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Ng LY, Howarth TP, Doss AX, Charakidis M, Karanth NV, Mo L, Heraganahally SS. Significance of lung nodules detected on chest CT among adult Aboriginal Australians - a retrospective descriptive study. J Med Radiat Sci 2024. [PMID: 38516966 DOI: 10.1002/jmrs.783] [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: 11/21/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION There are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia. METHODS Patients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules. RESULTS Of the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow-up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow-up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection. CONCLUSIONS Most lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population.
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Affiliation(s)
- Lai Yun Ng
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Timothy P Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Northern Savo, Finland
| | - Arockia X Doss
- Department of Medical Imaging, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Curtin Medical School, Bentley, Western Australia, Australia
| | - Michail Charakidis
- Department of Medical Oncology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Narayan V Karanth
- Department of Medical Oncology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lin Mo
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
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Seung SJ, Moldaver D, Hassan S, Syed I, Shanahan M, Liu G. Real-World Treatment Patterns and Survival Among Patients with Stage I-III, Non-Squamous, Non-Small Cell Lung Cancer Receiving Surgery as Primary Treatment. Oncol Ther 2024:10.1007/s40487-024-00268-5. [PMID: 38485888 DOI: 10.1007/s40487-024-00268-5] [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: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Approximately half of patients with non-small cell lung cancer (NSCLC) present with early-stage disease at diagnosis. Real-world outcomes data are limited for this population but are of interest given recent and impending results from trials evaluating epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and immunotherapies in neoadjuvant, adjuvant, and perioperative settings. METHODS A retrospective, longitudinal, population-level study was conducted in patients diagnosed with resected stage I-III non-squamous NSCLC in Ontario, Canada, between April 2010 and March 2019. Study outcomes included patient characteristics and median overall survival (mOS), with stratification by disease stage and treatment exposure. Patients receiving EGFR-TKIs (assumed EGFR mutation-positive by proxy) were a key population of interest. RESULTS Among 8255 cases, 4881 had stage I, 2124 had stage II, and 1250 had stage III NSCLC at diagnosis. The mean patient age was 68 years; 53.5% were female. In the overall cohort, 19.6% received adjuvant chemotherapy. Receipt of adjuvant chemotherapy was associated with significantly longer mOS than not receiving such therapy: stage II (7.6 [95% confidence interval: 6.5-8.5] vs. 4.4 [4.0-4.9] years) or stage III (4.4 [3.6-5.1] vs. 2.7 [2.3-3.3] years), both p < 0.0001. Patients receiving treatment (EGFR-TKIs and chemotherapy) were assumed to have experienced disease recurrence/relapse; mOS was longer among those receiving an EGFR-TKI than among those receiving chemotherapy (2.3 [1.8-3.0] vs. 1.1 [1.0-1.3] years). CONCLUSION In Ontario, between 2010 and 2019, uptake of adjuvant therapy was low among patients with resected NSCLC, despite such therapy being associated with improved survival. Patients assumed to have recurred/relapsed had markedly reduced mOS, regardless of subsequent therapy, compared with those who did not relapse/recur. Novel peri-adjuvant treatment options are needed to enhance outcomes after lung resection.
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Affiliation(s)
- Soo Jin Seung
- HOPE Research Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Daniel Moldaver
- AstraZeneca Canada Inc., 1004 Middlegate Road, Mississauga, ON, L4Y 1M4, Canada
| | - Shazia Hassan
- HOPE Research Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Iqra Syed
- AstraZeneca Canada Inc., 1004 Middlegate Road, Mississauga, ON, L4Y 1M4, Canada
| | - MaryKate Shanahan
- AstraZeneca Canada Inc., 1004 Middlegate Road, Mississauga, ON, L4Y 1M4, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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Bao T, Liu B, Li R, Li Z, Ji G, Wang Y, Yang H, Li W, Huang W, Huang Y, Tang H. LDCT screening results among eligible and ineligible screening candidates in preventive health check-ups population: a real world study in West China. Sci Rep 2024; 14:4848. [PMID: 38418532 PMCID: PMC10902338 DOI: 10.1038/s41598-024-55475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/23/2024] [Indexed: 03/01/2024] Open
Abstract
To compare the LDCT screening results between eligible and ineligible screening candidates in preventive health check-ups population. Using a real-world LDCT screening results among people who took yearly health check-up in health management center of West China Hospital between 2006 and 2017. Objects were classified according to the China National Lung Cancer Screening Guideline with Low-dose Computed Tomography (2018 version) eligibility criteria. Descriptive analysis were performed between eligible and ineligible screening candidates. The proportion of ineligible screening candidates was 64.13% (10,259), and among them there were 4005 (39.04%) subjects with positive screenings, 80 cases had a surgical lung biopsy. Pathology results from lung biopsy revealed 154 cancers (true-positive) and 26 benign results (false-positive), the surgical false-positive biopsy rate was 4.17%, and ineligible group (7.69%) was higher than eligible group (2.47%), P < 0.05. Further, in ineligible screening candidates, the proportion of current smokers was higher among males compared to females (53.85% vs. 4.88%, P < 0.05). Of the 69 lung cancer patients detected in ineligible screening candidates, lung adenocarcinoma accounts for a high proportion of lung cancers both in male (75.00%) and female (85.00%). The proportion of ineligible screening candidates and the surgical false-positive biopsy rate in ineligible candidates were both high in health check-ups population.
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Affiliation(s)
- Ting Bao
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Translational Informatics Center, Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610212, China
| | - Bingqing Liu
- West China School of Public Health, Department of Epidemiology and Health Statistics, Sichuan University, Chengdu, 610041, China
| | - Ruicen Li
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhenzhen Li
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guiyi Ji
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Youjuan Wang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hanwei Yang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, Sichuan University West China Hospital, Chengdu, 610041, China
| | - Wenxia Huang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yan Huang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Huairong Tang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Khan SM, Pearson DD, Eldridge EL, Morais TA, Ahanonu MIC, Ryan MC, Taron JM, Goodarzi AA. Rural communities experience higher radon exposure versus urban areas, potentially due to drilled groundwater well annuli acting as unintended radon gas migration conduits. Sci Rep 2024; 14:3640. [PMID: 38409201 PMCID: PMC10897331 DOI: 10.1038/s41598-024-53458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/31/2024] [Indexed: 02/28/2024] Open
Abstract
Repetitive, long-term inhalation of radioactive radon gas is one of the leading causes of lung cancer, with exposure differences being a function of geographic location, built environment, personal demographics, activity patterns, and decision-making. Here, we examine radon exposure disparities across the urban-to-rural landscape, based on 42,051 Canadian residential properties in 2034 distinct communities. People living in rural, lower population density communities experience as much as 31.2% greater average residential radon levels relative to urban equivalents, equating to an additional 26.7 Bq/m3 excess in geometric mean indoor air radon, and an additional 1 mSv/year in excess alpha radiation exposure dose rate to the lungs for occupants. Pairwise and multivariate analyses indicate that community-based radon exposure disparities are, in part, explained by increased prevalence of larger floorplan bungalows in rural areas, but that a majority of the effect is attributed to proximity to, but not water use from, drilled groundwater wells. We propose that unintended radon gas migration in the annulus of drilled groundwater wells provides radon migration pathways from the deeper subsurface into near-surface materials. Our findings highlight a previously under-appreciated determinant of radon-induced lung cancer risk, and support a need for targeted radon testing and reduction in rural communities.
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Affiliation(s)
- Selim M Khan
- Department of Biochemistry & Molecular Biology, Robson DNA Science Centre, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dustin D Pearson
- Department of Biochemistry & Molecular Biology, Robson DNA Science Centre, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Evangeline L Eldridge
- Department of Earth, Energy and Environment, Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Tiago A Morais
- Department of Earth, Energy and Environment, Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Marvit I C Ahanonu
- School of Architecture, Planning, and Landscape, University of Calgary, Calgary, AB, Canada
| | - M Cathryn Ryan
- Department of Earth, Energy and Environment, Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Joshua M Taron
- School of Architecture, Planning, and Landscape, University of Calgary, Calgary, AB, Canada.
| | - Aaron A Goodarzi
- Department of Biochemistry & Molecular Biology, Robson DNA Science Centre, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Oncology, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Choi E, Ding VY, Luo SJ, ten Haaf K, Wu JT, Aredo JV, Wilkens LR, Freedman ND, Backhus LM, Leung AN, Meza R, Lui NS, Haiman CA, Park SSL, Le Marchand L, Neal JW, Cheng I, Wakelee HA, Tammemägi MC, Han SS. Risk Model-Based Lung Cancer Screening and Racial and Ethnic Disparities in the US. JAMA Oncol 2023; 9:1640-1648. [PMID: 37883107 PMCID: PMC10603577 DOI: 10.1001/jamaoncol.2023.4447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/11/2023] [Indexed: 10/27/2023]
Abstract
Importance The revised 2021 US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening have been shown to reduce disparities in screening eligibility and performance between African American and White individuals vs the 2013 guidelines. However, potential disparities across other racial and ethnic groups in the US remain unknown. Risk model-based screening may reduce racial and ethnic disparities and improve screening performance, but neither validation of key risk prediction models nor their screening performance has been examined by race and ethnicity. Objective To validate and recalibrate the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012) model-a well-established risk prediction model based on a predominantly White population-across races and ethnicities in the US and evaluate racial and ethnic disparities and screening performance through risk-based screening using PLCOm2012 vs the USPSTF 2021 criteria. Design, Setting, and Participants In a population-based cohort design, the Multiethnic Cohort Study enrolled participants in 1993-1996, followed up through December 31, 2018. Data analysis was conducted from April 1, 2022, to May 19. 2023. A total of 105 261 adults with a smoking history were included. Exposures The 6-year lung cancer risk was calculated through recalibrated PLCOm2012 (ie, PLCOm2012-Update) and screening eligibility based on a 6-year risk threshold greater than or equal to 1.3%, yielding similar eligibility as the USPSTF 2021 guidelines. Outcomes Predictive accuracy, screening eligibility-incidence (E-I) ratio (ie, ratio of the number of eligible to incident cases), and screening performance (sensitivity, specificity, and number needed to screen to detect 1 lung cancer). Results Of 105 261 participants (60 011 [57.0%] men; mean [SD] age, 59.8 [8.7] years), consisting of 19 258 (18.3%) African American, 27 227 (25.9%) Japanese American, 21 383 (20.3%) Latino, 8368 (7.9%) Native Hawaiian/Other Pacific Islander, and 29 025 (27.6%) White individuals, 1464 (1.4%) developed lung cancer within 6 years from enrollment. The PLCOm2012-Update showed good predictive accuracy across races and ethnicities (area under the curve, 0.72-0.82). The USPSTF 2021 criteria yielded a large disparity among African American individuals, whose E-I ratio was 53% lower vs White individuals (E-I ratio: 9.5 vs 20.3; P < .001). Under the risk-based screening (PLCOm2012-Update 6-year risk ≥1.3%), the disparity between African American and White individuals was substantially reduced (E-I ratio: 15.9 vs 18.4; P < .001), with minimal disparities observed in persons of other minoritized groups, including Japanese American, Latino, and Native Hawaiian/Other Pacific Islander. Risk-based screening yielded superior overall and race and ethnicity-specific performance to the USPSTF 2021 criteria, with higher overall sensitivity (67.2% vs 57.7%) and lower number needed to screen (26 vs 30) at similar specificity (76.6%). Conclusions The findings of this cohort study suggest that risk-based lung cancer screening can reduce racial and ethnic disparities and improve screening performance across races and ethnicities vs the USPSTF 2021 criteria.
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Affiliation(s)
- Eunji Choi
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Victoria Y. Ding
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Sophia J. Luo
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Kevin ten Haaf
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Julie T. Wu
- Stanford University School of Medicine, Stanford, California
| | | | - Lynne R. Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Leah M. Backhus
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ann N. Leung
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Natalie S. Lui
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Christopher A. Haiman
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Sung-Shim Lani Park
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Joel W. Neal
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Heather A. Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Martin C. Tammemägi
- Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Summer S. Han
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
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Towle R, Dickman CTD, MacLellan SA, Chen J, Prisman E, Guillaud M, Garnis C. Identification of a serum-based microRNA signature that detects recurrent oral squamous cell carcinoma before it is clinically evident. Br J Cancer 2023; 129:1810-1817. [PMID: 37798371 PMCID: PMC10667517 DOI: 10.1038/s41416-023-02405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Survival rates for oral squamous cell carcinoma (OSCC) have remained poor for decades, a fact largely attributable to late-stage diagnoses and high recurrence rates. We report analysis of serum miRNA expression in samples from patients with high-risk oral lesions (HRL, including OSCC/carcinoma in situ lesions) and healthy non-cancer controls, with the aim of non-invasively detecting primary or recurrent disease before it is clinically evident. METHODS Discovery, test, and validation sets were defined from a total of 468 serum samples (305 HRL and 163 control samples). Samples were analysed using multiple qRT-PCR platforms. RESULTS A two-miRNA classifier comprised of miR-125b-5p and miR-342-3p was defined following discovery and test analyses. Analysis in an independent validation cohort reported sensitivity and specificity of ~74% for this classifier. Significantly, when this classifier was applied to serial serum samples taken from patients both before treatment and during post-treatment surveillance, it identified recurrence an average of 15 months prior to clinical presentation. CONCLUSIONS These results indicate this serum miRNA classifier is effective as a simple, non-invasive monitoring tool for earlier detection of recurrent disease when lesions are typically smaller and amenable to a wider array of treatment options to improve survival.
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Affiliation(s)
- Rebecca Towle
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Christopher T D Dickman
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Sara A MacLellan
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Jiahua Chen
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Eitan Prisman
- Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Martial Guillaud
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Cathie Garnis
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada.
- Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
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Senthil P, Kuhan S, Potter AL, Jeffrey Yang CF. Update on Lung Cancer Screening Guideline. Thorac Surg Clin 2023; 33:323-331. [PMID: 37806735 DOI: 10.1016/j.thorsurg.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Lung cancer screening has been shown to reduce lung cancer mortality and is recommended for individuals meeting age and smoking history criteria. Despite the expansion of lung cancer screening guidelines in 2021, racial/ethnic and sex disparities persist. High-risk racial minorities and women are more likely to be diagnosed with lung cancer at younger ages and have lower smoking histories when compared with White and male counterparts, resulting in higher rates of ineligibility for screening. Risk prediction models, biomarkers, and deep learning may help refine the selection of individuals who would benefit from screening.
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Affiliation(s)
- Priyanka Senthil
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sangkavi Kuhan
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Alexandra L Potter
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Khodayari Moez E, Warkentin MT, Brhane Y, Lam S, Field JK, Liu G, Zulueta JJ, Valencia K, Mesa-Guzman M, Nialet AP, Atkar-Khattra S, Davies MPA, Grant B, Murison K, Montuenga LM, Amos CI, Robbins HA, Johansson M, Hung RJ. Circulating proteome for pulmonary nodule malignancy. J Natl Cancer Inst 2023; 115:1060-1070. [PMID: 37369027 PMCID: PMC10483334 DOI: 10.1093/jnci/djad122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/29/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Although lung cancer screening with low-dose computed tomography is rolling out in many areas of the world, differentiating indeterminate pulmonary nodules remains a major challenge. We conducted one of the first systematic investigations of circulating protein markers to differentiate malignant from benign screen-detected pulmonary nodules. METHODS Based on 4 international low-dose computed tomography screening studies, we assayed 1078 protein markers using prediagnostic blood samples from 1253 participants based on a nested case-control design. Protein markers were measured using proximity extension assays, and data were analyzed using multivariable logistic regression, random forest, and penalized regressions. Protein burden scores (PBSs) for overall nodule malignancy and imminent tumors were estimated. RESULTS We identified 36 potentially informative circulating protein markers differentiating malignant from benign nodules, representing a tightly connected biological network. Ten markers were found to be particularly relevant for imminent lung cancer diagnoses within 1 year. Increases in PBSs for overall nodule malignancy and imminent tumors by 1 standard deviation were associated with odds ratios of 2.29 (95% confidence interval: 1.95 to 2.72) and 2.81 (95% confidence interval: 2.27 to 3.54) for nodule malignancy overall and within 1 year of diagnosis, respectively. Both PBSs for overall nodule malignancy and for imminent tumors were substantially higher for those with malignant nodules than for those with benign nodules, even when limited to Lung Computed Tomography Screening Reporting and Data System (LungRADS) category 4 (P < .001). CONCLUSIONS Circulating protein markers can help differentiate malignant from benign pulmonary nodules. Validation with an independent computed tomographic screening study will be required before clinical implementation.
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Affiliation(s)
- Elham Khodayari Moez
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Matthew T Warkentin
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yonathan Brhane
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Stephen Lam
- Integrative Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - John K Field
- Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Geoffrey Liu
- Computational Biology and Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Javier J Zulueta
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine, New York, NY, USA
| | - Karmele Valencia
- Center of Applied Medical Research (CIMA) and Schools of Sciences and Medicine, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Centro de Investigacion Biomedica en Red de Cancer (CIBERONC), Madrid, Spain
| | - Miguel Mesa-Guzman
- Thoracic Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Andrea Pasquier Nialet
- Center of Applied Medical Research (CIMA) and Schools of Sciences and Medicine, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Centro de Investigacion Biomedica en Red de Cancer (CIBERONC), Madrid, Spain
| | | | - Michael P A Davies
- Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Benjamin Grant
- Computational Biology and Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Kiera Murison
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Luis M Montuenga
- Center of Applied Medical Research (CIMA) and Schools of Sciences and Medicine, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Centro de Investigacion Biomedica en Red de Cancer (CIBERONC), Madrid, Spain
| | - Christopher I Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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9
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Simkin J, Khoo E, Darvishian M, Sam J, Bhatti P, Lam S, Woods RR. Addressing Inequity in Spatial Access to Lung Cancer Screening. Curr Oncol 2023; 30:8078-8091. [PMID: 37754501 PMCID: PMC10529474 DOI: 10.3390/curroncol30090586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The successful implementation of an equitable lung cancer screening program requires consideration of factors that influence accessibility to screening services. METHODS Using lung cancer cases in British Columbia (BC), Canada, as a proxy for a screen-eligible population, spatial access to 36 screening sites was examined using geospatial mapping and vehicle travel time from residential postal code at diagnosis to the nearest site. The impact of urbanization and Statistics Canada's Canadian Index of Multiple Deprivation were examined. RESULTS Median travel time to the nearest screening site was 11.7 min (interquartile range 6.2-23.2 min). Urbanization was significantly associated with shorter drive time (p < 0.001). Ninety-nine percent of patients with ≥60 min drive times lived in rural areas. Drive times were associated with sex, ethnocultural composition, situational vulnerability, economic dependency, and residential instability. For example, the percentage of cases with drive times ≥60 min among the least deprived situational vulnerability group was 4.7% versus 44.4% in the most deprived group. CONCLUSIONS Populations at risk in rural and remote regions may face more challenges accessing screening services due to increased travel times. Drive times increased with increasing sociodemographic and economic deprivations highlighting groups that may require support to ensure equitable access to lung cancer screening.
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Affiliation(s)
- Jonathan Simkin
- BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 4C2, Canada
| | - Edwin Khoo
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Maryam Darvishian
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Janette Sam
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1G1, Canada; (P.B.); (R.R.W.)
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen Lam
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Ryan R. Woods
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1G1, Canada; (P.B.); (R.R.W.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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10
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Parker K, Colhoun S, Bartholomew K, Sandiford P, Lewis C, Milne D, McKeage M, McKree Jansen R, Fong KM, Marshall H, Tammemägi M, Rankin NM, Hotu S, Young R, Hopkins R, Walker N, Brown R, Crengle S. Invitation methods for Indigenous New Zealand Māori in lung cancer screening: Protocol for a pragmatic cluster randomized controlled trial. PLoS One 2023; 18:e0281420. [PMID: 37527237 PMCID: PMC10393155 DOI: 10.1371/journal.pone.0281420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/22/2023] [Indexed: 08/03/2023] Open
Abstract
Lung cancer screening can significantly reduce mortality from lung cancer. Further evidence about how to optimize lung cancer screening for specific populations, including Aotearoa New Zealand (NZ)'s Indigenous Māori (who experience disproportionately higher rates of lung cancer), is needed to ensure it is equitable. This community-based, pragmatic cluster randomized trial aims to determine whether a lung cancer screening invitation from a patient's primary care physician, compared to from a centralized screening service, will optimize screening uptake for Māori. Participating primary care practices (clinics) in Auckland, Aotearoa NZ will be randomized to either the primary care-led or centralized service for delivery of the screening invitation. Clinic patients who meet the following criteria will be eligible: Māori; aged 55-74 years; enrolled in participating clinics in the region; ever-smokers; and have at least a 2% risk of developing lung cancer within six years (determined using the PLCOM2012 risk prediction model). Eligible patients who respond positively to the invitation will undertake shared decision-making with a nurse about undergoing a low dose CT scan (LDCT) and an assessment for Chronic Obstructive Pulmonary Disease (COPD). The primary outcomes are: 1) the proportion of eligible population who complete a risk assessment and 2) the proportion of people eligible for a CT scan who complete the CT scan. Secondary outcomes include evaluating the contextual factors needed to inform the screening process, such as including assessment for Chronic Obstructive Pulmonary Disease (COPD). We will also use the RE-AIM framework to evaluate specific implementation factors. This study is a world-first, Indigenous-led lung cancer screening trial for Māori participants. The study will provide policy-relevant information on a key policy parameter, invitation method. In addition, the trial includes a nested analysis of COPD in the screened Indigenous population, and it provides baseline (T0 screen round) data using RE-AIM implementation outcomes.
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Affiliation(s)
- Kate Parker
- Planning Funding and Outcomes, Waitematā District, Te Whatu Ora and Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand
| | - Sarah Colhoun
- Ngāi Tahu Māori Health Research Unit, School of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Karen Bartholomew
- Planning Funding and Outcomes, Waitematā District, Te Whatu Ora and Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand
| | | | - Chris Lewis
- Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand
| | - David Milne
- Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand
| | | | - Rawiri McKree Jansen
- Te Aka Whai Ora, Manukau, New Zealand
- National Hauora Coalition, Auckland, New Zealand
| | - Kwun M Fong
- Department of Thoracic Medicine, Prince Charles Hospital, Brisbane, Queensland, Australia
- University of Queensland Thoracic Research Centre, Brisbane, Queensland, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, Prince Charles Hospital, Brisbane, Queensland, Australia
- University of Queensland Thoracic Research Centre, Brisbane, Queensland, Australia
| | | | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Sydney School of Public Health, University of Sydney, Camperdown, Australia
| | - Sandra Hotu
- University of Auckland, Auckland, New Zealand
| | | | | | | | - Rachel Brown
- National Hauora Coalition, Auckland, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, School of Health Sciences, University of Otago, Dunedin, New Zealand
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11
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Ma Z, Lv J, Zhu M, Yu C, Ma H, Jin G, Guo Y, Bian Z, Yang L, Chen Y, Chen Z, Hu Z, Li L, Shen H. Lung cancer risk score for ever and never smokers in China. Cancer Commun (Lond) 2023; 43:877-895. [PMID: 37410540 PMCID: PMC10397566 DOI: 10.1002/cac2.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Most lung cancer risk prediction models were developed in European and North-American cohorts of smokers aged ≥ 55 years, while less is known about risk profiles in Asia, especially for never smokers or individuals aged < 50 years. Hence, we aimed to develop and validate a lung cancer risk estimate tool for ever and never smokers across a wide age range. METHODS Based on the China Kadoorie Biobank cohort, we first systematically selected the predictors and explored the nonlinear association of predictors with lung cancer risk using restricted cubic splines. Then, we separately developed risk prediction models to construct a lung cancer risk score (LCRS) in 159,715 ever smokers and 336,526 never smokers. The LCRS was further validated in an independent cohort over a median follow-up of 13.6 years, consisting of 14,153 never smokers and 5,890 ever smokers. RESULTS A total of 13 and 9 routinely available predictors were identified for ever and never smokers, respectively. Of these predictors, cigarettes per day and quit years showed nonlinear associations with lung cancer risk (Pnon-linear < 0.001). The curve of lung cancer incidence increased rapidly above 20 cigarettes per day and then was relatively flat until approximately 30 cigarettes per day. We also observed that lung cancer risk declined sharply within the first 5 years of quitting, and then continued to decrease but at a slower rate in the subsequent years. The 6-year area under the receiver operating curve for the ever and never smokers' models were respectively 0.778 and 0.733 in the derivation cohort, and 0.774 and 0.759 in the validation cohort. In the validation cohort, the 10-year cumulative incidence of lung cancer was 0.39% and 2.57% for ever smokers with low (< 166.2) and intermediate-high LCRS (≥ 166.2), respectively. Never smokers with a high LCRS (≥ 21.2) had a higher 10-year cumulative incidence rate than those with a low LCRS (< 21.2; 1.05% vs. 0.22%). An online risk evaluation tool (LCKEY; http://ccra.njmu.edu.cn/lckey/web) was developed to facilitate the use of LCRS. CONCLUSIONS The LCRS can be an effective risk assessment tool designed for ever and never smokers aged 30 to 80 years.
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Affiliation(s)
- Zhimin Ma
- Department of EpidemiologyCenter for Global HealthSchool of Public HealthNanjing Medical UniversityNanjingJiangsuP. R. China
- Jiangsu Key Lab of Cancer BiomarkersPrevention and TreatmentCollaborative Innovation Center for Cancer Personalized MedicineNanjing Medical UniversityNanjingJiangsuP. R. China
- Department of EpidemiologySchool of Public HealthSoutheast UniversityNanjingJiangsuP. R. China
| | - Jun Lv
- Department of Epidemiology & BiostatisticsSchool of Public HealthPeking UniversityBeijingP. R. China
- Ministry of EducationKey Laboratory of Molecular Cardiovascular Sciences (Peking University)BeijingP. R. China
| | - Meng Zhu
- Department of EpidemiologyCenter for Global HealthSchool of Public HealthNanjing Medical UniversityNanjingJiangsuP. R. China
- Jiangsu Key Lab of Cancer BiomarkersPrevention and TreatmentCollaborative Innovation Center for Cancer Personalized MedicineNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Canqing Yu
- Department of Epidemiology & BiostatisticsSchool of Public HealthPeking UniversityBeijingP. R. China
| | - Hongxia Ma
- Department of EpidemiologyCenter for Global HealthSchool of Public HealthNanjing Medical UniversityNanjingJiangsuP. R. China
- Jiangsu Key Lab of Cancer BiomarkersPrevention and TreatmentCollaborative Innovation Center for Cancer Personalized MedicineNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Guangfu Jin
- Department of EpidemiologyCenter for Global HealthSchool of Public HealthNanjing Medical UniversityNanjingJiangsuP. R. China
- Jiangsu Key Lab of Cancer BiomarkersPrevention and TreatmentCollaborative Innovation Center for Cancer Personalized MedicineNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Yu Guo
- Chinese Academy of Medical SciencesBeijingP. R. China
| | - Zheng Bian
- Chinese Academy of Medical SciencesBeijingP. R. China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordOxfordshireUK
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordOxfordshireUK
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordOxfordshireUK
| | - Zhibin Hu
- Department of EpidemiologyCenter for Global HealthSchool of Public HealthNanjing Medical UniversityNanjingJiangsuP. R. China
- Jiangsu Key Lab of Cancer BiomarkersPrevention and TreatmentCollaborative Innovation Center for Cancer Personalized MedicineNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Liming Li
- Department of Epidemiology & BiostatisticsSchool of Public HealthPeking UniversityBeijingP. R. China
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordOxfordshireUK
| | - Hongbing Shen
- Department of EpidemiologyCenter for Global HealthSchool of Public HealthNanjing Medical UniversityNanjingJiangsuP. R. China
- Jiangsu Key Lab of Cancer BiomarkersPrevention and TreatmentCollaborative Innovation Center for Cancer Personalized MedicineNanjing Medical UniversityNanjingJiangsuP. R. China
- Research Units of Cohort Study on Cardiovascular Diseases and CancersChinese Academy of Medical SciencesBeijingP. R. China
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12
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O'Dowd EL, Lee RW, Akram AR, Bartlett EC, Bradley SH, Brain K, Callister MEJ, Chen Y, Devaraj A, Eccles SR, Field JK, Fox J, Grundy S, Janes SM, Ledson M, MacKean M, Mackie A, McManus KG, Murray RL, Nair A, Quaife SL, Rintoul R, Stevenson A, Summers Y, Wilkinson LS, Booton R, Baldwin DR, Crosbie P. Defining the road map to a UK national lung cancer screening programme. Lancet Oncol 2023; 24:e207-e218. [PMID: 37142382 DOI: 10.1016/s1470-2045(23)00104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 05/06/2023]
Abstract
Lung cancer screening with low-dose CT was recommended by the UK National Screening Committee (UKNSC) in September, 2022, on the basis of data from trials showing a reduction in lung cancer mortality. These trials provide sufficient evidence to show clinical efficacy, but further work is needed to prove deliverability in preparation for a national roll-out of the first major targeted screening programme. The UK has been world leading in addressing logistical issues with lung cancer screening through clinical trials, implementation pilots, and the National Health Service (NHS) England Targeted Lung Health Check Programme. In this Policy Review, we describe the consensus reached by a multiprofessional group of experts in lung cancer screening on the key requirements and priorities for effective implementation of a programme. We summarise the output from a round-table meeting of clinicians, behavioural scientists, stakeholder organisations, and representatives from NHS England, the UKNSC, and the four UK nations. This Policy Review will be an important tool in the ongoing expansion and evolution of an already successful programme, and provides a summary of UK expert opinion for consideration by those organising and delivering lung cancer screenings in other countries.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard W Lee
- Early Diagnosis and Detection Centre, National Institute for Health and Care Research Biomedical Research Centre at the Royal Marsden and Institute of Cancer Research, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Emily C Bartlett
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Yan Chen
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anand Devaraj
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sinan R Eccles
- Royal Glamorgan Hospital, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jesme Fox
- Roy Castle Lung Cancer Foundation, Liverpool, UK
| | - Seamus Grundy
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sam M Janes
- Lungs for Living Research Centre, Department of Respiratory Medicine, University College London, London, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Kieran G McManus
- Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Samantha L Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Rintoul
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Anne Stevenson
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Yvonne Summers
- The Christie Hospital NHS Trust, Manchester University NHS Foundation Trust, Manchester, UK
| | - Louise S Wilkinson
- Oxford Breast Imaging Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Philip Crosbie
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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13
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Almatrafi A, Thomas O, Callister M, Gabe R, Beeken RJ, Neal R. The prevalence of comorbidity in the lung cancer screening population: A systematic review and meta-analysis. J Med Screen 2023; 30:3-13. [PMID: 35942779 PMCID: PMC9925896 DOI: 10.1177/09691413221117685] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Comorbidity is associated with adverse outcomes for all lung cancer patients, but its burden is less understood in the context of screening. This review synthesises the prevalence of comorbidities among lung cancer screening (LCS) candidates and summarises the clinical recommendations for screening comorbid individuals. METHODS We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases from January 1990 to February 2021. We included LCS studies that reported a prevalence of comorbidity, as a prevalence of a particular condition, or as a summary score. We also summarised LCS clinical guidelines that addressed comorbidity or frailty for LCS as a secondary objective for this review. Meta-analysis was used with inverse-variance weights obtained from a random-effects model to estimate the prevalence of selected comorbidities. RESULTS We included 69 studies in the review; seven reported comorbidity summary scores, two reported performance status, 48 reported individual comorbidities, and 12 were clinical guideline papers. The meta-analysis of individual comorbidities resulted in an estimated prevalence of 35.2% for hypertension, 23.5% for history of chronic obstructive pulmonary disease (COPD) (10.7% for severe COPD), 16.6% for ischaemic heart disease (IHD), 13.1% for peripheral vascular disease (PVD), 12.9% for asthma, 12.5% for diabetes, 4.5% for bronchiectasis, 2.2% for stroke, and 0.5% for pulmonary fibrosis. CONCLUSIONS Comorbidities were highly prevalent in LCS populations and likely to be more prevalent than in other cancer screening programmes. Further research on the burden of comorbid disease and its impact on screening uptake and outcomes is needed. Identifying individuals with frailty and comorbidities who might not benefit from screening should become a priority in LCS research.
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Affiliation(s)
- Anas Almatrafi
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,Department of Epidemiology, Umm Al-Qura University, Makkah, Saudi Arabia,Anas Almatrafi, Leeds Institute of Health
Sciences, University of Leeds, Leeds LS2 9NL, UK.
| | - Owen Thomas
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK
| | - Matthew Callister
- Department of Respiratory Medicine, Leeds
Teaching Hospitals, St James's University Hospital, Leeds, UK
| | - Rhian Gabe
- Center for Evaluation and Methods, Wolfson Institute of Population
Health, Queen Mary University of
London, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,Department of Behavioural Science and
Health, University College London, London, UK
| | - Richard Neal
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,College of Medicine and Health, University of Exeter, Exeter, UK
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14
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Voigt W, Prosch H, Silva M. Clinical Scores, Biomarkers and IT Tools in Lung Cancer Screening-Can an Integrated Approach Overcome Current Challenges? Cancers (Basel) 2023; 15:cancers15041218. [PMID: 36831559 PMCID: PMC9954060 DOI: 10.3390/cancers15041218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
As most lung cancer (LC) cases are still detected at advanced and incurable stages, there are increasing efforts to foster detection at earlier stages by low dose computed tomography (LDCT) based LC screening. In this scoping review, we describe current advances in candidate selection for screening (selection phase), technical aspects (screening), and probability evaluation of malignancy of CT-detected pulmonary nodules (PN management). Literature was non-systematically assessed and reviewed for suitability by the authors. For the selection phase, we describe current eligibility criteria for screening, along with their limitations and potential refinements through advanced clinical scores and biomarker assessments. For LC screening, we discuss how the accuracy of computerized tomography (CT) scan reading might be augmented by IT tools, helping radiologists to cope with increasing workloads. For PN management, we evaluate the precision of follow-up scans by semi-automatic volume measurements of CT-detected PN. Moreover, we present an integrative approach to evaluate the probability of PN malignancy to enable safe decisions on further management. As a clear limitation, additional validation studies are required for most innovative diagnostic approaches presented in this article, but the integration of clinical risk models, current imaging techniques, and advancing biomarker research has the potential to improve the LC screening performance generally.
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Affiliation(s)
- Wieland Voigt
- Medical Innovation and Management, Steinbeis University Berlin, Ernst-Augustin-Strasse 15, 12489 Berlin, Germany
- Correspondence:
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, General Hospital, 1090 Vienna, Austria
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, 43121 Parma, Italy
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15
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Adams SJ, Stone E, Baldwin DR, Vliegenthart R, Lee P, Fintelmann FJ. Lung cancer screening. Lancet 2023; 401:390-408. [PMID: 36563698 DOI: 10.1016/s0140-6736(22)01694-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022]
Abstract
Randomised controlled trials, including the National Lung Screening Trial (NLST) and the NELSON trial, have shown reduced mortality with lung cancer screening with low-dose CT compared with chest radiography or no screening. Although research has provided clarity on key issues of lung cancer screening, uncertainty remains about aspects that might be critical to optimise clinical effectiveness and cost-effectiveness. This Review brings together current evidence on lung cancer screening, including an overview of clinical trials, considerations regarding the identification of individuals who benefit from lung cancer screening, management of screen-detected findings, smoking cessation interventions, cost-effectiveness, the role of artificial intelligence and biomarkers, and current challenges, solutions, and opportunities surrounding the implementation of lung cancer screening programmes from an international perspective. Further research into risk models for patient selection, personalised screening intervals, novel biomarkers, integrated cardiovascular disease and chronic obstructive pulmonary disease assessments, smoking cessation interventions, and artificial intelligence for lung nodule detection and risk stratification are key opportunities to increase the efficiency of lung cancer screening and ensure equity of access.
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Affiliation(s)
- Scott J Adams
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily Stone
- Faculty of Medicine, University of New South Wales and Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital and National University of Singapore, Singapore
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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16
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Cressman S, Weber MF, Ngo PJ, Wade S, Behar Harpaz S, Caruana M, Tremblay A, Manser R, Stone E, Atkar-Khattra S, Karikios D, Ho C, Fernandes A, Yi Weng J, McWilliams A, Myers R, Mayo J, Yee J, Yuan R, Marshall HM, Fong KM, Lam S, Canfell K, Tammemägi MC. Economic impact of using risk models for eligibility selection to the International lung screening Trial. Lung Cancer 2023; 176:38-45. [PMID: 36592498 DOI: 10.1016/j.lungcan.2022.12.011] [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: 09/05/2022] [Revised: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Using risk models as eligibility criteria for lung screening can reduce race and sex-based disparities. We used data from the International Lung Screening Trial(ILST; NCT02871856) to compare the economic impact of using the PLCOm2012 risk model or the US Preventative Services' categorical age-smoking history-based criteria (USPSTF-2013). MATERIALS AND METHODS The cost-effectiveness of using PLCOm2012 versus USPSTF-2013 was evaluated with a decision analytic model based on the ILST and other screening trials. The primary outcomes were costs in 2020 International Dollars ($), quality-adjusted life-years (QALY) and incremental net benefit (INB, in $ per QALY). Secondary outcomes were selection characteristics and cancer detection rates (CDR). RESULTS Compared with the USPSTF-2013 criteria, the PLCOm2012 risk model resulted in $355 of cost savings per 0.2 QALYs gained (INB=$4294 at a willingness-to-pay threshold of $20 000/QALY (95 %CI: $4205-$4383). Using the risk model was more cost-effective in females at both a 1.5 % and 1.7 % 6-year risk threshold (INB=$6616 and $6112, respectively), compared with males ($5221 and $695). The PLCOm2012 model selected more females, more individuals with fewer years of formal education, and more people with other respiratory illnesses in the ILST. The CDR with the risk model was higher in females compared with the USPSTF-2013 criteria (Risk Ratio = 7.67, 95 % CI: 1.87-31.38). CONCLUSION The PLCOm2012 model saved costs, increased QALYs and mitigated socioeconomic and sex-based disparities in access to screening.
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Affiliation(s)
- Sonya Cressman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - Marianne F Weber
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney 2011, Australia
| | - Preston J Ngo
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney 2011, Australia
| | - Stephen Wade
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney 2011, Australia
| | - Silvia Behar Harpaz
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney 2011, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney 2011, Australia
| | - Alain Tremblay
- Division of Respiratory Medicine and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Renee Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parksville, Victoria, 3050, Australia; Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; University of Melbourne, Department of. Medicine, Royal Melbourne Hospital, Parksville, Victoria, 3010, Australia
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent Hospital, Sydney, Australia; School of Clinical Medicine; School of Public Health, University of Sydney, Australia
| | | | - Deme Karikios
- Nepean Clinical School, The University of Sydney, NSW 2747, Australia
| | - Cheryl Ho
- BC Cancer, Vancouver, British Columbia, Australia; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Aleisha Fernandes
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jing Yi Weng
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Renelle Myers
- BC Cancer Research Institute, Vancouver, BC, Canada; BC Cancer, Vancouver, British Columbia, Australia; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - John Mayo
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - John Yee
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Ren Yuan
- BC Cancer, Vancouver, British Columbia, Australia; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Henry M Marshall
- The Prince Charles Hospital and University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
| | - Kwun M Fong
- The Prince Charles Hospital and University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
| | - Stephen Lam
- BC Cancer Research Institute, Vancouver, BC, Canada; BC Cancer, Vancouver, British Columbia, Australia; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney 2011, Australia
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17
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Dickson JL, Hall H, Horst C, Tisi S, Verghese P, Mullin AM, Teague J, Farrelly L, Bowyer V, Gyertson K, Bojang F, Levermore C, Anastasiadis T, McCabe J, Navani N, Nair A, Devaraj A, Hackshaw A, Quaife SL, Janes SM. Uptake of invitations to a lung health check offering low-dose CT lung cancer screening among an ethnically and socioeconomically diverse population at risk of lung cancer in the UK (SUMMIT): a prospective, longitudinal cohort study. Lancet Public Health 2023; 8:e130-e140. [PMID: 36709053 PMCID: PMC7615156 DOI: 10.1016/s2468-2667(22)00258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Lung cancer screening with low-dose CT reduces lung cancer mortality, but screening requires equitable uptake from candidates at high risk of lung cancer across ethnic and socioeconomic groups that are under-represented in clinical studies. We aimed to assess the uptake of invitations to a lung health check offering low-dose CT lung cancer screening in an ethnically and socioeconomically diverse cohort at high risk of lung cancer. METHODS In this multicentre, prospective, longitudinal cohort study (SUMMIT), individuals aged 55-77 years with a history of smoking in the past 20 years were identified via National Health Service England primary care records at practices in northeast and north-central London, UK, using electronic searches. Eligible individuals were invited by letter to a lung health check offering lung cancer screening at one of four hospital sites, with non-responders re-invited after 4 months. Individuals were excluded if they had dementia or metastatic cancer, were receiving palliative care or were housebound, or declined research participation. The proportion of individuals invited who responded to the lung health check invitation by telephone was used to measure uptake. We used univariable and multivariable logistic regression analyses to estimate associations between uptake of a lung health check invitation and re-invitation of non-responders, adjusted for sex, age, ethnicity, smoking, and deprivation score. This study was registered prospectively with ClinicalTrials.gov, NCT03934866. FINDINGS Between March 20 and Dec 12, 2019, the records of 2 333 488 individuals from 251 primary care practices across northeast and north-central London were screened for eligibility; 1 974 919 (84·6%) individuals were outside the eligible age range, 7578 (2·1%) had pre-existing medical conditions, and 11 962 (3·3%) had opted out of particpation in research and thus were not invited. 95 297 individuals were eligible for invitation, of whom 29 545 (31·0%) responded. Due to the COVID-19 pandemic, re-invitation letters were sent to only a subsample of 4594 non-responders, of whom 642 (14·0%) responded. Overall, uptake was lower among men than among women (odds ratio [OR] 0·91 [95% CI 0·88-0·94]; p<0·0001), and higher among older age groups (1·48 [1·42-1·54] among those aged 65-69 years vs those aged 55-59 years; p<0·0001), groups with less deprivation (1·89 [1·76-2·04] for the most vs the least deprived areas; p<0·0001), individuals of Asian ethnicity (1·14 [1·09-1·20] vs White ethnicity; p<0·0001), and individuals who were former smokers (1·89 [1·83-1·95] vs current smokers; p<0·0001). When ethnicity was subdivided into 16 groups, uptake was lower among individuals of other White ethnicity than among those with White British ethnicity (0·86 [0·83-0·90]), whereas uptake was higher among Chinese, Indian, and other Asian ethnicities than among those with White British ethnicity (1·33 [1·13-1·56] for Chinese ethnicity; 1·29 [1·19-1·40] for Indian ethnicity; and 1·19 [1·08-1·31] for other Asian ethnicity). INTERPRETATION Inviting eligible adults for lung health checks in areas of socioeconomic and ethnic diversity should achieve favourable participation in lung cancer screening overall, but inequalities by smoking, deprivation, and ethnicity persist. Reminder and re-invitation strategies should be used to increase uptake and the equity of response. FUNDING GRAIL.
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Affiliation(s)
- Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Anne-Marie Mullin
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jon Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Fanta Bojang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - John McCabe
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.
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18
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Wang P, Chapron J, Bennani S, Revel MP, Wislez M. [Lung cancer screening: Update, news and perspectives]. Bull Cancer 2023; 110:42-54. [PMID: 36496261 DOI: 10.1016/j.bulcan.2022.11.006] [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: 10/11/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
Lung cancer is the leading cause of cancer death in France and worldwide (20 % of cancer deaths). This mortality is partly linked to an overrepresentation of metastatic stages at diagnosis (approximately 55 % of lung cancers at diagnosis). Low-dose chest CT in a target population to detect early forms accessible to radical treatment has been evaluated through multiple randomized trials (NLST, NELSON, MILD, DANTE…). These trials demonstrated a reduction in lung cancer specific mortality. The current problem is to integrate a CT screening policy CT at a national level, which should be both efficient and cost-effective, while presenting the least harms for the eligible population. Finally, it is necessary to optimize the participation of the eligible population and particularly in the most deprived areas and ensure the proper implementation of smoking cessation measures.
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Affiliation(s)
- Pascal Wang
- AP-HP, hôpital Cochin, université Paris Cité, unité d'oncologie thoracique, service de pneumologie, 75014 Paris, France
| | - Jeanne Chapron
- AP-HP, hôpital Cochin, université Paris Cité, unité d'oncologie thoracique, service de pneumologie, 75014 Paris, France
| | - Souhail Bennani
- AP-HP, hôpital Cochin, Université Paris Cité, service de radiologie, 75014 Paris, France
| | - Marie-Pierre Revel
- AP-HP, hôpital Cochin, Université Paris Cité, service de radiologie, 75014 Paris, France
| | - Marie Wislez
- AP-HP, hôpital Cochin, université Paris Cité, unité d'oncologie thoracique, service de pneumologie, 75014 Paris, France; Université de Paris, centre de recherche des cordeliers, sorbonne université, Inserm, Team Inflammation, Complement, and Cancer, 75006 Paris, France.
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19
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Behar Harpaz S, Weber MF, Wade S, Ngo PJ, Vaneckova P, Sarich PEA, Cressman S, Tammemagi MC, Fong K, Marshall H, McWilliams A, Zalcberg JR, Caruana M, Canfell K. Updated cost-effectiveness analysis of lung cancer screening for Australia, capturing differences in the health economic impact of NELSON and NLST outcomes. Br J Cancer 2023; 128:91-101. [PMID: 36323879 DOI: 10.1038/s41416-022-02026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/24/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A national, lung cancer screening programme is under consideration in Australia, and we assessed cost-effectiveness using updated data and assumptions. METHODS We estimated the cost-effectiveness of lung screening by applying screening parameters and outcomes from either the National Lung Screening Trial (NLST) or the NEderlands-Leuvens Longkanker Screenings ONderzoek (NELSON) to Australian data on lung cancer risk, mortality, health-system costs, and smoking trends using a deterministic, multi-cohort model. Incremental cost-effectiveness ratios (ICERs) were calculated for a lifetime horizon. RESULTS The ICER for lung screening compared to usual care in the NELSON-based scenario was AU$39,250 (95% CI $18,150-108,300) per quality-adjusted life year (QALY); lower than the NLST-based estimate (ICER = $76,300, 95% CI $41,750-236,500). In probabilistic sensitivity analyses, lung screening was cost-effective in 15%/60% of NELSON-like simulations, assuming a willingness-to-pay threshold of $30,000/$50,000 per QALY, respectively, compared to 0.5%/6.7% for the NLST. ICERs were most sensitive to assumptions regarding the screening-related lung cancer mortality benefit and duration of benefit over time. The cost of screening had a larger impact on ICERs than the cost of treatment, even after quadrupling the 2006-2016 healthcare costs of stage IV lung cancer. DISCUSSION Lung screening could be cost-effective in Australia, contingent on translating trial-like lung cancer mortality benefits to the clinic.
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Affiliation(s)
- Silvia Behar Harpaz
- The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia.
| | - Marianne F Weber
- The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Stephen Wade
- The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Preston J Ngo
- The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Pavla Vaneckova
- The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Peter E A Sarich
- The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Sonya Cressman
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Martin C Tammemagi
- Department of Health Sciences, Brock University, St Catharines, ON, Canada
| | - Kwun Fong
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia.,University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Chermside, QLD, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia.,University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Chermside, QLD, Australia
| | | | - John R Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Caruana
- The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia
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20
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Chien LH, Chen TY, Chen CH, Chen KY, Hsiao CF, Chang GC, Tsai YH, Su WC, Huang MS, Chen YM, Chen CY, Liang SK, Chen CY, Wang CL, Hung HH, Jiang HF, Hu JW, Rothman N, Lan Q, Liu TW, Chen CJ, Yang PC, Chang IS, Hsiung CA. Recalibrating Risk Prediction Models by Synthesizing Data Sources: Adapting the Lung Cancer PLCO Model for Taiwan. Cancer Epidemiol Biomarkers Prev 2022; 31:2208-2218. [PMID: 36129788 PMCID: PMC9720426 DOI: 10.1158/1055-9965.epi-22-0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/20/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Methods synthesizing multiple data sources without prospective datasets have been proposed for absolute risk model development. This study proposed methods for adapting risk models for another population without prospective cohorts, which would help alleviate the health disparities caused by advances in absolute risk models. To exemplify, we adapted the lung cancer risk model PLCOM2012, well studied in the west, for Taiwan. METHODS Using Taiwanese multiple data sources, we formed an age-matched case-control study of ever-smokers (AMCCSE), estimated the number of ever-smoking lung cancer patients in 2011-2016 (NESLP2011), and synthesized a dataset resembling the population of cancer-free ever-smokers in 2010 regarding the PLCOM2012 risk factors (SPES2010). The AMCCSE was used to estimate the overall calibration slope, and the requirement that NESLP2011 equals the estimated total risk of individuals in SPES2010 was used to handle the calibration-in-the-large problem. RESULTS The adapted model PLCOT-1 (PLCOT-2) had an AUC of 0.78 (0.75). They had high performance in calibration and clinical usefulness on subgroups of SPES2010 defined by age and smoking experience. Selecting the same number of individuals for low-dose computed tomography screening using PLCOT-1 (PLCOT-2) would have identified approximately 6% (8%) more lung cancers than the US Preventive Services Task Forces 2021 criteria. Smokers having 40+ pack-years had an average PLCOT-1 (PLCOT-2) risk of 3.8% (2.6%). CONCLUSIONS The adapted PLCOT models had high predictive performance. IMPACT The PLCOT models could be used to design lung cancer screening programs in Taiwan. The methods could be applicable to other cancer models.
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Affiliation(s)
- Li-Hsin Chien
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Tzu-Yu Chen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chung-Hsing Chen
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Kuan-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Fu Hsiao
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.,Taiwan Lung Cancer Tissue/Specimen Information Resource Center, National Health Research Institutes, Zhunan, Taiwan
| | - Gee-Chen Chang
- School of Medicine and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan.,Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ying-Huang Tsai
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan.,Department of Pulmonary and Critical Care, Xiamen Chang Gung Hospital, Xiamen, China
| | - Wu-Chou Su
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Shyan Huang
- Department of Internal Medicine, E-Da Cancer Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yuh-Min Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yi Chen
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sheng-Kai Liang
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.,Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chung-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Chih-Liang Wang
- Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Han Hung
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Hsin-Fang Jiang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Jia-Wei Hu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Pan-Chyr Yang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Shou Chang
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan.,Corresponding Authors: Chao A. Hsiung, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan. Phone: 372-06166, ext. 36120; Fax: 375-86467; E-mail: ; and I-Shou Chang, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan. Phone: 372-06166, ext. 36130; E-mail:
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.,Corresponding Authors: Chao A. Hsiung, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan. Phone: 372-06166, ext. 36120; Fax: 375-86467; E-mail: ; and I-Shou Chang, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan. Phone: 372-06166, ext. 36130; E-mail:
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21
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Grolleau E, de Bermont J, Devun F, Pérol D, Lacoste V, Delastre L, Fleurisson F, Devouassoux G, Mornex JF, Cotton F, Darrason M, Tammemagi M, Couraud S. Eligibility to lung cancer screening among staffs of a university hospital: A large cross-sectional survey. Respir Med Res 2022; 83:100970. [PMID: 36724677 DOI: 10.1016/j.resmer.2022.100970] [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: 06/21/2022] [Revised: 09/26/2022] [Accepted: 10/24/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Implementation of Lung cancer screening (LCS) programs is challenging. The ILYAD study objectives is to evaluate communication methods to improve participation rate among the Lyon University Hospital employees. In this first part of the study, we aimed to determinate the number of eligible individuals among our population of employees. METHOD In November 2020, we conducted a questionnaire based cross sectional survey among the Lyon University Hospital employees (N = 26,954). We evaluated the PLCO m2012 risk prediction model and the eligibility criteria recommended by French guidelines. We assessed the proportion of eligible individuals among the responders and calculated the total eligible individuals in our hospital. RESULTS Overall, 4,526 questionnaires were available for analysis. 16.0% were current smokers, and 28.2% were former smokers. Among the 50-75yo ever-smoker employees, 27% were eligible according to the French guidelines, 2.7% of all eversmokers according to a PLCO m2012 score ≥ 1.51%, and thus, 3.8% of the surveyed population were eligible to the combined criteria. The factors associated with higher eligibility among 50-75yo ever-smokers were educational level, feeling symptoms related to tobacco smoking, personal history of COPD and family history of lung cancer. Using the French guidelines criteria only, we estimated the total number of eligible individuals in the hospital at 838. CONCLUSION In this study, we determined a theoretical number of eligible employees to LCS in our institution and the factors associated to eligibility. Secondly, we will propose LCS to all eligible employees of Lyon University Hospital with incremented information actions.
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Affiliation(s)
- Emmanuel Grolleau
- Service de pneumologie aigue et cancérologie thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite, France; Centre d'Innovation en Cancérologie de Lyon EA 3738, Faculté de médecine Lyon-Sud, Université Lyon 1, 69600, Oullins, France
| | - Julie de Bermont
- Service de pneumologie aigue et cancérologie thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite, France.
| | - Flavien Devun
- Unité de Recherche Commune en Oncologie Thoracique, Hospices Civils de Lyon, Lyon, France
| | - David Pérol
- Bureau d'études cliniques, Centre Léon Bérard, Lyon, France
| | - Véronique Lacoste
- Applied Linguistics Research Center, Lyon 2 university, Lyon, France
| | - Loïc Delastre
- Medical Management Department, Hospices Civils de Lyon, Lyon, France
| | - Fanny Fleurisson
- Medical Management Department, Hospices Civils de Lyon, Lyon, France
| | - Gilles Devouassoux
- Service de Pneumologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jean-François Mornex
- Service de Pneumologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - François Cotton
- Service d'Imagerie Médicale, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Marie Darrason
- Service de pneumologie aigue et cancérologie thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite, France; Institut de Recherche en Philosophie, Lyon 3 University, Lyon, France
| | | | - Sébastien Couraud
- Service de pneumologie aigue et cancérologie thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite, France; Centre d'Innovation en Cancérologie de Lyon EA 3738, Faculté de médecine Lyon-Sud, Université Lyon 1, 69600, Oullins, France; Unité de Recherche Commune en Oncologie Thoracique, Hospices Civils de Lyon, Lyon, France
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22
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Qin N, Wang C, Chen C, Yang L, Liu S, Xiang J, Xie Y, Liang S, Zhou J, Xu X, Zhao X, Zhu M, Jin G, Ma H, Dai J, Hu Z, Shen H. Association of the interaction between mosaic chromosomal alterations and polygenic risk score with the risk of lung cancer: an array-based case-control association and prospective cohort study. Lancet Oncol 2022; 23:1465-1474. [DOI: 10.1016/s1470-2045(22)00600-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
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23
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Lung Cancer Recurrence Risk Prediction through Integrated Deep Learning Evaluation. Cancers (Basel) 2022; 14:cancers14174150. [PMID: 36077686 PMCID: PMC9454871 DOI: 10.3390/cancers14174150] [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: 07/29/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Prognostic risk factors for completely resected stage IA non-small-cell lung cancers (NSCLCs) have advanced minimally over recent decades. Although several biomarkers have been found to be associated with cancer recurrence, their added value to TNM staging and tumor grade are unclear. Methods: Features of preoperative low-dose CT image and histologic findings of hematoxylin- and eosin-stained tissue sections of resected lung tumor specimens were extracted from 182 stage IA NSCLC patients in the National Lung Screening Trial. These features were combined to predict the risk of tumor recurrence or progression through integrated deep learning evaluation (IDLE). Added values of IDLE to TNM staging and tumor grade in progression risk prediction and risk stratification were evaluated. Results: The 5-year AUC of IDLE was 0.817 ± 0.037 as compared to the AUC = 0.561 ± 0.042 and 0.573 ± 0.044 from the TNM stage and tumor grade, respectively. The IDLE score was significantly associated with cancer recurrence (p < 0.0001) even after adjusting for TNM staging and tumor grade. Synergy between chest CT image markers and histological markers was the driving force of the deep learning algorithm to produce a stronger prognostic predictor. Conclusions: Integrating markers from preoperative CT images and pathologist’s readings of resected lung specimens through deep learning can improve risk stratification of stage 1A NSCLC patients over TNM staging and tumor grade alone. Our study suggests that combining markers from nonoverlapping platforms can increase the cancer risk prediction accuracy.
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24
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Qiu ZB, Wang MM, Yan JH, Zhang C, Wu YL, Zhang S, Zhong WZ. A Novel Radiopathological Grading System to Tailor Recurrence Risk for Pathologic Stage IA Lung Adenocarcinoma. Semin Thorac Cardiovasc Surg 2022; S1043-0679:00135-00136. [PMID: 35709883 DOI: 10.1053/j.semtcvs.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023]
Abstract
To validate the efficiency of pathologic grading system in pathologic stage IA lung adenocarcinoma (LUAD), and explore whether integrating preoperative radiological features would enhance the performance of recurrence discrimination. We retrospectively collected 510 patients with resected stage IA LUAD between January 2012 and December 2019 from Guangdong Provincial People's Hospital (GDPH). Pathologic grade classification of each case was based on the International Association for the Study of Lung Cancer (IASLC) pathologic staging system. Kaplan-Meier curves was used to assess the power of recurrence stratification. Concordance index (C-Index) and receiver operating characteristic curves (ROC) were used for evaluating the clinical utility of different grading systems for recurrence discrimination. Patients of lower IASLC grade showed improved recurrence-free survival (RFS) (P < 0.0001) where numerically difference was found between grade II and grade III (P = 0.119). By integrating the IASLC grading system and radiological feature, we found the RFS rate decreased as the novel radiopathological (RP) grading system increased (P < 0.0001). The difference of RFS curves between any 2 groups as per the RP grading system was statisticallysignificant (RP grade I vs RP grade II, p = 0.007; RP grade I vs RP grade III, P < 0.0001; RP grade II vs RP grade III, P = 0.0003). Compared with the IASLC grading system, the RP grading system remarkably improved recurrence survival discrimination (C-index: 0.822; area under the curve, 0.845). Integrating imaging features into pathologic grading system enhanced the efficiency of recurrence discrimination for resected stage IA LUAD and might help conduct subsequent management.
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Affiliation(s)
- Zhen-Bin Qiu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Shantou University Medical College, Shantou, China
| | - Meng-Min Wang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jin-Hai Yan
- Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sheng Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Tremblay A, Ezer N, Burrowes P, MacGregor JH, Lee A, Armstrong GA, Pereira R, Bristow M, Taylor JL, MacEachern P, Taghizadeh N, Koetzler R, Bedard E. Development and application of an electronic synoptic report for reporting and management of low-dose computed tomography lung cancer screening examination. BMC Med Imaging 2022; 22:111. [PMID: 35690733 PMCID: PMC9188213 DOI: 10.1186/s12880-022-00837-y] [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: 04/11/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Interpretation of Low Dose CT scans and protocol driven management of findings is a key aspect of lung cancer screening program performance. Reliable and reproducible methods are needed to communicate radiologists’ interpretation to the screening program or clinicians driving management decision.
Methods We performed an audit of a subset of dictated reports from the PANCAN study to assess for omissions. We developed an electronic synoptic reporting tool for radiologists embedded in a clinical documentation system software. The tool was then used for reporting as part of the Alberta Lung Cancer Screening Study and McGill University Health Centre Pilot Lung Cancer Screening Program.
Results Fifty reports were audited for completeness. At least one omission was noted in 30 (70%) of reports, with a major omission (missing lobe, size, type of nodule in report or actionable incidental finding in recommendation section of report) in 24 (48%). Details of the reporting template and functionality such as automated nodule cancer risk assessment, Lung-RADS category assignment, auto-generated narrative type report as well as personalize participant results letter is provided. A description of the system’s performance in its application in 2815 CT reports is then summarized. Conclusions We found that narrative type radiologist reports for lung cancer screening CT examinations frequently lacked specific discrete data elements required for management. We demonstrate the successful implementation of a radiology synoptic reporting system for use in lung cancer screening, and the use of this information to drive program management and communications.
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Affiliation(s)
- Alain Tremblay
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Nicole Ezer
- Department of Medicine, McGill University Health Centre, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Paul Burrowes
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - John Henry MacGregor
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Andrew Lee
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Gavin A Armstrong
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Raoul Pereira
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Michael Bristow
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Jana L Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Paul MacEachern
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Niloofar Taghizadeh
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Rommy Koetzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Eric Bedard
- Department of Surgery, Faculty of Medicine and Dentistry, Walter C. MacKenzie Health Sciences Centre, University of Alberta, Edmonton, 2J2.00T6G 2R7, Canada
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Expected Cost Savings from Low Dose Computed Tomography Scan Screening for Lung Cancer in Alberta, Canada. JTO Clin Res Rep 2022; 3:100350. [PMID: 35769390 PMCID: PMC9234227 DOI: 10.1016/j.jtocrr.2022.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction The expensive modern therapeutic regimens for advanced lung cancer (LC) stages have been recently approved. We evaluated whether low-dose computed tomography (LDCT) LC screening of high-risk Albertans is cost saving. Methods We used a decision analytical modeling technique with a health system perspective and a time horizon of 3 years to compare benefits associated with reduced health service utilization (HSU) from earlier diagnosis to the costs of screening. Using patient-level data, HSU costs by stage of disease were estimated for patients with LC, including inpatient, outpatient, and physician services, and costs for prescription drugs and cancer treatments. Results Of 101,000 people aged 55 to 74 years eligible for screening, an estimated 88,476 scans would be performed in Alberta in 3 years. Given LDCT sensitivity and specificity of 90.5% and 93.1%, respectively, we estimated that a stage shift toward earlier diagnosis would be expected whereby 43% more patients would be identified at stage 1 or 2 as compared with without screening. The estimated cost of screening is $35.6 million (M), whereas the stage shift associated with screening would avoid $42M in HSU costs. The net cost avoidance associated with screening is therefore $6.65M. The probability for the screening to be cost saving is estimated at 72%. Conclusions This study has revealed that LDCT LC screening is likely to be cost saving in Alberta. Adoption of this program into the provincial health care system is worth considering provided constraints in the system related to surgical capacity and CT wait times could be addressed.
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Li C, Wang H, Jiang Y, Fu W, Liu X, Zhong R, Cheng B, Zhu F, Xiang Y, He J, Liang W. Advances in lung cancer screening and early detection. Cancer Biol Med 2022; 19:j.issn.2095-3941.2021.0690. [PMID: 35535966 PMCID: PMC9196057 DOI: 10.20892/j.issn.2095-3941.2021.0690] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Lung cancer is associated with a heavy cancer-related burden in terms of patients' physical and mental health worldwide. Two randomized controlled trials, the US-National Lung Screening Trial (NLST) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON), indicated that low-dose CT (LDCT) screening results in a statistically significant decrease in mortality in patients with lung cancer, LDCT has become the standard approach for lung cancer screening. However, many issues in lung cancer screening remain unresolved, such as the screening criteria, high false-positive rate, and radiation exposure. This review first summarizes recent studies on lung cancer screening from the US, Europe, and Asia, and discusses risk-based selection for screening and the related issues. Second, an overview of novel techniques for the differential diagnosis of pulmonary nodules, including artificial intelligence and molecular biomarker-based screening, is presented. Third, current explorations of strategies for suspected malignancy are summarized. Overall, this review aims to help clinicians understand recent progress in lung cancer screening and alleviate the burden of lung cancer.
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Affiliation(s)
- Caichen Li
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Huiting Wang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Yu Jiang
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Wenhai Fu
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Xiwen Liu
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Ran Zhong
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Bo Cheng
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Feng Zhu
- Department of Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, Michigan 48235, USA
| | - Yang Xiang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Jianxing He
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China
| | - Wenhua Liang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
- Department of Oncology, the First People’s Hospital of Zhaoqing, Zhaoqing 526020, China
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Lung Cancer Screening: New Perspective and Challenges in Europe. Cancers (Basel) 2022; 14:cancers14092343. [PMID: 35565472 PMCID: PMC9099920 DOI: 10.3390/cancers14092343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Screening for lung cancer in a high-risk population has been shown to be beneficial, with reduced mortality in large randomised trials. However, the general implementation of screening is not evident and many factors have to be considered. In this paper, we will review the current status of screening for lung cancer in Europe and the many hurdles that have to be overcome. Multidisciplinary cooperation between all specialists dealing with lung cancer is required to obtain the best outcome. Hopefully, Europe’s Beating Cancer Plan will incorporate screening for lung cancer to allow general implementation by similar programmes in every European Member State. This will also provide an opportunity for further, large-scale studies to refine the inclusion of specific risk populations, diagnosis and management of screen-detected nodules. Abstract Randomized-controlled trials have shown clear evidence that lung cancer screening with low-dose CT in a high-risk population of current or former smokers can significantly reduce lung-cancer-specific mortality by an inversion of stage distribution at diagnosis. This paper will review areas in which there is good or emerging evidence and areas which still require investment, research or represent implementation challenges. The implementation of population-based lung cancer screening in Europe is variable and fragmented. A number of European countries seem be on the verge of implementing lung cancer screening, mainly through the implementation of studies or trials. The cost and capacity of CT scanners and radiologists are considered to be the main hurdles for future implementation. Actions by the European Commission, related to its published Europe’s Beating Cancer Plan and the proposal to update recommendations on cancer screening, could be an incentive to help speed up its implementation.
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Lee H, Sin DD. GETting to know the many causes and faces of COPD. THE LANCET RESPIRATORY MEDICINE 2022; 10:426-428. [DOI: 10.1016/s2213-2600(22)00049-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
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Smith RJ, Vijayaharan T, Linehan V, Sun Z, Ein Yong JH, Harris S, Mariathas HH, Bhatia R. Efficacy of Risk Prediction Models and Thresholds to Select Patients for Lung Cancer Screening. Can Assoc Radiol J 2022; 73:672-679. [PMID: 35471946 DOI: 10.1177/08465371221089899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PurposeScreening for lung cancer is recommended to reduce lung cancer mortality, but there is no consensus on patient selection for screening in Canada. Risk prediction models are more efficacious than the screening recommendations of the Canadian Task Force on Preventive Health Care (CTFPHC), but it remains to be determined which model and threshold are optimal. MethodsWe retrospectively applied the PLCOm2012, PLCOall2014 and LLPv2 risk prediction models to 120 lung cancer patients from a Canadian province, at risk thresholds of ≥ 1.51% and ≥ 2.00%, to determine screening eligibility at time of diagnosis. OncoSim modelling was used to compare these risk thresholds. ResultsSensitivities of the risk prediction models at a threshold of ≥ 1.51% were similar with 93 (77.5%), 96 (80.0%), and 97 (80.8%) patients selected for screening, respectively. The PLCOm2012 and PLCOall2014 models selected significantly more patients for screening at a ≥ 1.51% threshold. The OncoSim simulation model estimated that the ≥ 1.51% threshold would detect 4 more cancers per 100 000 people than the ≥ 2.00% threshold. All risk prediction models, at both thresholds, achieved greater sensitivity than CTFPHC recommendations, which selected 56 (46.7%) patients for screening. ConclusionCommonly considered lung cancer screening risk thresholds (≥1.51% and ≥2.00%) are more sensitive than the CTFPHC 30-pack-years criterion to detect lung cancer. A lower risk threshold would achieve a larger population impact of lung cancer screening but would require more resources. Patients with limited or no smoking history, young patients, and patients with no history of COPD may be missed regardless of the model chosen.
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Affiliation(s)
- Richard J Smith
- Discipline of Radiology, Faculty of Medicine, 12360Memorial University of Newfoundland, St. John's, NL, Canada
| | - Thurairajah Vijayaharan
- Discipline of Radiology, Faculty of Medicine, 12360Memorial University of Newfoundland, St. John's, NL, Canada
| | - Victoria Linehan
- Department of Diagnostic Radiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Zhuolu Sun
- Institute of Health Policy, Management and Evaluation, 206712University of Toronto, Toronto, ON, Canada
| | | | - Scott Harris
- Discipline of Radiology, Faculty of Medicine, 12360Memorial University of Newfoundland, St. John's, NL, Canada
| | - Hensley H Mariathas
- Discipline of Radiology, Faculty of Medicine, 12360Memorial University of Newfoundland, St. John's, NL, Canada
| | - Rick Bhatia
- Discipline of Radiology, Faculty of Medicine, 12360Memorial University of Newfoundland, St. John's, NL, Canada
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Smoking Cessation by Phone Counselling in a Lung Cancer Screening Program: A Retrospective Comparative Cohort Study. Can Respir J 2022; 2022:5446751. [PMID: 35495872 PMCID: PMC9050320 DOI: 10.1155/2022/5446751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Smoking cessation integration within lung cancer screening programs is challenging. Currently, phone counselling is available across Canada for individuals referred by healthcare workers and by self-referral. We compared quit rates after phone counselling interventions between participants who self-refer, those referred by healthcare workers, and those referred by a lung cancer screening program. Methods This is a retrospective cohort study of participants referred to provincial smoking cessation quit line in contemporaneous cohorts: self-referred participants, healthcare worker referred, and those referred by a lung cancer screening program if they were still actively smoking at the time of first contact. Baseline, covariates (sociodemographic information, smoking history, and history of mental health disorder) and quit intentions (stage of change, readiness for change, previous use of quit programs, and previous quit attempts) were compared among the three cohorts. Our primary outcome was defined as self-reported 30-day abstinence rates at 6 months. Multivariable logistic regression was used to identify whether group assignment was associated with higher quit rates. Results Participants referred by a lung cancer screening program had low quit rates (12%, 95% CI: 5–19) at six months despite the use of phone counselling. Compared to patients who were self-referred to the smoking cessation phone helpline, individuals referred by a lung cancer screening program were much less likely to quit (adjusted OR 0.37; 95% CI: 0.17–0.8), whereas those referred by healthcare workers were twice as likely to quit (adjusted OR 2.16 (1.3–3.58)) even after adjustment for differences in smoking intensity and quit intentions. Conclusions Phone counselling alone has very limited benefit in a lung cancer screening program. Participants differ significantly from those who are otherwise referred by healthcare workers. This study underlines the importance of a dedicated and personalized tobacco treatment program within every lung cancer screening program. The program should incorporate best practices and encourage treatment regardless of readiness to quit.
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Fahrmann JF, Marsh T, Irajizad E, Patel N, Murage E, Vykoukal J, Dennison JB, Do KA, Ostrin E, Spitz MR, Lam S, Shete S, Meza R, Tammemägi MC, Feng Z, Hanash SM. Blood-Based Biomarker Panel for Personalized Lung Cancer Risk Assessment. J Clin Oncol 2022; 40:876-883. [PMID: 34995129 PMCID: PMC8906454 DOI: 10.1200/jco.21.01460] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate whether a panel of circulating protein biomarkers would improve risk assessment for lung cancer screening in combination with a risk model on the basis of participant characteristics. METHODS A blinded validation study was performed using prostate lung colorectal ovarian (PLCO) Cancer Screening Trial data and biospecimens to evaluate the performance of a four-marker protein panel (4MP) consisting of the precursor form of surfactant protein B, cancer antigen 125, carcinoembryonic antigen, and cytokeratin-19 fragment in combination with a lung cancer risk prediction model (PLCOm2012) compared with current US Preventive Services Task Force (USPSTF) screening criteria. The 4MP was assayed in 1,299 sera collected preceding lung cancer diagnosis and 8,709 noncase sera. RESULTS The 4MP alone yielded an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.77 to 0.82) for case sera collected within 1-year preceding diagnosis and 0.74 (95% CI, 0.72 to 0.76) among the entire specimen set. The combined 4MP + PLCOm2012 model yielded an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.82 to 0.88) for case sera collected within 1 year preceding diagnosis. The benefit of the 4MP in the combined model resulted from improvement in sensitivity at high specificity. Compared with the USPSTF2021 criteria, the combined 4MP + PLCOm2012 model exhibited statistically significant improvements in sensitivity and specificity. Among PLCO participants with ≥ 10 smoking pack-years, the 4MP + PLCOm2012 model would have identified for annual screening 9.2% more lung cancer cases and would have reduced referral by 13.7% among noncases compared with USPSTF2021 criteria. CONCLUSION A blood-based biomarker panel in combination with PLCOm2012 significantly improves lung cancer risk assessment for lung cancer screening.
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Affiliation(s)
- Johannes F Fahrmann
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tracey Marsh
- Biostatistics Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ehsan Irajizad
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nikul Patel
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eunice Murage
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jody Vykoukal
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer B Dennison
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kim-Anh Do
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edwin Ostrin
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Stephen Lam
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI
| | - Martin C Tammemägi
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Ziding Feng
- Biostatistics Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Samir M Hanash
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
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Robbins HA, Cheung LC, Chaturvedi AK, Baldwin DR, Berg CD, Katki HA. Management of Lung Cancer Screening Results Based on Individual Prediction of Current and Future Lung Cancer Risks. J Thorac Oncol 2022; 17:252-263. [PMID: 34648946 PMCID: PMC10186153 DOI: 10.1016/j.jtho.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We propose a risk-tailored approach for management of lung cancer screening results. This approach incorporates individual risk factors and low-dose computed tomography (LDCT) image features into calculations of immediate and next-screen (1-y) risks of lung cancer detection, which in turn can recommend short-interval imaging or 1-year or 2-year screening intervals. METHODS We first extended the "LCRAT+CT" individualized risk calculator to predict lung cancer risk after either a negative or abnormal LDCT screen result. To develop the abnormal screen portion, we analyzed 18,129 abnormal LDCT results in the National Lung Screening Trial (NLST), including lung cancers detected immediately (n = 649) or at the next screen (n = 235). We estimated the potential impact of this approach among NLST participants with any screen result (negative or abnormal). RESULTS Applying the draft National Health Service (NHS) England protocol for lung screening to NLST participants referred 76% of participants to a 2-year interval, but delayed diagnosis for 40% of detectable cancers. The Lung Cancer Risk Assessment Tool+Computed Tomography (LCRAT+CT) risk model, with a threshold of less than 0.95% cumulative lung cancer risk, would also refer 76% of participants to a 2-year interval, but would delay diagnosis for only 30% of cancers, a 25% reduction versus the NHS protocol. Alternatively, LCRAT+CT, with a threshold of less than 1.7% cumulative lung cancer risk, would also delay diagnosis for 40% of cancers, but would refer 85% of participants for a 2-year interval, a 38% further reduction in the number of required 1-year screens beyond the NHS protocol. CONCLUSIONS Using individualized risk models to determine management in lung cancer screening could substantially reduce the number of screens or increase early detection.
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Affiliation(s)
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - Christine D. Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Cortellini A, Giusti R, Filetti M, Citarella F, Adamo V, Santini D, Buti S, Nigro O, Cantini L, Di Maio M, Aerts JGJV, Bria E, Bertolini F, Ferrara MG, Ghidini M, Grossi F, Guida A, Berardi R, Morabito A, Genova C, Mazzoni F, Antonuzzo L, Gelibter A, Marchetti P, Chiari R, Macerelli M, Rastelli F, Della Gravara L, Gori S, Tuzi A, De Tursi M, Di Marino P, Mansueto G, Pecci F, Zoratto F, Ricciardi S, Migliorino MR, Passiglia F, Metro G, Spinelli GP, Banna GL, Friedlaender A, Addeo A, Ficorella C, Porzio G, Tiseo M, Russano M, Russo A, Pinato DJ. High familial burden of cancer correlates with improved outcome from immunotherapy in patients with NSCLC independent of somatic DNA damage response gene status. J Hematol Oncol 2022; 15:9. [PMID: 35062993 PMCID: PMC8780322 DOI: 10.1186/s13045-022-01226-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 12/26/2022] Open
Abstract
Family history of cancer (FHC) is a hallmark of cancer risk and an independent predictor of outcome, albeit with uncertain biologic foundations. We previously showed that FHC-high patients experienced prolonged overall (OS) and progression-free survival (PFS) following PD-1/PD-L1 checkpoint inhibitors. To validate our findings in patients with NSCLC, we evaluated two multicenter cohorts of patients with metastatic NSCLC receiving either first-line pembrolizumab or chemotherapy. From each cohort, 607 patients were randomly case–control matched accounting for FHC, age, performance status, and disease burden. Compared to FHC-low/negative, FHC-high patients experienced longer OS (HR 0.67 [95% CI 0.46–0.95], p = 0.0281), PFS (HR 0.65 [95% CI 0.48–0.89]; p = 0.0074) and higher disease control rates (DCR, 86.4% vs 67.5%, p = 0.0096), within the pembrolizumab cohort. No significant associations were found between FHC and OS/PFS/DCR within the chemotherapy cohort. We explored the association between FHC and somatic DNA damage response (DDR) gene alterations as underlying mechanism to our findings in a parallel cohort of 118 NSCLC, 16.9% of whom were FHC-high. The prevalence of ≥ 1 somatic DDR gene mutation was 20% and 24.5% (p = 0.6684) in FHC-high vs. FHC-low/negative, with no differences in tumor mutational burden (6.0 vs. 7.6 Mut/Mb, p = 0.6018) and tumor cell PD-L1 expression. FHC-high status identifies NSCLC patients with improved outcomes from pembrolizumab but not chemotherapy, independent of somatic DDR gene status. Prospective studies evaluating FHC alongside germline genetic testing are warranted.
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Aredo JV, Choi E, Ding VY, Tammemägi MC, ten Haaf K, Luo SJ, Freedman ND, Wilkens LR, Le Marchand L, Wakelee HA, Meza R, Park SSL, Cheng I, Han SS. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6583194. [PMID: 35642317 PMCID: PMC9156850 DOI: 10.1093/jncics/pkac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/05/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Jacqueline V Aredo
- Department of Medicine, University of California, San Francisco, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Eunji Choi
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Kevin ten Haaf
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sophia J Luo
- Stanford University School of Medicine, Stanford, CA, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Heather A Wakelee
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Division of Oncology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sung-Shim Lani Park
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Summer S Han
- Stanford University School of Medicine, Stanford, CA, USA
- Correspondence to: Summer S. Han, PhD, Stanford University School of Medicine, 1701 Page Mill Rd, Room 234, Stanford, CA 94304, USA (e-mail: )
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Tammemägi MC, Ruparel M, Tremblay A, Myers R, Mayo J, Yee J, Atkar-Khattra S, Yuan R, Cressman S, English J, Bedard E, MacEachern P, Burrowes P, Quaife SL, Marshall H, Yang I, Bowman R, Passmore L, McWilliams A, Brims F, Lim KP, Mo L, Melsom S, Saffar B, Teh M, Sheehan R, Kuok Y, Manser R, Irving L, Steinfort D, McCusker M, Pascoe D, Fogarty P, Stone E, Lam DCL, Ng MY, Vardhanabhuti V, Berg CD, Hung RJ, Janes SM, Fong K, Lam S. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study. Lancet Oncol 2022; 23:138-148. [PMID: 34902336 PMCID: PMC8716337 DOI: 10.1016/s1470-2045(21)00590-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lung cancer is a major health problem. CT lung screening can reduce lung cancer mortality through early diagnosis by at least 20%. Screening high-risk individuals is most effective. Retrospective analyses suggest that identifying individuals for screening by accurate prediction models is more efficient than using categorical age-smoking criteria, such as the US Preventive Services Task Force (USPSTF) criteria. This study prospectively compared the effectiveness of the USPSTF2013 and PLCOm2012 model eligibility criteria. METHODS In this prospective cohort study, participants from the International Lung Screening Trial (ILST), aged 55-80 years, who were current or former smokers (ie, had ≥30 pack-years smoking history or ≤15 quit-years since last permanently quitting), and who met USPSTF2013 criteria or a PLCOm2012 risk threshold of at least 1·51% within 6 years of screening, were recruited from nine screening sites in Canada, Australia, Hong Kong, and the UK. After enrolment, patients were assessed with the USPSTF2013 criteria and the PLCOm2012 risk model with a threshold of at least 1·70% at 6 years. Data were collected locally and centralised. Main outcomes were the comparison of lung cancer detection rates and cumulative life expectancies in patients with lung cancer between USPSTF2013 criteria and the PLCOm2012 model. In this Article, we present data from an interim analysis. To estimate the incidence of lung cancers in individuals who were USPSTF2013-negative and had PLCOm2012 of less than 1·51% at 6 years, ever-smokers in the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) who met these criteria and their lung cancer incidence were applied to the ILST sample size for the mean follow-up occurring in the ILST. This trial is registered at ClinicalTrials.gov, NCT02871856. Study enrolment is almost complete. FINDINGS Between June 17, 2015, and Dec 29, 2020, 5819 participants from the International Lung Screening Trial (ILST) were enrolled on the basis of meeting USPSTF2013 criteria or the PLCOm2012 risk threshold of at least 1·51% at 6 years. The same number of individuals was selected for the PLCOm2012 model as for the USPSTF2013 criteria (4540 [78%] of 5819). After a mean follow-up of 2·3 years (SD 1·0), 135 lung cancers occurred in 4540 USPSTF2013-positive participants and 162 in 4540 participants included in the PLCOm2012 of at least 1·70% at 6 years group (cancer sensitivity difference 15·8%, 95% CI 10·7-22·1%; absolute odds ratio 4·00, 95% CI 1·89-9·44; p<0·0001). Compared to USPSTF2013-positive individuals, PLCOm2012-selected participants were older (mean age 65·7 years [SD 5·9] vs 63·3 years [5·7]; p<0·0001), had more comorbidities (median 2 [IQR 1-3] vs 1 [1-2]; p<0·0001), and shorter life expectancy (13·9 years [95% CI 12·8-14·9] vs 14·8 [13·6-16·0] years). Model-based difference in cumulative life expectancies for those diagnosed with lung cancer were higher in those who had PLCOm2012 risk of at least 1·70% at 6 years than individuals who were USPSTF2013-positive (2248·6 years [95% CI 2089·6-2425·9] vs 2000·7 years [1841·2-2160·3]; difference 247·9 years, p=0·015). INTERPRETATION PLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes. FUNDING Terry Fox Research Institute, The UBC-VGH Hospital Foundation and the BC Cancer Foundation, the Alberta Cancer Foundation, the Australian National Health and Medical Research Council, Cancer Research UK and a consortium of funders, and the Roy Castle Lung Cancer Foundation for the UK Lung Screen Uptake Trial.
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Affiliation(s)
- Martin C Tammemägi
- Department of Health Sciences, Brock University, St Catharines, ON, Canada.
| | - Mamta Ruparel
- Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Alain Tremblay
- Division of Respiratory Medicine & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Renelle Myers
- BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Mayo
- Department of Radiology, Vancouver, BC, Canada
| | - John Yee
- Department of Thoracic Surgery, Vancouver, BC, Canada
| | | | - Ren Yuan
- Vancouver Coastal Health, Vancouver, BC, Canada; Department of Radiology, BC Cancer, Vancouver, BC, Canada
| | - Sonya Cressman
- Centre for Epidemiology and Evaluation, SFU, Burnaby, BC, Canada
| | | | - Eric Bedard
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Paul MacEachern
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Burrowes
- Department of Diagnostic Imaging, Foothills Medical Center, Calgary, AB, Canada
| | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Henry Marshall
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Ian Yang
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Rayleen Bowman
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Linda Passmore
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Curtin Medical School, National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA, Australia
| | - Kuan Pin Lim
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Lin Mo
- Royal Darwin Hospital, Tiwi, NT, Australia
| | - Stephen Melsom
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Bann Saffar
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Mark Teh
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ramon Sheehan
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Yijin Kuok
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Renee Manser
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mark McCusker
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Diane Pascoe
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Paul Fogarty
- Epworth Internal Medicine Clinical Institute, Melbourne VIC, Australia
| | - Emily Stone
- St Vincent's Hospital, Kinghorn Cancer Centre, University of New South Wales, Sydney, NSW, Australia
| | - David C L Lam
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong
| | | | | | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Samuel M Janes
- Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Kwun Fong
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Stephen Lam
- BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada
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Salloum RG, Braithwaite D. Expansion of Guideline-Recommended Lung Cancer Screening Eligibility: Implications for Health Equity of Joint Screening and Cessation Interventions. J Thorac Oncol 2022; 17:13-15. [PMID: 34930605 DOI: 10.1016/j.jtho.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida; Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville, Florida.
| | - Dejana Braithwaite
- Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville, Florida; Department of Epidemiology, University of Florida, Gainesville, Florida
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Dickson JL, Horst C, Nair A, Tisi S, Prendecki R, Janes SM. Hesitancy around low-dose CT screening for lung cancer. Ann Oncol 2022; 33:34-41. [PMID: 34555501 DOI: 10.1016/j.annonc.2021.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 12/17/2022] Open
Abstract
Lung cancer is the leading cause of cancer death worldwide. The absence of symptoms in early-stage (I/II) disease, when curative treatment is possible, results in >70% of cases being diagnosed at late stage (III/IV), when treatment is rarely curative. This contributes greatly to the poor prognosis of lung cancer, which sees only 16.2% of individuals diagnosed with the disease alive at 5 years. Early detection is key to improving lung cancer survival outcomes. As a result, there has been longstanding interest in finding a reliable screening test. After little success with chest radiography and sputum cytology, in 2011 the United States National Lung Screening Trial demonstrated that annual low-dose computed tomography (LDCT) screening reduced lung cancer-specific mortality by 20%, when compared with annual chest radiography. In 2020, the NELSON study demonstrated an even greater reduction in lung cancer-specific mortality for LDCT screening at 0, 1, 3 and 5.5 years of 24% in men, when compared to no screening. Despite these impressive results, a call to arms in the 2017 European position statement on lung cancer screening (LCS) and the widespread introduction across the United States, there was, until recently, no population-based European national screening programme in place. We address the potential barriers and outstanding concerns including common screening foes, such as false-positive tests, overdiagnosis and the negative psychological impact of screening, as well as others more unique to LDCT LCS, including appropriate risk stratification of potential participants, radiation exposure and incidental findings. In doing this, we conclude that whilst the evidence generated from ongoing work can be used to refine the screening process, for those risks which remain, appropriate and acceptable mitigations are available, and none should serve as barriers to the implementation of national unified LCS programmes across Europe and beyond.
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Affiliation(s)
- J L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - C Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - A Nair
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Radiology, University College London Hospital, London, UK
| | - S Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - R Prendecki
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - S M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospital, London, UK.
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Jacobs C, Setio AAA, Scholten ET, Gerke PK, Bhattacharya H, M Hoesein FA, Brink M, Ranschaert E, de Jong PA, Silva M, Geurts B, Chung K, Schalekamp S, Meersschaert J, Devaraj A, Pinsky PF, Lam SC, van Ginneken B, Farahani K. Deep Learning for Lung Cancer Detection on Screening CT Scans: Results of a Large-Scale Public Competition and an Observer Study with 11 Radiologists. Radiol Artif Intell 2021; 3:e210027. [PMID: 34870218 DOI: 10.1148/ryai.2021210027] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/15/2022]
Abstract
Purpose To determine whether deep learning algorithms developed in a public competition could identify lung cancer on low-dose CT scans with a performance similar to that of radiologists. Materials and Methods In this retrospective study, a dataset consisting of 300 patient scans was used for model assessment; 150 patient scans were from the competition set and 150 were from an independent dataset. Both test datasets contained 50 cancer-positive scans and 100 cancer-negative scans. The reference standard was set by histopathologic examination for cancer-positive scans and imaging follow-up for at least 2 years for cancer-negative scans. The test datasets were applied to the three top-performing algorithms from the Kaggle Data Science Bowl 2017 public competition: grt123, Julian de Wit and Daniel Hammack (JWDH), and Aidence. Model outputs were compared with an observer study of 11 radiologists that assessed the same test datasets. Each scan was scored on a continuous scale by both the deep learning algorithms and the radiologists. Performance was measured using multireader, multicase receiver operating characteristic analysis. Results The area under the receiver operating characteristic curve (AUC) was 0.877 (95% CI: 0.842, 0.910) for grt123, 0.902 (95% CI: 0.871, 0.932) for JWDH, and 0.900 (95% CI: 0.870, 0.928) for Aidence. The average AUC of the radiologists was 0.917 (95% CI: 0.889, 0.945), which was significantly higher than grt123 (P = .02); however, no significant difference was found between the radiologists and JWDH (P = .29) or Aidence (P = .26). Conclusion Deep learning algorithms developed in a public competition for lung cancer detection in low-dose CT scans reached performance close to that of radiologists.Keywords: Lung, CT, Thorax, Screening, Oncology Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Colin Jacobs
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Arnaud A A Setio
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Ernst T Scholten
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Paul K Gerke
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Haimasree Bhattacharya
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Firdaus A M Hoesein
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Monique Brink
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Erik Ranschaert
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Pim A de Jong
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Mario Silva
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Bram Geurts
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Kaman Chung
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Steven Schalekamp
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Joke Meersschaert
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Anand Devaraj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Paul F Pinsky
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Stephen C Lam
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Bram van Ginneken
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Keyvan Farahani
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
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Gao R, Tang Y, Khan MS, Xu K, Paulson AB, Sullivan S, Huo Y, Deppen S, Massion PP, Sandler KL, Landman BA. Cancer Risk Estimation Combining Lung Screening CT with Clinical Data Elements. Radiol Artif Intell 2021; 3:e210032. [PMID: 34870220 DOI: 10.1148/ryai.2021210032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 12/26/2022]
Abstract
Purpose To develop a model to estimate lung cancer risk using lung cancer screening CT and clinical data elements (CDEs) without manual reading efforts. Materials and Methods Two screening cohorts were retrospectively studied: the National Lung Screening Trial (NLST; participants enrolled between August 2002 and April 2004) and the Vanderbilt Lung Screening Program (VLSP; participants enrolled between 2015 and 2018). Fivefold cross-validation using the NLST dataset was used for initial development and assessment of the co-learning model using whole CT scans and CDEs. The VLSP dataset was used for external testing of the developed model. Area under the receiver operating characteristic curve (AUC) and area under the precision-recall curve were used to measure the performance of the model. The developed model was compared with published risk-prediction models that used only CDEs or imaging data alone. The Brock model was also included for comparison by imputing missing values for patients without a dominant pulmonary nodule. Results A total of 23 505 patients from the NLST (mean age, 62 years ± 5 [standard deviation]; 13 838 men, 9667 women) and 147 patients from the VLSP (mean age, 65 years ± 5; 82 men, 65 women) were included. Using cross-validation on the NLST dataset, the AUC of the proposed co-learning model (AUC, 0.88) was higher than the published models predicted with CDEs only (AUC, 0.69; P < .05) and with images only (AUC, 0.86; P < .05). Additionally, using the external VLSP test dataset, the co-learning model had a higher performance than each of the published individual models (AUC, 0.91 [co-learning] vs 0.59 [CDE-only] and 0.88 [image-only]; P < .05 for both comparisons). Conclusion The proposed co-learning predictive model combining chest CT images and CDEs had a higher performance for lung cancer risk prediction than models that contained only CDE or only image data; the proposed model also had a higher performance than the Brock model.Keywords: Computer-aided Diagnosis (CAD), CT, Lung, Thorax Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Riqiang Gao
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Yucheng Tang
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Mirza S Khan
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Kaiwen Xu
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Alexis B Paulson
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Shelbi Sullivan
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Yuankai Huo
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Stephen Deppen
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Pierre P Massion
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Kim L Sandler
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Bennett A Landman
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
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Shokoohi A, Al-Hashami Z, Moore S, Pender A, Wong SK, Wang Y, Leung B, Wu J, Ho C. Effect of targeted therapy and immunotherapy on advanced nonsmall-cell lung cancer outcomes in the real world. Cancer Med 2021; 11:86-93. [PMID: 34786889 PMCID: PMC8704182 DOI: 10.1002/cam4.4427] [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: 08/09/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 12/26/2022] Open
Abstract
The evolution of diagnosis and treatment of advanced nonsmall‐cell lung cancer (NSCLC) has led to increasing the use of targeted therapy and immune checkpoint inhibitors. The study goal was to assess the effect of molecular testing and the introduction of new therapies on overall survival (OS). All patients with stage IV NSCLC referred to BC Cancer were included in the study. Four 1‐year time cohorts were created based on molecular testing implementation and funded drug availability: C1 baseline (2009), C2 EGFR TKI access (2011), C3 ALK inhibitor access (2015), C4 immunotherapy availability (2017). Baseline demographics, disease characteristics, and systemic therapy details were collected retrospectively. OS was calculated using the Kaplan–Meier method and compared using the log‐rank test. There were 3421 patients identified with stage IV NSCLC and 1319 (39%) received systemic therapy. In the four 1‐year time cohorts C1/C2/C3/C4: driver mutation‐targeted treatment increased 1/17/27/34% (of total systemic therapy), as did treatment with any line immunotherapy <1/1/9/38%. Median OS with best supportive care (BSC) was 3.4/3.1/3.2/2.9 m (p = 0.16) and with systemic treatment 9.9/10.9/13.9/15.0 m (p < 0.001). Median OS by treatment exposure was BSC 3.1 m, chemotherapy only 7.3 m, targeted therapy 17.5 m, and immunotherapy 20.7 m. In our real‐world study, following the introduction of targeted therapy and immune checkpoint inhibitors, there was a significant improvement in OS in each successive time cohort concordant with advancements in therapeutic options.
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Affiliation(s)
- Aria Shokoohi
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Zamzam Al-Hashami
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara Moore
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra Pender
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Selina K Wong
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ying Wang
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bonnie Leung
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Jonn Wu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Cheryl Ho
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Wilkinson AN, Lam S. Lung cancer screening primer: Key information for primary care providers. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:817-822. [PMID: 34772708 DOI: 10.46747/cfp.6711817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review new evidence reported since the 2016 publication of the Canadian Task Force on Preventive Health Care recommendations and to summarize key facets of lung cancer screening to better equip primary care providers (PCPs) in anticipation of wider implementation of the recommendations. QUALITY OF EVIDENCE A new, large randomized controlled trial has been published since 2016, as have updates from 4 other trials. PubMed was searched for studies published between January 1, 2004, and December 31, 2020, using search words including lung cancer screening eligibility, lung cancer screening criteria, and lung cancer screening guidelines. All information from peer-reviewed articles, reference lists, books, and websites was considered. MAIN MESSAGE Lung cancers diagnosed at stage 4 have a 5-year survival rate of only 5% and have a disproportionate impact on those with lower socioeconomic status, rural populations, and Indigenous populations. By downstaging, or diagnosing lung cancers at an earlier and more treatable stage, lung cancer screening reduces mortality with a number needed to screen of 250 to prevent 1 death. Practical aspects of lung cancer screening are reviewed, including criteria to screen, appropriate low-dose computed tomography screening, and management of findings. Harms of screening, such as overdiagnosis and incidental findings, are discussed to allow PCPs to appropriately counsel their patients in the face of ongoing implementation of new lung cancer screening programs. CONCLUSION Lung cancer screening, with its embedded emphasis on smoking cessation, is an excellent addition to PCPs' preventive health care tools. The implementation of formal and pilot lung cancer screening programs across Canada means that PCPs will be increasingly required to counsel their patients around the uptake of lung cancer screening.
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Affiliation(s)
- Anna N Wilkinson
- Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, a family physician with the Ottawa Academic Family Health Team, a general practitioner oncologist at The Ottawa Hospital Cancer Centre, Program Director of PGY-3 FP-Oncology, Chair of the Cancer Care Member Interest Group at the College of Family Physicians of Canada, and Regional Cancer Primary Care Lead for Champlain Region.
| | - Stephen Lam
- Professor of Medicine at the University of British Columbia in Vancouver, a respirologist at BC Cancer, and Distinguished Scientist Leon Judah Blackmore Chair in Lung Cancer Research and Medical Director of the BC Lung Screening Program at the BC Cancer Research Centre
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43
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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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Darrason M, Grolleau E, De Bermont J, Couraud S. UKLS trial: looking beyond negative results. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100184. [PMID: 34806064 PMCID: PMC8589705 DOI: 10.1016/j.lanepe.2021.100184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marie Darrason
- Service de Pneumologie et oncologie thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
- Institut de Recherches Philosophiques de Lyon, Université Jean Moulin Lyon 3, France
| | - Emmanuel Grolleau
- Service de Pneumologie et oncologie thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
- Center for Innovation in Cancer of Lyon, Lyon 1 University, Oullins, France
| | - Julie De Bermont
- Service de Pneumologie et oncologie thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Sébastien Couraud
- Service de Pneumologie et oncologie thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
- Center for Innovation in Cancer of Lyon, Lyon 1 University, Oullins, France
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45
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Linehan V, Harris S, Bhatia R. An Audit of Opportunistic Lung Cancer Screening in a Canadian Province. J Prim Care Community Health 2021; 12:21501327211051484. [PMID: 34663119 PMCID: PMC8529306 DOI: 10.1177/21501327211051484] [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] Open
Abstract
Objectives: Lung cancer is a leading cause of cancer-related death in Canada. Early
detection can improve outcomes and despite recommendations from the Canadian
Task Force on Preventive Health Care to screen patients who are 55 to
74 years old and have a 30+ pack-year history, formal screening programs are
rare in Canada. Our goal was to determine if screening is being performed in
a representative Canadian population, if recommendations are being followed,
and how screening impacts lung cancer stage at diagnosis and prognosis. Methods: A retrospective chart review was performed to identify patients either
screened for lung cancer or imaged due to lung cancer symptoms in Eastern
Newfoundland between 2015 and 2018. Age, smoking history, screening
modality, diagnosis, cancer stage, and mortality were recorded. Results: Under 6.0% of the eligible population were screened for lung cancer with only
28.13% meeting age and smoking criteria and being screened appropriately
with low-dose CT. However, 70% of patients that had lung cancers found by
screening met age and smoking screening criteria. While lung cancer
detection rates were similar, screening detected cancer in patients at an
earlier stage (50% Stage 1) compared to patients who were not screened (20%
Stage 1). Patients who were screened had an improved prognosis. Conclusions: Physicians are opportunistically screening for lung cancer, but not
consistently following screening guidelines. As screening is sensitive,
leads to earlier stage diagnosis, and has a mortality benefit,
implementation of an organized screening program could increase quality
assurance and prevent many lung-cancer related deaths.
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Affiliation(s)
| | | | - Rick Bhatia
- Health Sciences Centre, St. John's, NL, Canada
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46
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Aggarwal R, Lam AC, Huang J, Hueniken K, Nguyen D, Khan K, Shaikh T, Shepherd FA, Tsao MS, Xu W, Kavanagh J, Liu G. Stratification and management of patients ineligible for lung cancer screening. Respir Med 2021; 188:106610. [PMID: 34592536 DOI: 10.1016/j.rmed.2021.106610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/26/2021] [Accepted: 09/05/2021] [Indexed: 11/16/2022]
Abstract
This study identifies participants ineligible for lung cancer screening with the greatest likelihood of future eligibility. Lung cancer risk in participants enrolled in longitudinal lung screening was assessed using the Prostate, Lung, Colorectal and Ovarian lung cancer risk calculator (PLCOm2012) at two timepoints: baseline (T1) and follow-up (T2). Separate analyses were performed on four PLCOm2012 eligibility thresholds (3.25%, 2.00%, 1.50%, and 1.00%); only participants with a T1 risk less than the threshold were included in that analysis. Cox-models identified T1 risk factors associated with screen-eligibility at T2. Three models, applying differing assumptions of participant behavior, predicted future eligibility and were benchmarked against the observed cohort. Nine hundred and fifty-six participants had a T1 risk <3.25%; at 2.00% n= 755; at 1.50% n= 652; at 1.00% n= 484. Lung cancer risk increased over time in most screen-ineligible participants. However, risk increased much faster in participants who became screen-eligible at T2 compared to those who remained screen-ineligible (median per-year increase of 0.35% versus 0.02%, when using a 3.25% threshold). Participants smoking for >30 years, current smokers, less educated participants, and those with chronic obstructive pulmonary disease (COPD) at T1 were significantly more likely to become screen-eligible. New diagnoses of COPD and/or non-lung cancers between T1 and T2 precipitated eligibility in a subset of participants. The prediction model that assumed health behaviors observed at T1 continued to T2 reasonably predicted changes in lung cancer risk. This prediction model and the identified baseline risk factors can identify screen-ineligible participants who should be closely followed for future eligibility.
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Affiliation(s)
- Reenika Aggarwal
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, M5T 3M7, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada
| | - Andrew Cl Lam
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada
| | - Jingyue Huang
- Department of Biostatistics, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Katrina Hueniken
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Daniel Nguyen
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Khaleeq Khan
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Taariq Shaikh
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Frances A Shepherd
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada
| | - Ming-Sound Tsao
- Department of Pathology, Laboratory Medicine, University Health Network, 585 University Ave, Toronto, M5B 2N2, Canada; Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, M5G 1L7, Canada
| | - Wei Xu
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, M5T 3M7, Canada; Department of Biostatistics, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - John Kavanagh
- Joint Department of Medical Imaging, University Health Network, 263 McCaul St, Toronto, M5T 1W7, Canada.
| | - Geoffrey Liu
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, M5T 3M7, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada; Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, M5G 1L7, Canada; Institute of Medical Science, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada; Pharmacology and Toxicology, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada
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47
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Rundo L, Ledda RE, di Noia C, Sala E, Mauri G, Milanese G, Sverzellati N, Apolone G, Gilardi MC, Messa MC, Castiglioni I, Pastorino U. A Low-Dose CT-Based Radiomic Model to Improve Characterization and Screening Recall Intervals of Indeterminate Prevalent Pulmonary Nodules. Diagnostics (Basel) 2021; 11:1610. [PMID: 34573951 PMCID: PMC8471292 DOI: 10.3390/diagnostics11091610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022] Open
Abstract
Lung cancer (LC) is currently one of the main causes of cancer-related deaths worldwide. Low-dose computed tomography (LDCT) of the chest has been proven effective in secondary prevention (i.e., early detection) of LC by several trials. In this work, we investigated the potential impact of radiomics on indeterminate prevalent pulmonary nodule (PN) characterization and risk stratification in subjects undergoing LDCT-based LC screening. As a proof-of-concept for radiomic analyses, the first aim of our study was to assess whether indeterminate PNs could be automatically classified by an LDCT radiomic classifier as solid or sub-solid (first-level classification), and in particular for sub-solid lesions, as non-solid versus part-solid (second-level classification). The second aim of the study was to assess whether an LCDT radiomic classifier could automatically predict PN risk of malignancy, and thus optimize LDCT recall timing in screening programs. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, positive predictive value, negative predictive value, sensitivity, and specificity. The experimental results showed that an LDCT radiomic machine learning classifier can achieve excellent performance for characterization of screen-detected PNs (mean AUC of 0.89 ± 0.02 and 0.80 ± 0.18 on the blinded test dataset for the first-level and second-level classifiers, respectively), providing quantitative information to support clinical management. Our study showed that a radiomic classifier could be used to optimize LDCT recall for indeterminate PNs. According to the performance of such a classifier on the blinded test dataset, within the first 6 months, 46% of the malignant PNs and 38% of the benign ones were identified, improving early detection of LC by doubling the current detection rate of malignant nodules from 23% to 46% at a low cost of false positives. In conclusion, we showed the high potential of LDCT-based radiomics for improving the characterization and optimizing screening recall intervals of indeterminate PNs.
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Affiliation(s)
- Leonardo Rundo
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK;
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK
| | - Roberta Eufrasia Ledda
- Unit of Radiological Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, 43126 Parma, Italy; (R.E.L.); (G.M.); (N.S.)
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (G.A.); (U.P.)
| | - Christian di Noia
- Department of Physics “Giuseppe Occhialini”, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK;
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK
| | - Giancarlo Mauri
- Department of Informatics, Systems and Communication, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Gianluca Milanese
- Unit of Radiological Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, 43126 Parma, Italy; (R.E.L.); (G.M.); (N.S.)
| | - Nicola Sverzellati
- Unit of Radiological Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, 43126 Parma, Italy; (R.E.L.); (G.M.); (N.S.)
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (G.A.); (U.P.)
| | - Maria Carla Gilardi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.C.G.); (M.C.M.)
| | - Maria Cristina Messa
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.C.G.); (M.C.M.)
- Institute of Biomedical Imaging and Physiology, Italian National Research Council (IBFM-CNR), Segrate, 20090 Milan, Italy
- Fondazione Tecnomed, University of Milano-Bicocca, 20900 Monza, Italy
| | - Isabella Castiglioni
- Department of Physics “Giuseppe Occhialini”, University of Milano-Bicocca, 20126 Milan, Italy;
- Institute of Biomedical Imaging and Physiology, Italian National Research Council (IBFM-CNR), Segrate, 20090 Milan, Italy
| | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (G.A.); (U.P.)
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48
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Yeh MCH, Wang YH, Yang HC, Bai KJ, Wang HH, Li YCJ. Artificial Intelligence-Based Prediction of Lung Cancer Risk Using Nonimaging Electronic Medical Records: Deep Learning Approach. J Med Internet Res 2021; 23:e26256. [PMID: 34342588 PMCID: PMC8371476 DOI: 10.2196/26256] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/03/2021] [Accepted: 05/04/2021] [Indexed: 01/20/2023] Open
Abstract
Background Artificial intelligence approaches can integrate complex features and can be used to predict a patient’s risk of developing lung cancer, thereby decreasing the need for unnecessary and expensive diagnostic interventions. Objective The aim of this study was to use electronic medical records to prescreen patients who are at risk of developing lung cancer. Methods We randomly selected 2 million participants from the Taiwan National Health Insurance Research Database who received care between 1999 and 2013. We built a predictive lung cancer screening model with neural networks that were trained and validated using pre-2012 data, and we tested the model prospectively on post-2012 data. An age- and gender-matched subgroup that was 10 times larger than the original lung cancer group was used to assess the predictive power of the electronic medical record. Discrimination (area under the receiver operating characteristic curve [AUC]) and calibration analyses were performed. Results The analysis included 11,617 patients with lung cancer and 1,423,154 control patients. The model achieved AUCs of 0.90 for the overall population and 0.87 in patients ≥55 years of age. The AUC in the matched subgroup was 0.82. The positive predictive value was highest (14.3%) among people aged ≥55 years with a pre-existing history of lung disease. Conclusions Our model achieved excellent performance in predicting lung cancer within 1 year and has potential to be deployed for digital patient screening. Convolution neural networks facilitate the effective use of EMRs to identify individuals at high risk for developing lung cancer.
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Affiliation(s)
- Marvin Chia-Han Yeh
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hsiang Wang
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Jen Bai
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Han Wang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chuan Jack Li
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, School of Medicine, Taipei Medical University, Taipei, Taiwan
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49
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Yasukawa M, Kawaguchi T, Kimura M, Tojo T, Taniguchi S. Implications of Preoperative Transbronchial Lung Biopsy for Non-small Cell Lung Cancer Less than 3-cm. In Vivo 2021; 35:1027-1031. [PMID: 33622898 DOI: 10.21873/invivo.12346] [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: 11/03/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Transbronchial lung biopsy (TBLB) has been recommended for patients with suspected lung cancer. However, its diagnostic value is limited to small lesions, and some studies have indicated that biopsy might be related to metastasis and/or dissemination. This study aimed to evaluate the outcomes after preoperative TBLB for non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS Data were reviewed from 371 patients with resected pN0 NSCLC less than 3-cm. Patients were divided into two groups: TBLB and Non-TBLB. Recurrence-free survival (RFS) curves were plotted using the Kaplan-Meier method. Cox regression analyses were used to evaluate the hazard ratio (HR) with the endpoint RFS. RESULTS The 5-year RFS rates were 75.5% in the TBLB group and 91.4% in the Non-TBLB group (p<0.001). Poor RFS was independently associated with TBLB (HR=2.491, 95%CI=1.337-4.640; p=0.004). CONCLUSION Preoperative TBLB may adversely affect RFS among NSCLC patients with small size tumours.
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Affiliation(s)
- Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan; .,Department of Surgery, Osaka Kaisei Hospital, Osaka, Japan
| | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Michitaka Kimura
- Department of Thoracic Surgery, Saiseikai Chuwa Hospital, Nara, Japan
| | - Takashi Tojo
- Department of Thoracic Surgery, Saiseikai Chuwa Hospital, Nara, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
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50
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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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