scholarly journals ESR/ERS white paper on lung cancer screening

2015 ◽  
Vol 46 (1) ◽  
pp. 28-39 ◽  
Author(s):  
Hans-Ulrich Kauczor ◽  
Lorenzo Bonomo ◽  
Mina Gaga ◽  
Kristiaan Nackaerts ◽  
Nir Peled ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Risk Model ◽  
Lung Cancer Screening ◽  
Chronic Obstructive ◽  
Computer Assisted ◽  
European Respiratory Society ◽  
Effective Radiation Dose ◽  
Central Registry

Lung cancer is the most frequently fatal cancer, with poor survival once the disease is advanced. Annual low dose computed tomography has shown a survival benefit in screening individuals at high risk for lung cancer. Based on the available evidence, the European Society of Radiology and the European Respiratory Society recommend lung cancer screening in comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. Minimum requirements include: standardised operating procedures for low dose image acquisition, computer-assisted nodule evaluation, and positive screening results and their management; inclusion/exclusion criteria; expectation management; and smoking cessation programmes. Further refinements are recommended to increase quality, outcome and cost-effectiveness of lung cancer screening: inclusion of risk models, reduction of effective radiation dose, computer-assisted volumetric measurements and assessment of comorbidities (chronic obstructive pulmonary disease and vascular calcification). All these requirements should be adjusted to the regional infrastructure and healthcare system, in order to exactly define eligibility using a risk model, nodule management and quality assurance plan. The establishment of a central registry, including biobank and image bank, and preferably on a European level, is strongly encouraged.

scholarly journals Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 – Key Elements for Programmatic Implementation of Lung Cancer Screening

2020 ◽  
Author(s):  
Stefan Delorme ◽  
Rudolf Kaaks
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Cancer Registries ◽  
Computer Assisted ◽  
Management Algorithm ◽  
Epidemiologic Surveillance ◽  
Set Up ◽  
High Level

Purpose For screening with low-dose CT (LDCT) to be effective, the benefits must outweigh the potential risks. In large lung cancer screening studies, a mortality reduction of approx. 20 % has been reported, which requires several organizational elements to be achieved in practice. Materials and Methods The elements to be set up are an effective invitation strategy, uniform and quality-assured assessment criteria, and computer-assisted evaluation tools resulting in a nodule management algorithm to assign each nodule the needed workup intensity. For patients with confirmed lung cancer, immediate counseling and guideline-compliant treatment in tightly integrated regional expert centers with expert skills are required. First, pulmonology contacts as well as CT facilities should be available in the participant’s neighborhood. IT infrastructure, linkage to clinical cancer registries, quality management as well as epidemiologic surveillance are also required. Results An effective organization of screening will result in an articulated structure of both widely distributed pulmonology offices as the participants’ primary contacts and CT facilities as well as central expert facilities for supervision of screening activities, individual clarification of suspicious findings, and treatment of proven cancer. Conclusion In order to ensure that the benefits of screening more than outweigh the potential harms and that it will be accepted by the public, a tightly organized structure is needed to ensure wide availability of pulmonologists as first contacts and CT facilities with expert skills and high-level equipment concentrated in central facilities. Key Points:  Citation Format

European lung cancer screening: valuable trial evidence for optimal practice implementation

2022 ◽  
Author(s):  
Mario Silva ◽  
Gianluca Milanese ◽  
Roberta E Ledda ◽  
Sundeep M Nayak ◽  
Ugo Pastorino ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Secondary Prevention ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
European Respiratory Society ◽  
European Society Of Radiology ◽  
Low Dose Computed Tomography ◽  
Practice Implementation ◽  
Trial Evidence

Lung cancer screening (LCS) by low-dose computed tomography is a strategy for secondary prevention of lung cancer. In the last two decades, LCS trials showed several options to practice secondary prevention in association with primary prevention, however, the translation from trial to practice is everything but simple. In 2020, the European Society of Radiology and European Respiratory Society published their joint statement paper on LCS. This commentary aims to provide the readership with detailed description about hurdles and potential solutions that could be encountered in the practice of LCS.

scholarly journals Chronic obstructive pulmonary disease prevalence and prediction in a high-risk lung cancer screening population

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
John R. Goffin ◽  
Gregory R. Pond ◽  
Serge Puksa ◽  
Alain Tremblay ◽  
Michael Johnston ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
High Prevalence ◽  
Screening Population

Abstract Background Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer. Lung cancer screening may provide an opportunity to improve COPD diagnosis. Using Pan-Canadian Early Detection of Lung Cancer (PanCan) study data, the present study sought to determine the following: 1) What is the prevalence of COPD in a lung cancer screening population? 2) Can a model based on clinical and screening low-dose CT scan data predict the likelihood of COPD? Methods The single arm PanCan study recruited current or former smokers age 50–75 who had a calculated risk of lung cancer of at least 2% over 6 years. A baseline health questionnaire, spirometry, and low-dose CT scan were performed. CT scans were assessed by a radiologist for extent and distribution of emphysema. With spirometry as the gold standard, logistic regression was used to assess factors associated with COPD. Results Among 2514 recruited subjects, 1136 (45.2%) met spirometry criteria for COPD, including 833 of 1987 (41.9%) of those with no prior diagnosis, 53.8% of whom had moderate or worse disease. In a multivariate model, age, current smoking status, number of pack-years, presence of dyspnea, wheeze, participation in a high-risk occupation, and emphysema extent on LDCT were all statistically associated with COPD, while the overall model had poor discrimination (c-statistic = 0.627 (95% CI of 0.607 to 0.650). The lowest and the highest risk decile in the model predicted COPD risk of 27.4 and 65.3%. Conclusions COPD had a high prevalence in a lung cancer screening population. While a risk model had poor discrimination, all deciles of risk had a high prevalence of COPD, and spirometry could be considered as an additional test in lung cancer screening programs. Trial registration (Clinical Trial Registration: ClinicalTrials.gov, number NCT00751660, registered September 12, 2008)

scholarly journals ESR/ERS statement paper on lung cancer screening

2020 ◽  
Vol 55 (2) ◽  
pp. 1900506 ◽  
Author(s):  
Hans-Ulrich Kauczor ◽  
Anne-Marie Baird ◽  
Torsten Gerriet Blum ◽  
Lorenzo Bonomo ◽  
Clementine Bostantzoglou ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Tobacco Cessation ◽  
Lung Cancer Screening ◽  
European Respiratory Society ◽  
Family Doctors ◽  
Positive Screen ◽  
New Findings ◽  
Central Registry

In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.

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.

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