
Abstract
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 risk‐stratification 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.
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Affiliation(s)
- Kevin Ten Haaf
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carlijn M van der Aalst
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
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Ricciardi S, Booton R, Petersen RH, Infante M, Scarci M, Veronesi G, Cardillo G. Managing of screening-detected sub-solid nodules-a European perspective. Transl Lung Cancer Res 2021; 10:2368-2377. [PMID: 34164284 PMCID: PMC8182699 DOI: 10.21037/tlcr.2020.03.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the National Lung Screening Trial in 2011 showed a 20% reduction in lung cancer mortality using annual low-dose computed tomography (LDCT), several randomised controlled trials and studies have been started in Europe. These include the Italian lung study (ITALUNG), the Dutch-Belgian lung cancer screening trial (NELSON), the UK lung cancer screening trial (UKLS), the Detection and screening of early lung cancer with novel imaging technology (DANTE), the Danish lung cancer screening trial (DLCST), the German lung cancer screening intervention trial (LUSI), the Multicentric Italian lung detection trial (MILD) and the CT screening for lung cancer study (COSMOS). As a result of the increasing number of screening trials and the growing utilization of LDCT, the high detection of subsolid nodules is an increasingly important clinical problem. In the last few years, several guidelines have been published and providing guidance on the optimal management of subsolid nodules, but many controversies still exist. Follow-up imaging plays an important role in clinical assessment and subsequent management of this particular type of lung nodules, since they can be transient inflammatory lesions, and if persistent they can be both benign lesions or lung cancers of variable clinical behaviour. However, the vast majority of subsolid nodules retain an indolent course over many years. The aim of this review is to present a European perspective in management of screening detected subsolid nodules.
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Affiliation(s)
- Sara Ricciardi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, Pathology and Critical Care, University Hospital of Pisa, Pisa, Italy
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University Foundation Trust & School of Biological Sciences, The University of Manchester, Manchester UK
| | - Renè Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Maurizio Infante
- Department of Thoracic Surgery, University and Hospital Trust, Verona, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, S. Gerardo Hospital, Monza, Italy
| | - Giulia Veronesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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76
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Silva M, Milanese G, Ledda RE, Pastorino U, Sverzellati N. Screen-detected solid nodules: from detection of nodule to structured reporting. Transl Lung Cancer Res 2021; 10:2335-2346. [PMID: 34164281 PMCID: PMC8182712 DOI: 10.21037/tlcr-20-296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer screening (LCS) is gaining some interest worldwide after positive results from International trials. Unlike other screening practices, LCS is performed by an extremely sensitive test, namely low-dose computed tomography (LDCT) that can detect the smallest nodules in lung parenchyma. Up-to-date detection approaches, such as computer aided detection systems, have been increasingly employed for lung nodule automatic identification and are largely used in most LCS programs as a complementary tool to visual reading. Solid nodules of any size are represented in the vast majority of subjects undergoing LDCT. However, less than 1% of solid nodules will be diagnosed lung cancer. This fact calls for specific characterization of nodules to avoid false positives, overinvestigation, and reduce the risks associated with nodule work up. Recent research has been exploring the potential of artificial intelligence, including deep learning techniques, to enhance the accuracy of both detection and characterisation of lung nodule. Computer aided detection and diagnosis algorithms based on artificial intelligence approaches have demonstrated the ability to accurately detect and characterize parenchymal nodules, reducing the number of false positives, and to outperform some of the currently used risk models for prediction of lung cancer risk, potentially reducing the proportion of surveillance CT scans. These forthcoming approaches will eventually integrate a new reasoning for development of future guidelines, which are expected to evolve into precision and personalized stratification of lung cancer risk stratification by continuous fashion, as opposed to the current format with a limited number of risk classes within fixed thresholds of nodule size. This review aims to detail the standard of reference for optimal management of solid nodules by low-dose computed and its projection into the fine selection of candidates for work up.
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Affiliation(s)
- Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Roberta E Ledda
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Ugo Pastorino
- Section of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
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Schreuder A, Mets OM, Schaefer-Prokop CM, Jacobs C, Prokop M. Microsimulation modeling of extended annual CT screening among lung cancer cases in the National Lung Screening Trial. Lung Cancer 2021; 156:5-11. [PMID: 33866117 DOI: 10.1016/j.lungcan.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To microsimulate the effects of three additional annual CT screening rounds on lung cancer (LC) survival in the National Lung Screening Trial (NLST). METHODS We used multiple imputation to model the effect of additional screening in the full NLST cohort on the time to LC diagnosis and on LC death in those participants who were diagnosed with LC by the end of NLST. Nodule growth models were derived from a Dutch in-vivo study. Microsimulations were repeated 500 times. The method was validated by simulating three rounds of CT screening in the original chest radiography (CXR) cohort. The times up to which the simulations remained within the 95 % confidence bands of the CT cohort's original results were used to estimate the validity of the results in the CT cohort with three additional simulated screening rounds. RESULTS Validation of the simulation approach on the CXR cohort resulted in a LC mortality reduction which remained well within the 95 % confidence intervals of the original CT cohort up to 6.5 years after the start of simulations. Simulating additional CT screening in the CT cohort led to LCs being diagnosed earlier than originally, resulting in a relative risk reduction in LC mortality of 11 % (95 % confidence bands, 7 %-14 %) at 6.5 years. This is equivalent to preventing 71 % (48 %-94 %) more LC deaths than the original CT cohort achieved in comparison to the original CXR cohort. CONCLUSION Three additional annual CT screening rounds in the NLST may have led to substantial further LC mortality reduction.
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Affiliation(s)
- Anton Schreuder
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Onno M Mets
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Cornelia M Schaefer-Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology, Meander Medisch Centrum, Amersfoort, the Netherlands
| | - Colin Jacobs
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
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Tringali G, Milanese G, Ledda RE, Pastorino U, Sverzellati N, Silva M. Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation. ROFO-FORTSCHR RONTG 2021; 193:1153-1161. [PMID: 33772489 DOI: 10.1055/a-1382-8648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer death worldwide. Several trials with different screening approaches have recognized the role of lung cancer screening with low-dose CT for reducing lung cancer mortality. The efficacy of lung cancer screening depends on many factors and implementation is still pending in most European countries. METHODS This review aims to portray current evidence on lung cancer screening with a focus on the potential for opportunities for implementation strategies. Pillars of lung cancer screening practice will be discussed according to the most updated literature (PubMed search until November 16, 2020). RESULTS AND CONCLUSION The NELSON trial showed reduction of lung cancer mortality, thus confirming previous results of independent European studies, notably by volume of lung nodules. Heterogeneity in patient recruitment could influence screening efficacy, hence the importance of risk models and community-based screening. Recruitment strategies develop and adapt continuously to address the specific needs of the heterogeneous population of potential participants, the most updated evidence comes from the UK. The future of lung cancer screening is a tailored approach with personalized continuous stratification of risk, aimed at reducing costs and risks. KEY POINTS · Secondary prevention of lung cancer by low-dose computed tomography showed a reduction of lung cancer mortality.. · Semi-automated volume measurement and use of volume doubling time should be the reference method for optimization of risks, namely controlling measurement variability and the false-positive rate.. · A conservative approach with surveillance of subsolid nodules can be one of the strategies to reduce the risk of overdiagnosis and overtreatment.. · The goal of a tailored approach with personalized risk stratification aims to reduce costs and risks. A longer interval between rounds is one option for participants at lower risk.. CITATION FORMAT · Tringali G, Milanese G, Ledda RE et al. Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation. Fortschr Röntgenstr 2021; 193: 1153 - 1161.
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Affiliation(s)
- Giulia Tringali
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Roberta Eufrasia Ledda
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Mario Silva
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
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79
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Krilaviciute A, Brenner H. Low positive predictive value of computed tomography screening for lung cancer irrespective of commonly employed definitions of target population. Int J Cancer 2021; 149:58-65. [PMID: 33634860 DOI: 10.1002/ijc.33522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/19/2021] [Accepted: 02/11/2021] [Indexed: 12/09/2022]
Abstract
Screening for lung cancer (LC) by low-dose computed tomography (LDCT) has been demonstrated to reduce LC mortality in randomized clinical trials (RCTs), and its implementation is in preparation in many countries. However, definition of the target population, which was based on various combinations of age ranges and definitions of heavy smoking in the RCTs, is subject to ongoing debate. Using epidemiological data from Germany, we aimed to estimate prevalence of preclinical LC and positive predictive value (PPV) of LDCT in potential target populations defined by age and smoking history. Populations aged 50 to 69, 55 to 69, 50 to 74 and 55 to 79 years were considered in this analysis. Sex-specific prevalence of preclinical LC was estimated using LC incidence data within those age ranges and annual transition rates from preclinical to clinical LC obtained by meta-analysis. Prevalence of preclinical LC among heavy smokers (defined by various pack-year thresholds) within those age ranges was estimated by combining LC prevalence in the general population with proportions of heavy smokers and relative risks for LC among them derived from epidemiological studies. PPVs were calculated by combining these prevalences with sensitivity and specificity estimates of LDCT. Estimated prevalence of LC was 0.3% to 0.5% (men) and 0.2% to 0.3% (women) in the general population and 0.8% to 1.7% in target populations of heavy smokers. Estimates of PPV of LDCT were <20% for all definitions of target populations of heavy smokers. Refined preselection of target populations would be highly desirable to increase PPV and efficiency of LDCT screening and to reduce numbers of false-positive LDCT findings.
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Affiliation(s)
- Agne Krilaviciute
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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80
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Smolarz M, Widlak P. Serum Exosomes and Their miRNA Load-A Potential Biomarker of Lung Cancer. Cancers (Basel) 2021; 13:cancers13061373. [PMID: 33803617 PMCID: PMC8002857 DOI: 10.3390/cancers13061373] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Early detection of lung cancer in screening programs is a rational way to reduce mortality associated with this malignancy. Low-dose computed tomography, a diagnostic tool used in lung cancer screening, generates a relatively large number of false-positive results, and its complementation with molecular biomarkers would greatly improve the effectiveness of such programs. Several biomarkers of lung cancer based on different components of blood, including miRNA signatures, were proposed. However, only a few of them have been positively validated in the context of early cancer detection yet, which imposes a constant need for new biomarker candidates. An emerging source of cancer biomarkers are exosomes and other types of extracellular vesicles circulating in body fluids. Hence, different molecular components of serum/plasma-derived exosomes were tested and showed different levels in lung cancer patients and healthy individuals. Several studies focused on the miRNA component of these vesicles. Proposed signatures of exosome miRNA had promising diagnostic value, though none of them have yet been clinically validated. These signatures involved a few dozen miRNA species overall, including a few species that recurred in different signatures. It is worth noting that all these miRNA species have cancer-related functions and have been associated with lung cancer progression. Moreover, a few of them, including known oncomirs miR-17, miR-19, miR-21, and miR-221, appeared in multiple miRNA signatures of lung cancer based on both the whole serum/plasma and serum/plasma-derived exosomes.
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81
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Bradley SH, Shinkins B, Kennedy MP. What is the balance of benefits and harms for lung cancer screening with low-dose computed tomography? J R Soc Med 2021; 114:164-170. [PMID: 33715495 PMCID: PMC8091370 DOI: 10.1177/0141076821991108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Stephen H Bradley
- Leeds Institute of Health Sciences, 4468University of Leeds, Leeds LS2 9JT, UK
| | - Bethany Shinkins
- Test Evaluation Group, Academic Unit of Health Economics, 4468University of Leeds, Leeds LS2 9JT, UK
| | - Martyn Pt Kennedy
- Department of Respiratory Medicine, 4472Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
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82
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Jonas DE, Reuland DS, Reddy SM, Nagle M, Clark SD, Weber RP, Enyioha C, Malo TL, Brenner AT, Armstrong C, Coker-Schwimmer M, Middleton JC, Voisin C, Harris RP. Screening for Lung Cancer With Low-Dose Computed Tomography: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:971-987. [PMID: 33687468 DOI: 10.1001/jama.2021.0377] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Lung cancer is the leading cause of cancer-related death in the US. OBJECTIVE To review the evidence on screening for lung cancer with low-dose computed tomography (LDCT) to inform the US Preventive Services Task Force (USPSTF). DATA SOURCES MEDLINE, Cochrane Library, and trial registries through May 2019; references; experts; and literature surveillance through November 20, 2020. STUDY SELECTION English-language studies of screening with LDCT, accuracy of LDCT, risk prediction models, or treatment for early-stage lung cancer. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Data were not pooled because of heterogeneity of populations and screening protocols. MAIN OUTCOMES AND MEASURES Lung cancer incidence, lung cancer mortality, all-cause mortality, test accuracy, and harms. RESULTS This review included 223 publications. Seven randomized clinical trials (RCTs) (N = 86 486) evaluated lung cancer screening with LDCT; the National Lung Screening Trial (NLST, N = 53 454) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON, N = 15 792) were the largest RCTs. Participants were more likely to benefit than the US screening-eligible population (eg, based on life expectancy). The NLST found a reduction in lung cancer mortality (incidence rate ratio [IRR], 0.85 [95% CI, 0.75-0.96]; number needed to screen [NNS] to prevent 1 lung cancer death, 323 over 6.5 years of follow-up) with 3 rounds of annual LDCT screening compared with chest radiograph for high-risk current and former smokers aged 55 to 74 years. NELSON found a reduction in lung cancer mortality (IRR, 0.75 [95% CI, 0.61-0.90]; NNS to prevent 1 lung cancer death of 130 over 10 years of follow-up) with 4 rounds of LDCT screening with increasing intervals compared with no screening for high-risk current and former smokers aged 50 to 74 years. Harms of screening included radiation-induced cancer, false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, and increases in distress. For every 1000 persons screened in the NLST, false-positive results led to 17 invasive procedures (number needed to harm, 59) and fewer than 1 person having a major complication. Overdiagnosis estimates varied greatly (0%-67% chance that a lung cancer was overdiagnosed). Incidental findings were common, and estimates varied widely (4.4%-40.7% of persons screened). CONCLUSIONS AND RELEVANCE Screening high-risk persons with LDCT can reduce lung cancer mortality but also causes false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers. Most studies reviewed did not use current nodule evaluation protocols, which might reduce false-positive results and invasive procedures for false-positive results.
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Affiliation(s)
- Daniel E Jonas
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Daniel S Reuland
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Shivani M Reddy
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Max Nagle
- Michigan Medicine, University of Michigan, Ann Arbor
| | - Stephen D Clark
- Department of Internal Medicine, Virginia Commonwealth University, Richmond
| | - Rachel Palmieri Weber
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Charli Armstrong
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Manny Coker-Schwimmer
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Jennifer Cook Middleton
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Christiane Voisin
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Russell P Harris
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
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83
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Couraud S, Ferretti G, Milleron B, Cortot A, Girard N, Gounant V, Laurent F, Leleu O, Quoix E, Revel MP, Wislez M, Westeel V, Zalcman G, Scherpereel A, Khalil A. [Recommendations of French specialists on screening for lung cancer]. Rev Mal Respir 2021; 38:310-325. [PMID: 33637394 DOI: 10.1016/j.rmr.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 01/25/2021] [Indexed: 12/17/2022]
Affiliation(s)
- S Couraud
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, hospices civils de Lyon, hôpital Lyon Sud, Pierre-Bénite, France; Intergroupe francophone de cancérologie thoracique, Paris, France.
| | - G Ferretti
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de radiologie diagnostique et interventionnel, CHU de Grenoble-Alpes, Grenoble, France
| | - B Milleron
- Intergroupe francophone de cancérologie thoracique, Paris, France
| | - A Cortot
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et oncologie thoracique, CHU de Lille, Lille, France
| | - N Girard
- Intergroupe francophone de cancérologie thoracique, Paris, France; Unité d'oncologie thoracique, institut Curie, Paris, France
| | - V Gounant
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
| | - F Laurent
- Service de radiologie, CHU de Bordeaux, Pessac, France
| | - O Leleu
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie, centre hospitalier Abbeville, Abbeville, France
| | - E Quoix
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie, CHRU Strasbourg, Strasbourg, France
| | - M-P Revel
- Service de radiologie, hôpital Cochin, Paris, France
| | - M Wislez
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, hôpital Cochin, Paris, France
| | - V Westeel
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et cancérologie thoracique, CHU de Besançon, Besançon, France
| | - G Zalcman
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
| | - A Scherpereel
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et oncologie thoracique, CHU de Lille, Lille, France
| | - A Khalil
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de radiologie, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
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84
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Intergroupe francophone de cancérologie thoracique, Société de pneumologie de langue française, and Société d'imagerie thoracique statement paper on lung cancer screening. Diagn Interv Imaging 2021; 102:199-211. [PMID: 33648872 DOI: 10.1016/j.diii.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
Following the American National Lung Screening Trial results in 2011 a consortium of French experts met to edit a statement. Recent results of other randomized trials gave the opportunity for our group to meet again in order to edit updated guidelines. After literature review, we provide here a new update on lung cancer screening in France. Notably, in accordance with all international guidelines, the experts renew their recommendation in favor of individual screening for lung cancer in France as per the conditions laid out in this document. In addition, the experts recommend the very rapid organization and funding of prospective studies, which, if conclusive, will enable the deployment of lung cancer screening organized at the national level.
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85
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Hunger T, Nekolla E, Griebel J, Brix G. [Scientific assessment and regulatory approval of radiological screening examinations in Germany]. Radiologe 2021; 61:21-27. [PMID: 33044561 DOI: 10.1007/s00117-020-00758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Radiologic imaging technologies like computed tomography (CT) have the potential to screen for various diseases. The potential benefits of screening are always associated with risks, particularly from the application of ionizing radiation. MATERIALS AND METHODS The International Basic Safety Standards as well as the Council Directive 2013/59/Euratom have set guidelines for the application of ionizing radiation in early detection which were transposed into the German Radiation Protection Law. Accordingly, the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU) approves screening examinations on a generic level, based on a scientific report provided by the German Federal Office for Radiation Protection (BfS), and defines in a federal statutory ordinance which type of screening is permissible for detecting a disease for a particular group of persons and under which conditions. RESULTS With exception of the mammography screening programme, no radiological examination for the early detection of disease has been approved in Germany to date. However, such screenings are currently being offered in Germany. The BfS is currently conducting a scientific evaluation for lung cancer screening with low-dose CT. CONCLUSIONS Screening examinations with radiological imaging can only be approved when studies with the highest level of evidence have demonstrated that the benefits outweigh the risks. To translate this favourable benefit-risk balance into general health care, strict requirements for the entire screening process including quality assurance must be defined.
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Affiliation(s)
- T Hunger
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland.
| | - E Nekolla
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
| | - J Griebel
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
| | - G Brix
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
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86
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Fischer AM, Yacoub B, Savage RH, Martinez JD, Wichmann JL, Sahbaee P, Grbic S, Varga-Szemes A, Schoepf UJ. Machine Learning/Deep Neuronal Network: Routine Application in Chest Computed Tomography and Workflow Considerations. J Thorac Imaging 2021; 35 Suppl 1:S21-S27. [PMID: 32317574 DOI: 10.1097/rti.0000000000000498] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The constantly increasing number of computed tomography (CT) examinations poses major challenges for radiologists. In this article, the additional benefits and potential of an artificial intelligence (AI) analysis platform for chest CT examinations in routine clinical practice will be examined. Specific application examples include AI-based, fully automatic lung segmentation with emphysema quantification, aortic measurements, detection of pulmonary nodules, and bone mineral density measurement. This contribution aims to appraise this AI-based application for value-added diagnosis during routine chest CT examinations and explore future development perspectives.
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Affiliation(s)
- Andreas M Fischer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Basel Yacoub
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Rock H Savage
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - John D Martinez
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | | | | | | | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
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87
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van der Aalst CM, Ten Haaf K, de Koning HJ. Implementation of lung cancer screening: what are the main issues? Transl Lung Cancer Res 2021; 10:1050-1063. [PMID: 33718044 PMCID: PMC7947387 DOI: 10.21037/tlcr-20-985] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Two large-scale RCTs have shown computed tomography (CT) lung cancer screening to be efficacious in reducing lung cancer mortality (8–24% in men, 26–59% in women). However, lung cancer screening implicitly means personalised and risk-based approaches. Health care systems’ implementation of personalised screening and prevention is still sparse, and likely to be of variable quality, because of important remaining uncertainties, which have been incompletely addressed or not at all so far. Further optimisation of lung cancer screening programs is expected to reduce harms and maintain or enhance benefit for eligible European citizens, whilst significantly reducing health care costs. Some main uncertainties (e.g., Risk-based eligibility, Risk-based screening intervals, Volume CT screening, Smoking Cessation, Gender and Sex differences, Cost-Effectiveness) are discussed in this review. 4-IN-THE-LUNG-RUN (acronym for: Towards INdividually tailored INvitations, screening INtervals and INtegrated co-morbidity reducing strategies in lung cancer screening) is the first multi-centred implementation trial on volume CT lung cancer screening amongst 24,000 males and females, at high risk for developing lung cancer, across five European countries, started in January 2020. Through providing answers to the remaining questions with this trial, many EU citizens will swiftly benefit from this high-quality screening technology, others will face less harms than previously anticipated, and health care costs will be substantially reduced. Implementing a new cancer screening programme is a major task, with many stakeholders and many possible facilitators but also barriers and obstacle.
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Affiliation(s)
- Carlijn M van der Aalst
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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88
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Zheng Q, Zhang J, Wang X, Zhang W, Xiao Y, Hu S, Xu J. Neutral Desorption Extractive Electrospray Ionization Mass Spectrometry Analysis Sputum for Non-Invasive Lung Adenocarcinoma Detection. Onco Targets Ther 2021; 14:469-479. [PMID: 33488101 PMCID: PMC7816046 DOI: 10.2147/ott.s269300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Increased use of low-dose spiral computed tomography (LDCT: low-dose computed tomography) screening has contributed to more frequent incidental detection of peripheral lung nodules, part of them were adenocarcinoma, which need to be further evaluated to establish a definitive diagnosis. Here, our primary objective was to evaluate the ambient mass spectrometry (AMS) sputum analysis as a non-invasive lung adenocarcinoma (LAC) diagnosis solution. Patients and Methods Neutral desorption extractive electrospray ionization mass spectrometry (ND-EESI-MS) and collision induced dissociation (CID) were used to detect sputum metabolites from 143 spontaneous sputum samples. Partial least squares-discriminant analysis (PLS-DA) was used to refine the biomarker panel, whereas orthogonal PLS-DA (OPLS-DA) was used to operationalize the enhanced biomarker panel for diagnosis. Results In this approach, 19 altered metabolites were detected by ND-EESI-MS from 76 cases of LAC and 67 cases of control. Significance testing and receiver operating characteristic (ROC) analysis identified 5 metabolites [hydroxyphenyllactic acid, phytosphingosine, N-nonanoylglycine, sphinganine, S-carboxymethyl-L-cysteine] with p <0.05 and AUC >0.75, respectively. Evaluation of model performance for prediction of LAC resulted in a cross-validation classification accuracy of 87.9%. Metabolic pathway analysis showed that sphingolipid metabolism, fatty acid metabolism, carnitine synthesis and Warburg effect were most impacted in response to disease. Conclusion This study indicates that the application of ND-EESI-MS to sputum analysis can be used as a non-invasive detection of peripheral lung nodules. The use of sputum metabolite biomarkers may aid in the development of a further evaluation program for lung adenocarcinoma.
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Affiliation(s)
- Qiaoling Zheng
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, People's Republic of China.,Jiangxi Health Vocational College, Nanchang, Jiangxi 330000, People's Republic of China
| | - Jianyong Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, People's Republic of China.,The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550000, People's Republic of China
| | - Xinchen Wang
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation, East China University of Technology, Nanchang, Jiangxi Province 330013, People's Republic of China
| | - Wenxiong Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, People's Republic of China
| | - Yipo Xiao
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation, East China University of Technology, Nanchang, Jiangxi Province 330013, People's Republic of China
| | - Sheng Hu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, People's Republic of China
| | - Jianjun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, People's Republic of China
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89
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Reich JM, Kim JS. Response to Grannis FW. Current Controversies in Cardiothoracic Imaging: Overdiagnosis at Lung Cancer Screening-No So Bad After All-Counterpoint. J Thorac Imaging 2021; 36:W11-W12. [PMID: 32141962 DOI: 10.1097/rti.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jerome M Reich
- Thoracic Oncology Program, Earle A Chiles Research Institute
| | - Jong S Kim
- Department of Mathematics and Statistics, Portland State University, Portland, OR
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90
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Sands J, Tammemägi MC, Couraud S, Baldwin DR, Borondy-Kitts A, Yankelevitz D, Lewis J, Grannis F, Kauczor HU, von Stackelberg O, Sequist L, Pastorino U, McKee B. Lung Screening Benefits and Challenges: A Review of The Data and Outline for Implementation. J Thorac Oncol 2021; 16:37-53. [PMID: 33188913 DOI: 10.1016/j.jtho.2020.10.127] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for almost a fifth of all cancer-related 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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Affiliation(s)
- Jacob Sands
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Sebastien Couraud
- Acute Respiratory Disease and Thoracic Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute; EMR-3738 Therapeutic Targeting in Oncology, Lyon Sud Medical Faculty, Lyon 1 University, Lyon, France
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Andrea Borondy-Kitts
- Lung Cancer and Patient Advocate, Consultant Patient Outreach & Research Specialist, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - David Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Lewis
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Fred Grannis
- City of Hope National Medical Center, Duarte, California
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology and Translational Lung Research Center, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology and Translational Lung Research Center, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Lecia Sequist
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ugo Pastorino
- Thoracic Surgery Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Brady McKee
- Division of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts
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91
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Fu F, Zhou Y, Zhang Y, Chen H. Lung cancer screening strategy for non-high-risk individuals: a narrative review. Transl Lung Cancer Res 2021; 10:452-461. [PMID: 33569326 PMCID: PMC7867778 DOI: 10.21037/tlcr-20-943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the deadliest malignancy worldwide, accounting for almost 20% of all cancer deaths. Clinical trials, such as NLST and NELSON, have proved the survival benefit of lung cancer screening using low-dose computed tomography (LDCT), and most of the lung cancer screening guidelines recommended annual lung cancer screening by LDCT for high-risk individuals. However, a relatively high proportion of lung cancer patients do not have risk factors, and it is questionable whether non-high-risk individuals should receive LDCT screening. In this review, we reviewed risk factors of lung cancer and summarized the benefits and potential harms of LDCT screening. After clarifying the differences between China and western countries in lung cancer screening, we recommended that non-high-risk individuals should receive LDCT screening with an interval of five to ten years. To better balance benefits and harms from LDCT screening, we also proposed a flexible screening strategy using LDCT based on lung cancer risk. Hopefully, it may help reduce unnecessary radiation exposure from CT scans while decreasing mortality of lung cancer.
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Affiliation(s)
- Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaodong Zhou
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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92
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Sullivan FM, Mair FS, Anderson W, Armory P, Briggs A, Chew C, Dorward A, Haughney J, Hogarth F, Kendrick D, Littleford R, McConnachie A, McCowan C, McMeekin N, Patel M, Rauchhaus P, Ritchie L, Robertson C, Robertson J, Robles-Zurita J, Sarvesvaran J, Sewell H, Sproule M, Taylor T, Tello A, Treweek S, Vedhara K, Schembri S. Earlier diagnosis of lung cancer in a randomised trial of an autoantibody blood test followed by imaging. Eur Respir J 2021; 57:2000670. [PMID: 32732334 PMCID: PMC7806972 DOI: 10.1183/13993003.00670-2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022]
Abstract
The EarlyCDT-Lung test is a high-specificity blood-based autoantibody biomarker that could contribute to predicting lung cancer risk. We report on the results of a phase IV biomarker evaluation of whether using the EarlyCDT-Lung test and any subsequent computed tomography (CT) scanning to identify those at high risk of lung cancer reduces the incidence of patients with stage III/IV/unspecified lung cancer at diagnosis compared with the standard clinical practice at the time the study began.The Early Diagnosis of Lung Cancer Scotland (ECLS) trial was a randomised controlled trial of 12 208 participants at risk of developing lung cancer in Scotland in the UK. The intervention arm received the EarlyCDT-Lung test and, if test-positive, low-dose CT scanning 6-monthly for up to 2 years. EarlyCDT-Lung test-negative and control arm participants received standard clinical care. Outcomes were assessed at 2 years post-randomisation using validated data on cancer occurrence, cancer staging, mortality and comorbidities.At 2 years, 127 lung cancers were detected in the study population (1.0%). In the intervention arm, 33 out of 56 (58.9%) lung cancers were diagnosed at stage III/IV compared with 52 out of 71 (73.2%) in the control arm. The hazard ratio for stage III/IV presentation was 0.64 (95% CI 0.41-0.99). There were nonsignificant differences in lung cancer and all-cause mortality after 2 years.ECLS compared EarlyCDT-Lung plus CT screening to standard clinical care (symptomatic presentation) and was not designed to assess the incremental contribution of the EarlyCDT-Lung test. The observation of a stage shift towards earlier-stage lung cancer diagnosis merits further investigations to evaluate whether the EarlyCDT-Lung test adds anything to the emerging standard of low-dose CT.
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Affiliation(s)
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Pauline Armory
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Andrew Briggs
- Dept of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cindy Chew
- Radiology, NHS Lanarkshire, Bothwell, UK
| | - Alistair Dorward
- Respiratory Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - John Haughney
- General Practice, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Fiona Hogarth
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Denise Kendrick
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Roberta Littleford
- Centre for Clinical Research, University of Queensland, Saint Lucia, Australia
| | - Alex McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Manish Patel
- Respiratory Medicine, NHS Lanarkshire, Bothwell, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Lewis Ritchie
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Chris Robertson
- Dept of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - John Robertson
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Herbert Sewell
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Agnes Tello
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kavita Vedhara
- School of Medicine, University of Nottingham, Nottingham, UK
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93
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The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries. NATURE CANCER 2020; 1:1140-1152. [PMID: 35121933 DOI: 10.1038/s43018-020-00142-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/09/2020] [Indexed: 12/12/2022]
Abstract
Lung cancer accounts for an alarming human and economic burden in low- and middle-income countries (LMICs). Recent landmark trials from high-income countries (HICs) by demonstrating that low-dose computed tomography (LDCT) screening effectively reduces lung cancer mortality have engendered enthusiasm for this approach. Here we examine the effectiveness and affordability of LDCT screening from the viewpoint of LMICs. We consider resource-restricted perspectives and discuss implementation challenges and strategies to enhance the feasibility and cost-effectiveness of LDCT screening in LMICs.
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94
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Delorme S, Kaaks R. Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 - Key Elements for Programmatic Implementation of Lung Cancer Screening. ROFO-FORTSCHR RONTG 2020; 193:644-651. [PMID: 33212539 DOI: 10.1055/a-1290-7817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE For screening with low-dose CT (LDCT) to be effective, the benefits must outweigh the potential risks. In large lung cancer screening studies, a mortality reduction of approx. 20 % has been reported, which requires several organizational elements to be achieved in practice. MATERIALS AND METHODS The elements to be set up are an effective invitation strategy, uniform and quality-assured assessment criteria, and computer-assisted evaluation tools resulting in a nodule management algorithm to assign each nodule the needed workup intensity. For patients with confirmed lung cancer, immediate counseling and guideline-compliant treatment in tightly integrated regional expert centers with expert skills are required. First, pulmonology contacts as well as CT facilities should be available in the participant's neighborhood. IT infrastructure, linkage to clinical cancer registries, quality management as well as epidemiologic surveillance are also required. RESULTS An effective organization of screening will result in an articulated structure of both widely distributed pulmonology offices as the participants' primary contacts and CT facilities as well as central expert facilities for supervision of screening activities, individual clarification of suspicious findings, and treatment of proven cancer. CONCLUSION In order to ensure that the benefits of screening more than outweigh the potential harms and that it will be accepted by the public, a tightly organized structure is needed to ensure wide availability of pulmonologists as first contacts and CT facilities with expert skills and high-level equipment concentrated in central facilities. KEY POINTS · For lung cancer screening, elements must function optimally and be tightly organized.. · Lung cancer screening requires a network of expert centers and collaborating facilities.. · IT infrastructure, QM, epidemiological surveillance, and linkage to cancer registries are essential.. CITATION FORMAT · Delorme S, Kaaks R: Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 - Key Elements for Programmatic Implementation of Lung Cancer Screening. Fortschr Röntgenstr 2021; 193: 644 - 651.
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Affiliation(s)
- Stefan Delorme
- Division of Radiology, German Cancer Research Centre, Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Germany
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95
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Kaaks R, Delorme S. Lung Cancer Screening by Low-Dose Computed Tomography - Part 1: Expected Benefits, Possible Harms, and Criteria for Eligibility and Population Targeting. ROFO-FORTSCHR RONTG 2020; 193:527-536. [PMID: 33212540 DOI: 10.1055/a-1290-7926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Trials in the USA and Europe have convincingly demonstrated the efficacy of screening by low-dose computed tomography (LDCT) as a means to lower lung cancer mortality, but also document potential harms related to radiation, psychosocial stress, and invasive examinations triggered by false-positive screening tests and overdiagnosis. To ensure that benefits (lung cancer deaths averted; life years gained) outweigh the risk of harm, lung cancer screening should be targeted exclusively to individuals who have an elevated risk of lung cancer, plus sufficient residual life expectancy. METHODS AND CONCLUSIONS Overall, randomized screening trials show an approximate 20 % reduction in lung cancer mortality by LDCT screening. In view of declining residual life expectancy, especially among continuing long-term smokers, risk of being over-diagnosed is likely to increase rapidly above the age of 75. In contrast, before age 50, the incidence of LC may be generally too low for screening to provide a positive balance of benefits to harms and financial costs. Concise criteria as used in the NLST or NELSON trials may provide a basic guideline for screening eligibility. An alternative would be the use of risk prediction models based on smoking history, sex, and age as a continuous risk factor. Compared to concise criteria, such models have been found to identify a 10 % to 20 % larger number of LC patients for an equivalent number of individuals to be screened, and additionally may help provide security that screening participants will all have a high-enough LC risk to balance out harm potentially caused by radiation or false-positive screening tests. KEY POINTS · LDCT screening can significantly reduce lung cancer mortality. · Screening until the age of 80 was shown to be efficient in terms of cancer deaths averted; in terms of LYG relative to overdiagnosis, stopping at a younger age (e. g. 75) may have greater efficiency. · Risk models may improve the overall net benefit of lung cancer screening. CITATION FORMAT · Kaaks R, Delorme S. Lung Cancer Screening by Low-Dose Computed Tomography - Part 1: Expected Benefits, Possible Harms, and Criteria for Eligibility and Population Targeting. Fortschr Röntgenstr 2021; 193: 527 - 536.
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Affiliation(s)
- Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Germany
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Centre, Heidelberg, Germany
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96
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Lam ACL, Aggarwal R, Huang J, Varadi R, Davis L, Tsao MS, Shepherd FA, Lam S, Kavanagh J, Liu G. Point-of-Care Spirometry Identifies High-Risk Individuals Excluded from Lung Cancer Screening. Am J Respir Crit Care Med 2020; 202:1473-1477. [PMID: 32673057 DOI: 10.1164/rccm.202005-1742le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrew C L Lam
- Princess Margaret Cancer Centre Toronto, Ontario, Canada.,University of Toronto Toronto, Ontario, Canada
| | - Reenika Aggarwal
- Princess Margaret Cancer Centre Toronto, Ontario, Canada.,University of Toronto Toronto, Ontario, Canada
| | - Jingyue Huang
- Princess Margaret Cancer Centre Toronto, Ontario, Canada
| | - Robert Varadi
- University of Toronto Toronto, Ontario, Canada.,West Park Healthcare Centre Toronto, Ontario, Canada
| | - Lori Davis
- West Park Healthcare Centre Toronto, Ontario, Canada
| | - Ming Sound Tsao
- University of Toronto Toronto, Ontario, Canada.,University Health Network Toronto, Ontario, Canada and
| | - Frances A Shepherd
- Princess Margaret Cancer Centre Toronto, Ontario, Canada.,University of Toronto Toronto, Ontario, Canada
| | - Stephen Lam
- British Columbia Cancer Agency Vancouver, British Columbia, Canada
| | - John Kavanagh
- University Health Network Toronto, Ontario, Canada and
| | - Geoffrey Liu
- Princess Margaret Cancer Centre Toronto, Ontario, Canada.,University of Toronto Toronto, Ontario, Canada
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97
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Ebell MH, Bentivegna M, Hulme C. Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis. Ann Fam Med 2020; 18:545-552. [PMID: 33168683 PMCID: PMC7708293 DOI: 10.1370/afm.2582] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Benefit of lung cancer screening using low-dose computed tomography (LDCT) in reducing lung cancer-specific and all-cause mortality is unclear. We undertook a meta-analysis to assess its associations with outcomes. METHODS We searched the literature and previous systematic reviews to identify randomized controlled trials comparing LDCT screening with usual care or chest radiography. We performed meta-analysis using a random effects model. The primary outcomes were lung cancer-specific mortality, all-cause mortality, and the cumulative incidence ratio of lung cancer between screened and unscreened groups as a measure of overdiagnosis. RESULTS Meta-analysis was based on 8 trials with 90,475 patients that had a low risk of bias. There was a significant reduction in lung cancer-specific mortality with LDCT screening (relative risk = 0.81; 95% CI, 0.74-0.89); the estimated absolute risk reduction was 0.4% (number needed to screen = 250). The reduction in all-cause mortality was not statistically significant (relative risk = 0.96; 95% CI, 0.92-1.01), but the absolute reduction was consistent with that for lung cancer-specific mortality (0.34%; number needed to screen = 294). In the studies with the longest duration of follow-up, the incidence of lung cancer was 25% higher in the screened group, corresponding to a 20% rate of overdiagnosis. CONCLUSIONS This meta-analysis showing a significant reduction in lung cancer-specific mortality, albeit with a tradeoff of likely overdiagnosis, supports recommendations to screen individuals at elevated risk for lung cancer with LDCT.
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Affiliation(s)
- Mark H Ebell
- Department of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia
| | - Michelle Bentivegna
- Department of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia
| | - Cassie Hulme
- Department of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia
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98
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Commonly Applied Selection Criteria for Lung Cancer Screening May Have Strongly Varying Diagnostic Performance in Different Countries. Cancers (Basel) 2020; 12:cancers12103012. [PMID: 33081402 PMCID: PMC7602978 DOI: 10.3390/cancers12103012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Smoking causes the majority of lung cancers. Smoking history is thus used to select individuals among whom screening for lung cancer could be the most beneficial. The aim of our study was to estimate sensitivity and specificity of pre-selection by heavy smoking in individual European countries. Due to differences in smoking histories across the countries and sexes within the countries, the sensitivities were found to be between 33 and 80% for men and between 9 and 79% for women. Corresponding specificities of heavy smoking varied between 48 and 90% (men) and 70 and 99% (women). Our results may inform the design of lung cancer screening programs in European countries and serve as benchmarks for novel alternative or complementary tests for selecting people at high risk for computed tomography-based lung cancer screening. Abstract Lung cancer (LC) screening often focuses heavy smokers as a target for screening group. Heavy smoking can thus be regarded as an LC pre-screening test with sensitivities and specificities being different in various populations due to the differences in smoking histories. We derive here expected sensitivities and specificities of various criteria to preselect individuals for LC screening in 27 European countries with diverse smoking prevalences. Sensitivities of various heavy-smoking-based pre-screening criteria were estimated by combining sex-specific proportions of people meeting these criteria in the target population for screening with associations of heavy smoking with LC risk. Expected specificities were approximated by the proportion of individuals not meeting the heavy smoking definition. Estimated sensitivities and specificities varied widely across countries, with sensitivities being generally higher among men (range: 33–80%) than among women (range: 9–79%), and specificities being generally lower among men (range: 48–90%) than among women (range: 70–99%). Major variation in sensitivities and specificities was also seen across different pre-selection criteria for LC screening within individual countries. Our results may inform the design of LC screening programs in European countries and serve as benchmarks for novel alternative or complementary tests for selecting people at high risk for CT-based LC screening.
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99
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Abstract
BACKGROUND Randomized controlled trials have evaluated the efficacy of low-dose CT (LDCT) lung cancer screening on lung cancer (LC) outcomes. OBJECTIVE Meta-analyze LDCT lung cancer screening trials. METHODS We identified studies by searching PubMed, Google Scholar, the Cochrane Registry, ClinicalTrials.gov , and reference lists from retrieved publications. We abstracted data on study design features, stage I LC diagnoses, LC and overall mortality, false positive results, harm from invasive diagnostic procedures, overdiagnosis, and significant incidental findings. We assessed study quality using the Cochrane risk-of-bias tool. We used random-effects models to calculate relative risks and assessed effect modulators with subgroup analyses and meta-regression. RESULTS We identified 9 studies that enrolled 96,559 subjects. The risk of bias across studies was judged to be low. Overall, LDCT screening significantly increased the detection of stage I LC, RR = 2.93 (95% CI, 2.16-3.98), I2 = 19%, and reduced LC mortality, RR = 0.84 (95% CI, 0.75-0.93), I2 = 0%. The number needed to screen to prevent an LC death was 265. Women had a lower risk of LC death (RR = 0.69, 95% CI, 0.40-1.21) than men (RR = 0.86, 95% CI, 0.66-1.13), p value for interaction = 0.11. LDCT screening did not reduce overall mortality, RR = 0.96 (95% CI, 0.91-1.01), I2 = 0%. The pooled false positive rate was 8% (95% CI, 4-18); subjects with false positive results had < 1 in 1000 risk of major complications following invasive diagnostic procedures. The most valid estimates for overdiagnosis and significant incidental findings were 8.9% and 7.5%, respectively. DISCUSSION LDCT screening significantly reduced LC mortality, though not overall mortality, with women appearing to benefit more than men. The estimated risks for false positive results, screening complications, overdiagnosis, and incidental findings were low. Long-term survival data were available only for North American and European studies limiting generalizability.
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100
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Liu WR, Zhang B, Chen C, Li Y, Ye X, Tang DJ, Zhang JC, Ma J, Zhou YL, Fan XJ, Yue DS, Li CG, Zhang H, Ma YC, Huo YS, Zhang ZF, He SY, Wang CL. Detection of circulating genetically abnormal cells in peripheral blood for early diagnosis of non-small cell lung cancer. Thorac Cancer 2020; 11:3234-3242. [PMID: 32989915 PMCID: PMC7606026 DOI: 10.1111/1759-7714.13654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Circulating genetically abnormal cells (CACs) with specific chromosome variations have been confirmed to be present in non-small cell lung cancer (NSCLC). However, the diagnostic performance of CAC detection remains unclear. This study aimed to evaluate the potential clinical application of the CAC test for the early diagnosis of NSCLC. METHODS In this prospective study, a total of 339 participants (261 lung cancer patients and 78 healthy volunteers) were enrolled. An antigen-independent fluorescence in situ hybridization was used to enumerate the number of CACs in peripheral blood. RESULTS Patients with early-stage NSCLC were found to have a significantly higher number of CACs than those of healthy participants (1.34 vs. 0.19; P < 0.001). The CAC test displayed an area under the receiver operating characteristic (ROC) curve of 0.76139 for discriminating stage I NSCLC from healthy participants with 67.2% sensitivity and 80.8% specificity, respectively. Compared with serum tumor markers, the sensitivity of CAC assays for distinguishing early-stage NSCLC was higher (67.2% vs. 48.7%, P < 0.001), especially in NSCLC patients with small nodules (65.4% vs. 36.5%, P = 0.003) and ground-glass nodules (pure GGNs: 66.7% vs. 40.9%, P = 0.003; mixed GGNs: 73.0% vs. 43.2%, P < 0.001). CONCLUSIONS CAC detection in early stage NSCLC was feasible. Our study showed that CACs could be used as a promising noninvasive biomarker for the early diagnosis of NSCLC. KEY POINTS What this study adds: This study aimed to evaluate the potential clinical application of the CAC test for the early diagnosis of NSCLC. Significant findings of the study: CAC detection in early stage NSCLC was feasible. Our study showed that CACs could be used as a promising noninvasive biomarker for the early diagnosis of NSCLC.
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Affiliation(s)
- Wei-Ran Liu
- Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Chen Chen
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yue Li
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xin Ye
- Joint Research Center of Liquid Biopsy in Guangdong, Hong kong, and Macao, Zhuhai, China.,Zhuhai Sanmed Biotech Ltd., Zhuhai, China.,Guangdong Postdoctoral Innovation Practice Bases, School of Biology and Biological Engineering, South China University of Technology, China
| | - Dong-Jiang Tang
- Joint Research Center of Liquid Biopsy in Guangdong, Hong kong, and Macao, Zhuhai, China.,Zhuhai Sanmed Biotech Ltd., Zhuhai, China
| | - Jun-Cheng Zhang
- Joint Research Center of Liquid Biopsy in Guangdong, Hong kong, and Macao, Zhuhai, China.,Zhuhai Sanmed Biotech Ltd., Zhuhai, China
| | - Jing Ma
- Department of Respiratory and Critical Care, Henan University Huaihe Hospital, Kaifeng, China
| | - Yan-Ling Zhou
- Joint Research Center of Liquid Biopsy in Guangdong, Hong kong, and Macao, Zhuhai, China.,Zhuhai Sanmed Biotech Ltd., Zhuhai, China
| | - Xian-Jun Fan
- Joint Research Center of Liquid Biopsy in Guangdong, Hong kong, and Macao, Zhuhai, China.,Zhuhai Sanmed Biotech Ltd., Zhuhai, China
| | - Dong-Sheng Yue
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Chen-Guang Li
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hua Zhang
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yu-Chen Ma
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yan-Song Huo
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhen-Fa Zhang
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Shu-Yu He
- Joint Research Center of Liquid Biopsy in Guangdong, Hong kong, and Macao, Zhuhai, China.,Zhuhai Sanmed Biotech Ltd., Zhuhai, China
| | - Chang-Li Wang
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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