Finding needles in a haystack: annual low-dose computed tomography screening reduces lung cancer mortality in a high-risk group

Lung cancer is the most common cause of death from cancer in the United States. Previous studies of screening with chest radiographs and sputum cytology have not been shown to decrease lung cancer mortality. For the first time, a randomized screening trial with low-dose computed tomography scans has demonstrated a 20% lung cancer mortality reduction compared with screenings with a chest x-ray. Investigation is underway on many breath, sputum, and blood biomarkers to determine markers of high risk. The hope is that some (or one) of them will add to the early detection of lung cancer observed with low-dose computed tomography.

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Estimate of Lung Cancer Mortality From Low-Dose Spiral Computed Tomography Screening Trials: Implications for Current Mass Screening Recommendations

Journal of Clinical Oncology ◽

10.1200/jco.2004.12.046 ◽

2004 ◽

Vol 22 (11) ◽

pp. 2202-2206 ◽

Cited By ~ 48

Author(s):

Edward F. Patz ◽

Stephen J. Swensen ◽

James E. Herndon

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

High Risk ◽

Mass Screening ◽

Cancer Mortality ◽

Low Dose ◽

Lung Cancer Mortality ◽

High Risk Population ◽

Ct Screening ◽

Screening Trials

Purpose Low-dose computed tomography (CT) has been suggested for lung cancer screening. Several observational trials have published their preliminary results, and some investigators suggest that this technique will save lives. There are no mortality statistics, however, and the current study used published data from these trials to estimate the disease-specific mortality in this high-risk population. Patients and Methods Two nonrandomized CT screening trials were selected from the literature for analysis. The number of trial participants, the number of lung cancers diagnosed per year, and stage distribution of the cancers was recorded. Previously published 5-year survival data were used to calculate the number of predicted lung cancer deaths and estimate the overall lung cancer mortality per 1,000 person-years among participants screened. These statistics were then compared to the previous Mayo Lung Project, which used chest radiographs and sputum cytology for screening high-risk individuals. Results This study estimates the lung cancer mortality is 4.1 deaths per 1,000 person-years in the Mayo Clinic CT screening trial, and is 5.5 deaths per 1,000 person-years in the Early Lung Cancer Action Program trial. These data are similar to the lung cancer mortality of 4.4 deaths per 1,000 person-years in the interventional arm, and 3.9 deaths per 1,000 person-years in the usual-care arm of the previous Mayo Lung Project. Conclusion These data suggest that CT screening could produce similar outcomes to prior chest radiographic trials in this high-risk group. Results from randomized trials are required, however, before the true utility of mass screening with CT for lung cancer can be determined.

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ELIGIBILITY FOR LOW-DOSE COMPUTED TOMOGRAPHY LUNG CANCER SCREENING IN OLDER ASIAN AMERICAN SMOKERS

Innovation in Aging ◽

10.1093/geroni/igz038.679 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S189-S189

Author(s):

Chien-Ching Li ◽

Kelsey Choi ◽

Alicia Matthews ◽

Raj Shah

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Asian American ◽

Low Dose ◽

Task Force ◽

Significant Proportion ◽

Lung Cancer Screening ◽

Lung Cancer Mortality ◽

Eligibility Criteria ◽

Low Dose Computed Tomography

Abstract Lung cancer is the leading cause of cancer-related deaths in Asian Americans. Low-dose computed tomography lung cancer (LDCT) screening is an effective way to decrease lung cancer mortality. This study aimed to examine the difference in LDCT screening eligibility among Asian American subgroups. The National Health Interview Survey data (2006-2016) was analyzed. The U.S. Preventive Services Task Force guideline was used to determine the LDCT eligibility. A higher and statistically significant proportion of current Filipino smokers (35.4%) met LDCT screening eligibility criteria compared to Chinese (26.5%) and other Asian smokers (22.7%) (p=0.02). Hierarchical logistic regression results further showed that Filipino were more likely to meet LDCT screening criteria than other Asian while adjusting demographics (OR=1.87; p=0.01). The differences in LDCT screening eligibility no longer existed after additionally adjusting socioeconomic factors as well as perceived health status. Future targeted outreach and intervention research is needed for Filipinos with lower socioeconomic status.

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Screening values of carcinoembryonic antigen and cytokeratin 19 fragment for lung cancer in combination with low-dose computed tomography in high-risk populations: Initial and 2-year screening outcomes

Lung Cancer ◽

10.1016/j.lungcan.2018.05.012 ◽

2018 ◽

Vol 122 ◽

pp. 243-248

Author(s):

Natthaya Triphuridet ◽

Sirachat Vidhyarkorn ◽

Akeanong Worakitsitisatorn ◽

Thaniya Sricharunrat ◽

Narongchai Teerayathanakul ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

High Risk ◽

Carcinoembryonic Antigen ◽

Low Dose ◽

Cytokeratin 19 ◽

High Risk Populations ◽

Low Dose Computed Tomography ◽

Cytokeratin 19 Fragment

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

European Journal of Public Health ◽

10.1093/eurpub/ckz186.293 ◽

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.

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