scholarly journals Implementation of targeted screening for lung cancer in a high-risk population within routine NHS practice using low-dose computed tomography

Thorax ◽  
2020 ◽  
Vol 75 (4) ◽  
pp. 348-350 ◽  
Author(s):  
Helen Grover ◽  
Thomas Ross ◽  
Elizabeth Fuller
Keyword(s):  
Lung Cancer ◽  
Low Dose ◽  
Screening Programme ◽  
Early Stage ◽  
High Risk Population ◽  
Curative Intent ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Targeted Screening ◽  
Low Dose Computed Tomography

We report a primary care-based lung cancer targeted screening programme using low-dose CT (LDCT) in South Tyneside and Sunderland. Ever smokers with ≥10 pack-years aged 55–74 years were identified at annual COPD review. 925 individuals attended for LDCT. 2% (n=19/925) had lung cancer diagnosed. 66.7% (n=14/21) had early stage disease and 78.9% (n=15/19) were offered treatment with curative intent. 79.3% of individuals attending for LDCT were ranked in the lowest deprivation quintiles. This approach has been successfully established in routine NHS practice; it is effective with improvements in stage of disease and engages individuals in deprived areas.

LOW-DOSE COMPUTED TOMOGRAPHY IN MOSCOW FOR LUNG CANCER SCREENING (LDCT-MLCS): BASELINE RESULTS

2019 ◽  
Vol 65 (2) ◽  
pp. 224-233
Author(s):  
Sergey Morozov ◽  
Viktor Gombolevskiy ◽  
Anton Vladzimirskiy ◽  
Albina Laypan ◽  
Pavel Kononets ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Early Stage ◽  
Lung Cancer Screening ◽  
Stage I ◽  
Malignant Neoplasms ◽  
Number Needed To Screen ◽  
Low Dose Computed Tomography

Study aim. To justify selective lung cancer screening via low-dose computed tomography and evaluate its effectiveness. Materials and methods. In 2017 we have concluded the baseline stage of “Lowdose computed tomography in Moscow for lung cancer screening (LDCT-MLCS)” trial. The trial included 10 outpatient clinics with 64-detector CT units (Toshiba Aquilion 64 and Toshiba CLX). Special low-dose protocols have been developed for each unit with maximum effective dose of 1 mSv (in accordance with the requirements of paragraph 2.2.1, Sanitary Regulations 2.6.1.1192-03). The study involved 5,310 patients (53% men, 47% women) aged 18-92 years (mean age 62 years). Diagnosis verification was carried out in the specialized medical organizations via consultations, additional instrumental, laboratory as well as pathohistological studies. The results were then entered into the “National Cancer Registry”. Results. 5310 patients (53% men, 47% women) aged 18 to 92 years (an average of 62 years) participated in the LDCT-MLCS. The final cohort was comprised of 4762 (89.6%) patients. We have detected 291 (6.1%) Lung-RADS 3 lesions, 228 (4.8%) Lung- RADS 4A lesions and 196 (4.1%) Lung-RADS 4B/4X lesions. All 4B and 4X lesions were routed in accordance with the project's methodology and legislative documents. Malignant neoplasms were verified in 84 cases (1.76% of the cohort). Stage I-II lung cancer was actively detected in 40.3% of these individuals. For the first time in the Russian Federation we have calculated the number needed to screen (NNS) to identify one lung cancer (NNS=57) and to detect one Stage I lung cancer (NNS=207). Conclusions. Based on the global experience and our own practices, we argue that selective LDCT is the most systematic solution to the problem of early-stage lung cancer screening.

scholarly journals Surgery in Small-Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 390
Author(s):  
Nicola Martucci ◽  
Alessandro Morabito ◽  
Antonello La Rocca ◽  
Giuseppe De Luca ◽  
Rossella De Cecio ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Stage I ◽  
Phase Iii ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease

Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies conducted in the 1960s and the 1980s reported negative results with surgery in SCLC patients with early-stage disease and, thereafter, surgery has been largely discouraged. Instead, several subsequent prospective studies have demonstrated the feasibility of a multimodality approach including surgery before or after chemotherapy and followed in most studies by thoracic radiotherapy, with a 5-year survival probability of 36–63% for patients with completely resected stage I SCLC. These results were substantially confirmed by retrospective studies and by large, population-based studies, conducted in the last 40 years, showing the benefit of surgery, particularly lobectomy, in selected patients with early-stage SCLC. On these bases, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging: in these cases, lobectomy with mediastinal lymphadenectomy is considered the standard approach. In all cases, surgery can be offered only as part of a multimodal treatment, which includes chemotherapy with or without radiotherapy and after a proper multidisciplinary evaluation.

scholarly journals Ten years of experience in lung cancer screening in Gdańsk, Poland: a comparative study of the evaluation and surgical treatment of 14 200 participants of 2 lung cancer screening programmes

2019 ◽  
Vol 29 (2) ◽  
pp. 266-274 ◽  
Author(s):  
Marcin Ostrowski ◽  
Tomasz Marjański ◽  
Robert Dziedzic ◽  
Małgorzata Jelitto-Górska ◽  
Katarzyna Dziadziuszko ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Pilot Study ◽  
Low Dose ◽  
Screening Programme ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Diagnostic Work ◽  
Low Dose Computed Tomography ◽  
Tomography Scan

Abstract OBJECTIVES The European Society of Thoracic Surgeons’ recommendations confirm the implementation of lung cancer screening in Europe. We compared 2 screening programmes, the Pilot Pomeranian Lung Cancer Screening Programme (pilot study) and the Moltest Bis programme, completed in a single centre. METHODS A total of 8649 healthy volunteers (aged 50–75 years, smoking history ≥20 pack-years) were enrolled in a pilot study between 2009 and 2011, and a total of 5534 healthy volunteers (aged 50–79, smoking history ≥30 pack-years) were enrolled in the Moltest Bis programme between 2016 and 2017. Each participant had a low-dose computed tomography scan of the chest. Participants with a nodule diameter of >10 mm or with suspected tumour morphology underwent a diagnostic work-up in the pilot study. In the Moltest Bis programme, the criteria were based on the volume of the detected nodule on the baseline low-dose computed tomography scan and the volume doubling time in the subsequent rounds. RESULTS Lung cancer was diagnosed in 107 (1.24%) and 105 (1.90%) participants of the pilot study and of the Moltest Bis programme, respectively (P = 0.002). A total of 300 (3.5%) and 199 (3.6%) patients, respectively, were referred for further invasive diagnostic work-ups (P = 0.69). A total of 125 (1.5%) and 80 (1.5%) patients, respectively, underwent surgical resection (P = 0.74). The number of resected benign lesions was similar: 44 (35.0%) and 20 (25.0%), respectively (P = 0.13), but with a downwards trend. Lobectomies and/or segmentectomies were performed in 84.0% and 90.0% of patients with lung cancer, respectively (P = 0.22). Notably, patients in the Moltest Bis programme underwent video-assisted thoracoscopic surgery more often than did those in the pilot study (72.5% vs 24.0%, P < 0.001). Surgical patients with stages I and II non-small-cell lung cancer (NSCLC) accounted for 83.4% of the Moltest patients and 86.4% of the pilot study patients (P = 0.44). CONCLUSIONS Modified inclusion criteria in the screening programme lead to a higher detection rate of NSCLC. Growing expertise in lung cancer screening leads to increased indications for minimally invasive surgery and an increased proportion of lung-sparing resections. A single-team experience in lung cancer screening does not lead to a major reduction in the rate of diagnostic procedures and operations for non-malignant lesions.

CT findings of early-stage small cell lung cancer in a low-dose CT screening programme

Lung Cancer ◽  
2007 ◽  
Vol 56 (2) ◽  
pp. 207-215 ◽  
Author(s):  
Shusuke Sone ◽  
Tomio Nakayama ◽  
Takayuki Honda ◽  
Kenji Tsushima ◽  
Feng Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Low Dose ◽  
Screening Programme ◽  
Early Stage ◽  
Small Cell ◽  
Small Cell Lung ◽  
Ct Screening ◽  
Low Dose Ct

scholarly journals Cost-effectiveness analysis of low-dose computed tomography screening for lung cancer in Hungary

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Z Voko ◽  
A Molnar ◽  
V Valay ◽  
M Moizs ◽  
A Kerpel-Fronius ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Low Dose ◽  
Screening Programme ◽  
Risk Group ◽  
Lung Cancer Screening ◽  
Cost Effective ◽  
Low Dose Computed Tomography

Abstract Background Hungary has the highest incidence of lung cancer in the world (GLOBOCAN, 2018). Since lung cancer is rarely treatable in its advanced stage, one possible way to reduce mortality is early diagnosis and subsequent treatment. The possibility and necessity of introducing low-dose computed tomography (LDCT) lung cancer screening as a public health programme is a current and relevant health policy issue. Methods A Markov cohort model was built to assess the cost-effectiveness of such a risk group screening programme in Hungary. The model was populated with transition probabilities and resource utilization data derived from the HUNCHEST Hungarian lung cancer screening trial. The model results are presented in incremental cost-effectiveness ratio. Results A closed cohort of 10,000 smokers with the average starting age of 59 years was followed over life-time horizon and screened for lung cancer annually until the age of 74. Compared to the current scenario of no organized lung cancer screening in Hungary, the model resulted in an additional 0.1614 life-year gained per individual and an additional 0.2924 disease-free life-year gained per individual with annual screening frequency. The incremental cost-effectiveness ratio was EUR 608 indicating that assessed intervention is cost-effective in the analyzed setting. Sensitivity analyses confirmed the robustness of the model results. Conclusions Results suggest that introducing low-dose computed tomography screening for lung cancer is a cost-effective intervention in Hungary. Considering the exceptionally high incidence and mortality of lung cancer in Hungary, the population could benefit from such a risk group screening programme. Key messages Low-dose computed tomography screening for lung cancer is cost-effectiveness in the Hungarian setting. Policy makers are encouraged to consider the introduction of a risk group screening programme.

scholarly journals Epithelial cell migration as a potential therapeutic target in early lung cancer

2017 ◽  
Vol 26 (143) ◽  
pp. 160069 ◽  
Author(s):  
Fraser R. Millar ◽  
Sam M. Janes ◽  
Adam Giangreco
Keyword(s):  
Lung Cancer ◽  
Cell Migration ◽  
Rho Gtpase ◽  
Early Stage ◽  
Cancer Type ◽  
Preclinical Research ◽  
Early Stage Lung Cancer ◽  
Early Stage Disease ◽  
Early Lung Cancer ◽  
Stage Disease

Lung cancer is the most lethal cancer type worldwide, with the majority of patients presenting with advanced stage disease. Targeting early stage disease pathogenesis would allow dramatic improvements in lung cancer patient survival. Recently, cell migration has been shown to be an integral process in early lung cancer ontogeny, with preinvasive lung cancer cells shown to migrate across normal epithelium prior to developing into invasive disease. TP53 mutations are the most abundant mutations in human nonsmall cell lung cancers and have been shown to increase cell migrationviaregulation of Rho-GTPase protein activity. In this review, we explore the possibility of targeting TP53-mediated Rho-GTPase activity in early lung cancer and the opportunities for translating this preclinical research into effective therapies for early stage lung cancer patients.

Clinical and molecular characteristics of non-small cell lung cancer patients from rural Maine.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18237-e18237
Author(s):  
Antoine Harb ◽  
Adam Curtis ◽  
Laura Skacel ◽  
Michael Babcock ◽  
Marek Skacel
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
P53 Mutation ◽  
Small Cell ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Disease Free

e18237 Background: Non-Small Cell Lung Cancer (NSCLC) is the most common malignancy worldwide and the leading cause of malignancy-related mortality in the United States. The state of Maine in particular, has one of the highest rates of lung cancer in the country. Methods: We reviewed all NSCLC patients (adenocarcinoma (AC) and squamous cell (SC) histology) diagnosed between January 2017 and June 2018 at Northern Light Cancer Institute. 261 patients with clinical follow-up were identified. We correlated their clinical characteristics with molecular abnormalities identified by Next Generation Sequencing (NGS) and Fluorescence in situ hybridization, PD-L1 status by immunohistochemistry, disease-free and overall survival. Results: 210 patients had AC and 51 SC. They were evenly split between men and women. The median age at diagnosis was 68 years. 99% of patients were Caucasian. 15 patients were never smokers, the rest were equally divided between active and previous smokers. 44% had early stage disease (I/II) and 56% had late stage disease (III/IV) on presentation. 36.4% had a PD-L1 high status. The frequencies of the molecular aberrations identified in AC and SC are listed in the table below: Treatment differed by stage, including surgery/Radiation +/- adjuvant chemotherapy for early stage disease, definitive chemo-radiation followed by immunotherapy for stage III disease. Stage IV patients were treated with immunotherapy, combination chemo-immunotherapy, targeted therapy, palliative radiation and hospice referral. After a median follow-up of 10.6 months, overall survival (OS) was 66%. Disease free survival (DFS) was 33%. Using univariate (chi-square), multivariate (logistic regression) and Kaplan-Meier (log rank) analyses, we identified that in addition to a high clinical stage, which was associated with shorter OS and DFS, high PD-L1 status, and the presence of p53 mutation, were independent predictors of shorter OS, and p53 mutation of shorter DFS. Conclusions: NGS-based molecular testing deployed in real-time non-academic setting proved to be a valuable tool to identify therapeutic and prognostic targets in NSCLC. Besides those endorsed by the NCCN guidelines, p53 mutation is a common abnormality associated with adverse outcomes. While high PD-L1 expression is a desirable immunotherapy marker, its presence also predicted adverse overall outcomes in our patients.[Table: see text]

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