The evidence behind lung cancer screening: a narrative review of randomized clinical trials

PURPOSE This meta-analysis aims to combine and analyze randomized clinical trials comparing computed tomography lung screening (CTLS) versus either no screening (NS) or chest x-ray (CXR) in subjects with cigarette smoking history, to provide a precise and reliable estimation of the benefits and harms associated with CTLS. MATERIALS AND METHODS Data from all published randomized trials comparing CTLS versus either NS or CXR in a highly tobacco-exposed population were collected, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses by comparator (NS or CXR) were performed. Pooled risk ratio (RR) and relative 95% CIs were calculated for dichotomous outcomes. The certainty of the evidence was assessed using the GRADE approach. RESULTS Nine eligible trials (88,497 patients) were included. Pooled analysis showed that CTLS is associated with: a significant reduction of lung cancer–related mortality (overall RR, 0.87; 95% CI, 0.78 to 0.98; NS RR, 0.80; 95% CI, 0.69 to 0.92); a significant increase of early-stage tumors diagnosis (overall RR, 2.84; 95% CI 1.76 to 4.58; NS RR, 3.33; 95% CI, 2.27 to 4.89; CXR RR, 1.52; 95% CI, 1.04 to 2.23); a significant decrease of late-stage tumors diagnosis (overall RR, 0.75; 95% CI, 0.68 to 0.83; NS RR, 0.67; 95% CI, 0.56 to 0.80); a significant increase of resectability rate (NS RR, 2.57; 95% CI, 1.76 to 3.74); a nonsignificant reduction of all-cause mortality (overall RR, 0.99; 95% CI, 0.94 to 1.05); and a significant increase of overdiagnosis rate (NS, 38%; 95% CI, 14 to 63). The analysis of lung cancer–related mortality by sex revealed nonsignificant differences between men and women ( P = .21; I-squared = 33.6%). CONCLUSION Despite there still being uncertainty about overdiagnosis estimate, this meta-analysis suggested that the CTLS benefits outweigh harms, in subjects with cigarette smoking history, ultimately supporting the systematic implementation of lung cancer screening worldwide.

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A narrative review of lung cancer screening in underserved populations

Current Challenges in Thoracic Surgery ◽

10.21037/ccts-2020-lcs-07 ◽

2021 ◽

Vol 0 ◽

pp. 0-0

Author(s):

Omar Toubat ◽

Elizabeth A. David

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Underserved Populations ◽

Lung Cancer Screening ◽

Narrative Review

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Biomarkers in lung cancer screening: a narrative review

Current Challenges in Thoracic Surgery ◽

10.21037/ccts-2020-lcs-06 ◽

2021 ◽

Vol 0 ◽

pp. 0-0

Author(s):

Hannah N. Marmor ◽

J. Tyler Zorn ◽

Stephen A. Deppen ◽

Pierre P. Massion ◽

Eric L. Grogan

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Narrative Review

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A narrative review of lung cancer screening: risks of lung cancer screening

Current Challenges in Thoracic Surgery ◽

10.21037/ccts-2020-lcs-08 ◽

2021 ◽

Vol 0 ◽

pp. 0-0

Author(s):

Natthaya Triphuridet ◽

David F. Yankelevitz ◽

Andrea Wolf

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Narrative Review

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Lung cancer screening strategy for non-high-risk individuals: a narrative review

Translational Lung Cancer Research ◽

10.21037/tlcr-20-943 ◽

2021 ◽

Vol 10 (1) ◽

pp. 452-461

Author(s):

Fangqiu Fu ◽

Yaodong Zhou ◽

Yang Zhang ◽

Haiquan Chen

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

High Risk ◽

Lung Cancer Screening ◽

Screening Strategy ◽

Narrative Review

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Lung Cancer Screening and Smoking Cessation Clinical Trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201705-0909ci ◽

2018 ◽

Vol 197 (2) ◽

pp. 172-182 ◽

Cited By ~ 30

Author(s):

Anne M. Joseph ◽

Alexander J. Rothman ◽

Daniel Almirall ◽

Abbie Begnaud ◽

Caroline Chiles ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Trials ◽

Smoking Cessation ◽

Cancer Screening ◽

Lung Cancer Screening

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AB0253 A REVIEW OF SMOKING CESSATION STRATEGIES AND LUNG CANCER SCREENING PRACTICES IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4751 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1426.2-1426

Author(s):

M. A. Lopez-Olivo ◽

R. Volk ◽

K. J. Krause ◽

M. Suarez-Almazor

Keyword(s):

Rheumatoid Arthritis ◽

Lung Cancer ◽

Smoking Cessation ◽

Cancer Screening ◽

Randomized Clinical Trials ◽

Case Reports ◽

Lung Cancer Screening ◽

Nicotine Replacement ◽

Screening Practices ◽

Quit Smoking

Background:Smoking rates among patients with rheumatoid arthritis (RA) exceed those reported in the general population. In addition, people with RA who smoke are more likely to develop lung cancer than smokers who do not have RA.Objectives:To identify smoking cessation strategies and lung cancer screening practices in patients with RA.Methods:We conducted a review of the literature in electronic databases (i.e., PubMed, EMBASE, Cochrane, Scopus, and Web of Science) from inception until June 2019. We included studies that reported on the results of interventions for smoking cessation or lung cancer screening in patients with RA. We excluded case reports, reviews, guidelines, protocols, or studies on tobacco use not reporting interventions. We included studies published in abstract or full-text format. We extracted study and intervention characteristics including delivery format, timing and results.Results:We retrieved 394 relevant citations and ultimately included 9 studies evaluating smoking cessation strategies, and one regarding lung cancer screening practices. Five studies were reported in abstract format. There were 3 studies conducted in the United Kingdom, and one each in Croatia, France, Ireland, New Zealand, Sweden, Spain and United States. Two studies were randomized control trials and the remaining were uncontrolled. Follow-up ranged between 1 month and 24 months, however, one study only reported data on the assessment immediately after the intervention. Sample sizes ranged between 20 and 185 current smokers. Smoking cessation strategies included: 1) brief advice and nicotine replacement therapy + smoking cessation counseling for 3 months; 2) information booklet on harms of smoking (i.e., impact on disease and treatment); 3) spoken information on harms of smoking (i.e., impact on disease and treatment) plus advice to quit smoking; 4) advice to quit smoking plus nicotine replacement; 5) smoking cessation support with contact every 4 weeks; 6) spoken information on harms of smoking (i.e., impact on disease and treatment) plus advice to quit smoking plus nurse telephone visit at 3rdmonth; 6) staff driven tobacco QUIT line referral process; 7) multi-modality intervention with advise to quit smoking plus guidance on safe alcohol use plus dietary advise with booklet and swimming group. The lung cancer screening study reported on a program with nurse evaluation of comorbidities and risk factors, and recommendations for lung cancer screening with a chest X-ray and smoking cessation. Most studies reported benefits when implementing a structured plan to educate, counsel, and offer pharmacological treatment to patients with RA.Conclusion:There was large heterogeneity among studies in patient characteristics and interventions proposed, and outcomes. Only 2 studies were randomized clinical trials. Additional controlled studies are needed to determine best practices for smoking cessation and lung cancer screening in patients with RA.Disclosure of Interests:None declared

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Community-based lung cancer screening adherence to Lung-RADS recommendations.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10540 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10540-10540

Author(s):

Roger Kim ◽

Katharine A. Rendle ◽

Christine Neslund-Dudas ◽

Robert T. Greenlee ◽

Andrea N. Burnett-Hartman ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Trials ◽

Cancer Screening ◽

Family Income ◽

Smoking Status ◽

Lung Cancer Screening ◽

System Level ◽

Community Based ◽

Screening Process ◽

Former Smokers

10540 Background: In the NLST and NELSON trials, most low-dose CT (LDCT) screen-detected lung cancers were not diagnosed during the first round of screening, suggesting that longitudinal adherence to lung cancer screening (LCS) recommendations is key. Adherence was as high as 95% in clinical trials, but limited data exist regarding LCS adherence in clinical practice. We aimed to determine adherence to Lung-RADS recommendations among community-based patients undergoing LCS. Methods: We performed a multicenter retrospective cohort study of patients screened for lung cancer at healthcare systems within the Lung Population-based Research to Optimize the Screening Process (PROSPR) Consortium. We included 55-80 year-old current or former smokers who received a baseline (T0) LDCT with a Lung-RADS score between January 1, 2015 and September 30, 2017 and excluded patients who were diagnosed with lung cancer prior to the T0 scan. Over a 24-month period, we calculated the proportion of patients adherent to Lung-RADS recommendations and evaluated associations with patient-level (age, sex, race, ethnicity, smoking status, body mass index, Elixhauser comorbidities, year of T0 scan, and Lung-RADS score) and census tract (median family income, level of education) data, using multivariable logistic regression with mixed effects to account for site variability. Results: Of the 6,723 patients in our cohort (median age 65 years [IQR 60-69]; 45.1% female; 73.0% white; 59.0% current smokers), 5,583 (83.0%) had Lung-RADS 1 or 2 T0 scans, 733 (10.9%) Lung-RADS 3, 274 (4.1%) Lung-RADS 4A, and 133 (2.0%) Lung-RADS 4B or 4X. Overall, 55.2% (3,709/6,723) of patients were adherent (Table). In the final multivariable model, Black patients had reduced adherence compared to white patients (adjusted odds ratio [aOR] 0.79, 95% CI 0.66-0.94), while greater adherence was observed in former smokers compared to current smokers (aOR 1.33, 95% 1.19-1.49). Compared to individuals with a negative T0 scan (Lung-RADS 1 or 2), those with Lung-RADS 3 (aOR 1.56, 95% CI 1.31-1.86), 4A (aOR 1.63, 95% CI 1.24-2.15), or 4B/4X (aOR 3.59, 95% CI 2.30-5.60) T0 scans had greater odds of adherence. Conclusions: In the largest study of real-world patients receiving LCS to date, adherence to Lung-RADS recommendations is lower than previously observed in clinical trials. Our results highlight the need for further study of system-level mechanisms to improve longitudinal LCS adherence rates.[Table: see text]

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