Early Detection of Lung Cancer

Pastorino, Ugo

doi:10.1159/000090990

Cited by 50 publications

(33 citation statements)

References 145 publications

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“…In the Mayo CT trial, the cumulative frequency of subjects with suspicious lesions was 74% at 5 years, but only 6% of them proved to have cancer, with a 70% rate of false-positive findings among all participants in the study (Swensen et al, 2005), whereas in the Milan study, using single-slice CT and a cutoff diameter above 5 mm, the frequency of subjects with suspicious lesions was only 19% at 5 years, 20% of whom proved to have cancer, with only 15% false-positive CTs overall (Pastorino, 2006). Nonetheless, the cumulative lung cancer detection rate was 4% in both trials (average 0.8% per year), with other major end points such as resectability and proportion of stage I disease being very similar.…”

Section: Issues Specific To Screening With Spiral Ct Prevalence Of Famentioning

confidence: 83%

Lung cancer screening

Pastorino

2010

Br J Cancer

114

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Lung cancer is the primary cause of cancer mortality in developed countries. First diagnosis only when disease has already reached the metastatic phase is the main reason for failure in treatment. To this regard, although low-dose spiral computed tomography (CT) has proven to be effective in the early detection of lung cancer (providing both higher resectability and higher long-term survival rates), the capacity of annual CT screening to reduce lung cancer mortality in heavy smokers has yet to be demonstrated. Numerous ongoing large-scale randomised trials are under way in high-risk individuals with different study designs. THE MAGNITUDE OF THE PROBLEMLung cancer kills more than 1.3 million people every year (Peto et al, 1996), with figures registering a continual increase in the Far East in countries such as China (Yang et al, 2004). Improvements in clinical management have been modest over the past 20 years, with an overall 5-year survival rate just above 10% in Europe (Verdecchia et al, 2007). Presence of metastatic disease at diagnosis is the main reason for treatment failure, and 5-year survival of patients resected in stage Ia is 470% (Goldstraw et al, 2007). In developed countries, smoking sanctions have achieved a significant reduction in the prevalence of active smokers and lung cancer mortality in males, but not yet in females (Levi et al, 2003). Despite the success of early prevention, a large cohort of former smokers remain at high risk of cancer for many years. PREVIOUS RESEARCH INVOLVING OTHER MODALITIESEarly detection trials with chest radiography (CXR) and sputum cytology, funded by the US National Cancer Institute in the 1970s, were ineffective in decreasing lung cancer mortality, despite the higher proportion of early-stage cancer identified through screening (Melamed et al, 1984). Quite unexpectedly, the 25-year followup of the Mayo trial showed that overall mortality was higher in the CXR arm compared with the standard care arm (difference not reaching statistical significance, P ¼ 0.09), even though the survival rate of lung cancer patients diagnosed at an early stage in the CXR arm was much higher (69 vs 54% at 5 years, median 16 years vs 5 years, respectively) (Marcus et al, 2006). These results confirmed the inefficacy of CXR monitoring, as well as the occurrence of overdiagnosis in the intervention arm. OBSERVATIONAL STUDIES WITH LOW-DOSE SPIRAL CTThe advent of low-dose spiral chest computed tomography (LDCT) opened a new perspective for early diagnosis, and initial studies conducted in Japan in the 1990s demonstrated the potential value of LDCT for lung cancer screening (Kaneko et al, 1996). Since then, the rapid technological development in multislice machines has improved the sensitivity and reliability of spiral CT, providing the concrete possibility of detecting pulmonary lesions of 3 -4 mm in size in a few seconds, without the use of intravenous contrast.In 1999, the Cornell University of New York published the first results of the Early Lung Cancer Action Project (ELCAP), showing...

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Section: Issues Specific To Screening With Spiral Ct Prevalence Of Famentioning

confidence: 83%

Lung cancer screening

Pastorino

2010

Br J Cancer

114

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“…Pulmonary function tests and assessment of FEV1 should be considered when constructing strategies for lung cancer screening, in order to improve selection criteria. In fact, the frequency of benign lesions with last generation multi-slice CT is o50 times higher than lung cancer detection rate (,1% per yr) [38][39][40]. As a consequence, very large numbers of subjects have to be recruited in early lung cancer detection programmes, with a high chance of false-positive results, elevated costs and potential morbidity for the screened population.…”

Section: Discussionmentioning

confidence: 99%

Lung function predicts lung cancer risk in smokers: a tool for targeting screening programmes

Calabrò¹,

Randi²,

Vecchia³

et al. 2009

Eur Respir J

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ABSTRACT:The relationship between smoking, lung cancer and airflow obstruction is recognised but it is unclear whether the presence of minimal lung function damage constitutes an independent risk factor for the development of lung cancer.In order to identify those individuals at higher risk of lung cancer on the basis of functional impairment, we evaluated baseline pulmonary function tests of 3,806 heavy smokers undergoing annual chest computed tomography screening, and compared the forced expiratory volume in 1 s (FEV1) % predicted of 57 lung cancer cases and that of 3,749 subjects without cancer.We obtained odds ratios (ORs) of lung cancer and the corresponding 95% confidence intervals (CIs) using unconditional logistic regression, adjusting for age, sex, study and smoking variables. Compared with subjects with FEV1 o90% pred, the OR of lung cancer was 2.45 (95% CI 1.39-4.33) for subjects with FEV1 ,90% pred and 2.90 (95% CI 1.34-6.27) for subjects with FEV1 ,70% pred.These data show that even a relatively small reduction in FEV1 % pred is a significant predictor of increased lung cancer risk. Test screening for lung cancer using airflow obstruction with FEV1 ,90% is a strategy worth future consideration.

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“…These include the Danish Lung Cancer Screening Trial (DLCST), Multi-centric Italian Lung Detection Trial (MILD), 38,39 Italian Lung cancer Computed Tomography screening trial (ITALUNG), 40,41 Detection and screening of early lung cancer by Novel imaging Technology and molecular assays trials in Italy 42 and the French randomised pilot study, Depiscan. 43 ITALUNG, 41 MILD 38 and DLCST 44 have all reported on their mortality data, which showed no difference in the CT-screened arm; however, none of the studies was powered to provide such a result. 39,41,44 A summary of the European randomised lung cancer screening trials is shown in Table 1.…”

Section: European Lung Cancer Screening Trialsmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

235

231

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BackgroundLung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects.ObjectivesTo (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening.DesignA pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years).SettingThoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire.ParticipantsIndividuals aged 50–75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres.InterventionsA thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria.Main outcome measuresPopulation-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling.ResultsA total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality.ConclusionsThe UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60–75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols.Future workThe UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch–Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation.Trial registrationCurrent Controlled Trials ISRCTN78513845.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.

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Early Detection of Lung Cancer

Cited by 50 publications

References 145 publications

Lung cancer screening

Lung cancer screening

Lung function predicts lung cancer risk in smokers: a tool for targeting screening programmes

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

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