Variation in the efficacy of low-dose computed tomographic lung screening based on risk of lung cancer mortality in the National Lung Screening Trial.

1523 Background: Low-dose computed tomography (LDCT) screening reduced lung cancer mortality by 20% in the National Lung Screening Trial (NLST). The efficacy of LDCT screening could be improved by targeting smokers at highest risk of lung cancer death, provided that the efficacy of LDCT screening increases with lung cancer mortality risk. Methods: We evaluated the efficacy of LDCT screening as compared to chest radiography in the NLST across groups defined by participants’ 5-year risk of lung cancer mortality at randomization, which was estimated using a validated prediction model. Across quintiles of 5-year lung cancer mortality risk [Q1: 0.15%-0.55%, Q2: 0.56%-0.84%, Q3: 0.85%-1.24%, Q4: 1.24%-2.0%, Q5: >2.0%], we estimated the number of participants with false positive screens, the number of prevented lung cancer deaths, and their ratio. Results: The number of prevented lung cancer deaths due to LDCT screening increased in tandem with lung cancer mortality risk (Q1=0.2, Q2=3.5, Q3=5.1, Q4=11.0, Q5=12.0 per 10,000 person-years; P-trend=0.01). The number of participants with false positive screens per lung cancer death prevented, a measure of screening efficiency, significantly decreased with increasing risk (Q1=1,648, Q2=181, Q3=147, Q4=64, Q5=65, P-trend<0.001). The 60% of participants at highest 5-year lung cancer mortality risk (0.85% or greater) accounted for 88% of LDCT-preventable lung cancer deaths and included only 64% of participants with a false positive screen. The 20% of participants at lowest lung cancer mortality risk (0.15%-0.55%) accounted for only 1% of LDCT-preventable lung cancer deaths. Conclusions: In the NLST, LDCT screening prevented the most lung cancer mortality among those at highest lung cancer mortality risk and prevented almost no mortality among those at lowest risk, providing empirical support for risk-based targeting of smokers to improve the efficacy of LDCT screening.

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Portable stove use is associated with lower lung cancer mortality risk in lifetime smoky coal users

British Journal of Cancer ◽

10.1038/sj.bjc.6604744 ◽

2008 ◽

Vol 99 (11) ◽

pp. 1934-1939 ◽

Cited By ~ 36

Author(s):

H D Hosgood ◽

R Chapman ◽

M Shen ◽

A Blair ◽

E Chen ◽

...

Keyword(s):

Lung Cancer ◽

Mortality Risk ◽

Cancer Mortality ◽

Lung Cancer Mortality ◽

Lower Lung ◽

Smoky Coal ◽

Cancer Mortality Risk

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BMI, long-term changes in BMI, and risk of cancer mortality in a large cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.1502 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 1502-1502

Author(s):

Niloofar Taghizadeh ◽

Judith M. Vonk ◽

H. Marike Boezen

Keyword(s):

Breast Cancer ◽

Prostate Cancer ◽

Lung Cancer ◽

Cohort Study ◽

Mortality Risk ◽

Cancer Mortality ◽

Lung Cancer Mortality ◽

Prostate Cancer Mortality ◽

Risk Of Mortality ◽

Cancer Mortality Risk

1502 Background: There are indications of an association between Body Mass Index (BMI) and risk of different cancer types. There is dispute whether this association differs between males and females. Methods: We studied the association of BMI at the first survey with risk of mortality from the most common types of cancer (lung, colorectal, breast and prostate cancer) in a large general population-based cohort study (Vlagtwedde-Vlaardingen, 1965-1990) with follow-up on mortality status until 2009. Additionally, we assessed this association based on tertiles of the annual change in BMI (defined as the difference between BMI at last survey and first survey divided by the time between last and first survey). We used 3 categories of BMI (< 25 kg/m2, 25-30 kg/m2, and ≥ 30 kg/m2) and changes in BMI (< 0.02 kg/m2/yr, 0.02-0.2 kg/m2/yr, and > 0.2 kg/m2/yr) in the analyses. The multivariate Cox regression model was adjusted for age, smoking, gender. Analyses were additionally stratified by gender and smoking. Results: Among all 8645 subjects, 1194 died due to cancer (lung cancer: 275; colorectal cancer: 134; breast cancer: 117; prostate cancer: 83). Mortality from all types of cancer was significantly increased in subjects with BMI > 30 kg/m2 (HR (95 % CI)) = 1.22 (1.00-1.48)), especially in females (1.38 (1.06-1.81)) and in never smokers (1.39 (1.02-1.90)). Prostate cancer mortality was significantly increased in males with BMI 25-30 kg/m2 (2.04 (1.90-3.83)) and > 30 kg/m2 (2.61 (1.02-6.67)). This association between prostate cancer mortality and BMI was higher in smokers. Lung cancer mortality risk was decreased in subjects with BMI 25-30 kg/m2 (0.71 (0.54-0.93)) and > 30 kg/m2 (0.82 (0.50-1.32)), especially in males, in smokers, and in smoking males. There were no significant associations between BMI and colorectal or breast cancer mortality nor between change in BMI and mortality from all analyzed types of cancer. Conclusions: We show that an increase in BMI is associated with an increased risk of mortality from all types of cancer in females and with an increased mortality risk from prostate cancer in males but with a decreased lung cancer mortality risk, especially in males. More research is needed into the biological mechanisms that link BMI to cancer.

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Poster: A lung cancer mortality risk calculator based on SEER data

2011 IEEE 1st International Conference on Computational Advances in Bio and Medical Sciences (ICCABS) ◽

10.1109/iccabs.2011.5729887 ◽

2011 ◽

Cited By ~ 2

Author(s):

Ankit Agrawal ◽

Sanchit Misra ◽

Ramanathan Narayanan ◽

Lalith Polepeddi ◽

Alok Choudhary

Keyword(s):

Lung Cancer ◽

Mortality Risk ◽

Cancer Mortality ◽

Lung Cancer Mortality ◽

Risk Calculator ◽

Seer Data ◽

Cancer Mortality Risk

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False-positive screens and lung cancer risk in the National Lung Screening Trial: Implications for shared decision-making

Journal of Medical Screening ◽

10.1177/0969141317727771 ◽

2017 ◽

Vol 25 (2) ◽

pp. 110-112 ◽

Cited By ~ 19

Author(s):

Paul F Pinsky ◽

Christina R Bellinger ◽

David P Miller

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Risk ◽

False Positive ◽

Low Dose ◽

Lung Cancer Risk ◽

National Lung Screening Trial ◽

Low Dose Computed Tomography ◽

Lung Screening ◽

Screening Trial

Objectives Low-dose computed tomography lung cancer screening has been shown to reduce lung cancer mortality but has a high false-positive rate. The precision medicine approach to low-dose computed tomography screening assesses subjects’ benefits versus harms based on their personal lung cancer risk, where harms include false-positive screens and resultant invasive procedures. We assess the relationship between lung cancer risk and the rate of false-positive LDCT screens. Methods The National Lung Screening Trial randomized high-risk subjects to three annual screens with low-dose computed tomography or chest radiographs. Following the completion of National Lung Screening Trial, the Lung CT Screening Reporting and Data System (Lung-RADS) classification system was developed and retrospectively applied to National Lung Screening Trial low-dose computed tomography findings. The rate of false-positive screens (by Lung-RADS) and the resultant invasive procedures were examined as a function of lung cancer risk estimated by a model. Results Of 26,722 subjects randomized to the low-dose computed tomography arm, 26,309 received a baseline screen and were included in the analysis. The proportion with any false positive over three screening rounds increased from 12.9% to 25.9% from lowest to highest risk decile, and the proportion with an invasive procedure following a false positive also significantly increased from 0.7% to 2.0% from lowest to highest risk decile. Conclusion These findings indicate a need for personalized low-dose computed tomography lung cancer screening decision aids to accurately convey the benefits to harm trade-off.

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