Emphysema Detection in the Course of Lung Cancer Screening: Optimizing a Rare Opportunity to Impact Population Health

Mulshine, James L.; Aldigé, Carolyn; Ambrose, Laurie Fenton; Armato, Samuel G.; Avila, Ricardo S.; Cham, Matt; Estépar, Raúl San Jośe; Fain, S.B.; Gazourian, Lee; Gierada, David S.; Hatt, C.; Henschke, Claudia I.; Hoyos, Jody M.; Lynch, David A.; McGlothlin, Anita K; Oudkerk, Matthijs; Pasquinelli, Mary; Pinsky, Paul F.; Pyenson, Bruce; Rizzo, Albert; Ross, S. M.; Schmitz, Kathryn H.; Silva, Mario; Okwuosa, Tochukwu; Washko, George R.; Wisnivesky, Juan P.; Yankelevitz, David F.; Zulueta, Javier J.

doi:10.1513/annalsats.202207-631ps

Cited by 5 publications

(10 citation statements)

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“…This session further explored issues related to the ability to extract additional imaging information about other tobacco-related diseases such as emphysema on annual thoracic CT screenings performed for lung cancer. 10 Presenters including leading pulmonologists and radiologists explored the ability of widely available quantitative imaging technology and the importance of image quality considerations to routinely detect evidence of early emphysema in asymptomatic screening participants. 13 It is therefore appropriate to consider what next steps could be beneficial for screening subjects found to have emphysema.…”

Section: Clinical Implications Of Reporting Emphysema On Low-dose Ct ...mentioning

confidence: 99%

“…Therefore, getting more important health information from the thoracic CT obtained for lung cancer screening may enhance the value of this process. The QIW Workshop participants recently published a perspective about the opportunity to detect and manage emphysema, highlighting this example of additional health benefits that can emerge by using more complete imaging information routinely available from for the lung cancer screening process 10 . This is a remarkable opportunity in leveraging the monetary investment in lung cancer screening which requires the performance of a low dose CT, since that screening image can also be reviewed for evidence of pulmonary emphysema.…”

Section: Introductionmentioning

confidence: 99%

“…The QIW Workshop participants recently published a perspective about the opportunity to detect and manage emphysema, highlighting this example of additional health benefits that can emerge by using more complete imaging information routinely available from for the lung cancer screening process. 10 This is a remarkable opportunity in leveraging the monetary investment in lung cancer screening which requires the performance of a low dose CT, since that screening image can also be reviewed for evidence of pulmonary emphysema. This additional information can be used to personalize the recommendations for existing preventive interventions such as with smoking cessation if relevant, or with other existing recommendations for pneumococcal and flu vaccination as well as physical activity.…”

mentioning

confidence: 99%

“…We have recently called for urgent research to explore the actual benefit of preventive interventions such as with smoking cessation and increased physical activity as thoracic CT screening routinely detects more case of emphysema and coronary calcium than cases of lung cancer. 10,11 The QIW series has focused on the quality-control issues to acquire a more optimized thoracic CT scan for reliable quantitative assessment for lung cancer now will include robust quality measurements for these three major tobacco-related diseases. This more tobacco-exposure inclusive strategy could convey important health benefits at acceptable cost especially if preventive interventions based on quantitative imaging findings from analysis of annual thoracic CT scans are refined for optimal health benefit in this cohort of older, tobacco-exposed individuals.…”

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confidence: 99%

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Quantitative imaging workshop XIX: Utilizing quantitative thoracic imaging to optimize population health final summary

Mulshine,

Avila,

Rizzo

et al. 2023

Intl Journal of Cancer

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Lung cancer screening involves the use of thoracic CT for both detection and measurements of suspicious lung nodules to guide the screening management. Since lung cancer screening eligibility typically requires age over 50 years along with >20 pack‐year tobacco exposure, thoracic CT scans also frequently reveal evidence for pulmonary emphysema as well as coronary artery calcification. These three thoracic diseases are collectively three of the leading causes of premature death across the world. Screening for the major thoracic diseases in this heavily tobacco‐exposed cohort is broadening the focus of lung cancer screening to a more comprehensive health evaluation including discussing the relevance of screen‐detected findings of the heart and lung parenchyma. The status and implications of these emerging issues were reviewed in a multidisciplinary workshop focused on the process of quantitative imaging in the lung cancer screening setting to guide the evolution of this important new area of public health.

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Section: Clinical Implications Of Reporting Emphysema On Low-dose Ct ...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Quantitative imaging workshop XIX: Utilizing quantitative thoracic imaging to optimize population health final summary

Mulshine,

Avila,

Rizzo

et al. 2023

Intl Journal of Cancer

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show abstract

“…Furthermore, when evaluating the prevalence of conditions often associated with smoking, such as emphysema, it is important to note that 82% of the National Lung Screening Trial participants with emphysema detected at the baseline computed tomography (CT) and 76.5% of International Early Lung Cancer Action Program participants with CT evidence of emphysema did not report a history of emphysema or chronic obstructive pulmonary disease . Reporting these findings to the referring clinician offers an opportunity for intervention …”

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confidence: 99%

Separating Actionable From Incidental Findings—Imperative for Meaningful Clinical Outcomes—Reply

Gareen,

Hoffman,

Tailor

2023

JAMA Intern Med

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Willingness to participate in combination screening for lung cancer, chronic obstructive pulmonary disease and cardiovascular disease in four European countries

Behr,

Koffijberg,

IJzerman

et al. 2023

Eur Radiol

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Objectives Lung cancer screening (LCS), using low-dose computed tomography (LDCT), can be more efficient by simultaneously screening for chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), the Big-3 diseases. This study aimed to determine the willingness to participate in (combinations of) Big-3 screening in four European countries and the relative importance of amendable participation barriers. Methods An online cross-sectional survey aimed at (former) smokers aged 50–75 years elicited the willingness of individuals to participate in Big-3 screening and used analytical hierarchy processing (AHP) to determine the importance of participation barriers. Results Respondents were from France (n = 391), Germany (n = 338), Italy (n = 399), and the Netherlands (n = 342), and consisted of 51.2% men. The willingness to participate in screening was marginally influenced by the diseases screened for (maximum difference of 3.1%, for Big-3 screening (73.4%) vs. lung cancer and COPD screening (70.3%)) and by country (maximum difference of 3.7%, between France (68.5%) and the Netherlands (72.3%)). The largest effect on willingness to participate was personal perceived risk of lung cancer. The most important barriers were the missed cases during screening (weight 0.19) and frequency of screening (weight 0.14), while diseases screened for (weight 0.11) ranked low. Conclusions The difference in willingness to participate in LCS showed marginal increase with inclusion of more diseases and limited variation between countries. A marginal increase in participation might result in a marginal additional benefit of Big-3 screening. The amendable participation barriers are similar to previous studies, and the new criterion, diseases screened for, is relatively unimportant. Clinical relevance statement Adding diseases to combination screening modestly improves participation, driven by personal perceived risk. These findings guide program design and campaigns for lung cancer and Big-3 screening. Benefits of Big-3 screening lie in long-term health and economic impact, not participation increase. Key Points • It is unknown whether or how combination screening might affect participation. • The addition of chronic obstructive pulmonary disease and cardiovascular disease to lung cancer screening resulted in a marginal increase in willingness to participate. • The primary determinant influencing individuals' engagement in such programs is their personal perceived risk of the disease.

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Emphysema Detection in the Course of Lung Cancer Screening: Optimizing a Rare Opportunity to Impact Population Health

Cited by 5 publications

References 45 publications

Quantitative imaging workshop XIX: Utilizing quantitative thoracic imaging to optimize population health final summary

Quantitative imaging workshop XIX: Utilizing quantitative thoracic imaging to optimize population health final summary

Separating Actionable From Incidental Findings—Imperative for Meaningful Clinical Outcomes—Reply

Willingness to participate in combination screening for lung cancer, chronic obstructive pulmonary disease and cardiovascular disease in four European countries

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