Protocol and Rationale for the International Lung Screening Trial

Lim, Kuan Pin; Marshall, Henry; Tammemägi, Martin C.; Brims, Fraser; McWilliams, Annette; Stone, Emily; Manser, Renée; Canfell, Karen; Weber, Marianne; Connelly, Luke B.; Bowman, Rayleen V.; Yang, Ian A.; Fogarty, Paul; Mayo, John R.; Yee, John; Myers, Renelle; Atkar-Khattra, Sukhinder; Lam, David Chi‐Leung; Rosell, Antoni; Berg, Christine D.; Fong, Kwun M.; Lam, Stephen

doi:10.1513/annalsats.201902-102oc

Cited by 63 publications

(72 citation statements)

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“…A high standard of image quality is of importance in a LDCT lung cancer screening program. 32,41,[44][45][46][51][52][53][54][55][56][57][58][59][60] It should be noted that the Fleischner Society nodule guideline was created to guide management and follow-up of incidentally found pulmonary nodules, not screen-detected nodules. 57,58 Some guidelines are based on 2-D diameter size measurement while others use volumetric measurement or a combination of both.…”

Section: Updating This Statementmentioning

confidence: 99%

“…It is based on the PanCan lung nodule risk prediction model, which was built on data from the Pan-Canadian Early Detection of Lung Cancer Study baseline scans. 25,[59][60][61] The PanCan Protocol is the only one that allows for a 24-month follow-up after the baseline LDCT instead of the annual repeat screening mandated by other guidelines. The biennial 45 ; China practice guideline 55 ; Japan Society of CT Screening Society 56 ; Fleischner Society.…”

Section: Updating This Statementmentioning

confidence: 99%

“…To facilitate the use of lung nodule management guideline without separate protocols for different nodule types after the baseline scan, the PanCan lung nodule malignancy prediction tool was developed. 25,47,[59][60][61] It takes into account the nodule types (solid, nonsolid or part-solid), location, spiculation, number of lung nodules, emphysema, as well as age, gender and family history of lung cancer. The prediction tool (https://brocku.ca/lung-cancer-screening-and-riskprediction/risk-calculators/) has been validated in several studies in different settings by different research groups.…”

Section: Updating This Statementmentioning

confidence: 99%

“…32,51,52 One of the greatest strengths of the PanCan nodule malignancy risk calculator is identification of individuals with very low risk nodules who may have the next scheduled screening in two years instead of annually. 25,49,[59][60][61] Biennial screening protocol in 80% of low risk screenees instead of annual screening would have a significant impact on resource utilization. 49,61 Further prospective studies are needed to determine if the small subset of screenees without lung nodules or very low risk nodules, which is estimated to be <0.5%, 5,25,44,49,59,[61][62][63][64][65] may benefit from annual instead of biennial screening following the baseline LDCT can be identified.…”

Section: Updating This Statementmentioning

confidence: 99%

“…Often, "positive" screens, depending on definition of positive, do not require referral or any other workup beyond a repeat LDCT. 32,45,51,60 Providing guidance in the radiology report may limit over investigation. However, when referral is recommended for a very high-risk nodule (e.g., Lung RADS 4B/4X), radiologists should emphasize that negative diagnostic work up would be discordant and should prompt multidisciplinary discussion.…”

Section: Q How Can Screening Reports Best Guide Referring Physiciansmentioning

confidence: 99%

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Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

Lam

Bryant

Donahoe

et al. 2020

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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Section: Updating This Statementmentioning

confidence: 99%

Section: Updating This Statementmentioning

confidence: 99%

Section: Updating This Statementmentioning

confidence: 99%

Section: Updating This Statementmentioning

confidence: 99%

Section: Q How Can Screening Reports Best Guide Referring Physiciansmentioning

confidence: 99%

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Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

Lam

Bryant

Donahoe

et al. 2020

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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Screening for Lung Cancer

Force¹,

Krist

Davidson

et al. 2021

JAMA

1,014

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ung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228 820 persons were diagnosed with lung cancer, and 135 720 persons died of the disease. 1 Themostimportantriskfactorforlungcancerissmoking. 2,3 Smok-ingisestimatedtoaccountforabout90%ofalllungcancercases, 2 with a relative risk of lung cancer approximately 20-fold higher in smokers than in nonsmokers. 3 Increasing age is also a risk factor for lung cancer. The median age of diagnosis of lung cancer is 70 years. 4,5 Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. 1 However, early-stage lung cancer has a better prognosis and is more amenable to treatment. IMPORTANCE Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228 820 persons were diagnosed with lung cancer, and 135 720 persons died of the disease. The most important risk factor for lung cancer is smoking. Increasing age is also a risk factor for lung cancer. Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. However, early-stage lung cancer has a better prognosis and is more amenable to treatment.OBJECTIVE To update its 2013 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the accuracy of screening for lung cancer with low-dose computed tomography (LDCT) and on the benefits and harms of screening for lung cancer and commissioned a collaborative modeling study to provide information about the optimum age at which to begin and end screening, the optimal screening interval, and the relative benefits and harms of different screening strategies compared with modified versions of multivariate risk prediction models.POPULATION This recommendation statement applies to adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. EVIDENCE ASSESSMENTThe USPSTF concludes with moderate certainty that annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking.RECOMMENDATION The USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation) This recommendation replaces the 2013 USPSTF statement that recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

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Comparison Between the 2021 USPSTF Lung Cancer Screening Criteria and Other Lung Cancer Screening Criteria for Racial Disparity in Eligibility

Lusk

Neslund‐Dudas

et al. 2022

JAMA Oncol

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ImportanceIn 2021, the US Preventive Services Task Force (USPSTF) broadened its age and smoking pack-year requirement for lung cancer screening.ObjectivesTo compare the 2021 USPSTF lung cancer screening criteria with other lung cancer screening criteria and evaluate whether the sensitivity and specificity of these criteria differ by race.Design, Setting, and ParticipantsThis study included 912 patients with lung cancer and 1457 controls without lung cancer enrolled in an epidemiology study (INHALE [Inflammation, Health, Ancestry, and Lung Epidemiology]) in the Detroit metropolitan area between May 15, 2012, and March 31, 2018. Patients with lung cancer and controls were 21 to 89 years of age; patients with lung cancer who were never smokers and controls who were never smokers were not included in these analyses. Statistical analysis was performed from August 31, 2020, to April 13, 2021.Main Outcomes and MeasuresThe study assessed whether patients with lung cancer and controls would have qualified for lung cancer screening using the 2013 USPSTF, 2021 USPSTF, and 2012 modification of the model from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCOm2012) screening criteria. Sensitivity was defined as the percentage of patients with lung cancer who qualified for screening, while specificity was defined as the percentage of controls who did not qualify for lung cancer screening.ResultsParticipants included 912 patients with a lung cancer diagnosis (493 women [54%]; mean [SD] age, 63.7 [9.5] years) and 1457 control participants without lung cancer at enrollment (795 women [55%]; mean [SD] age, 60.4 [9.6] years). With the use of 2021 USPSTF criteria, 590 patients with lung cancer (65%) were eligible for screening compared with 619 patients (68%) per the PLCOm2012 criteria and 445 patients (49%) per the 2013 USPSTF criteria. With the use of 2013 USPSTF criteria, significantly more White patients than African American patients with lung cancer (324 of 625 [52%] vs 121 of 287 [42%]) would have been eligible for screening. This racial disparity was absent when using 2021 USPSTF criteria (408 of 625 [65%] White patients vs 182 of 287 [63%] African American patients) and PLCOm2012 criteria (427 of 625 [68%] White patients vs 192 of 287 [67%] African American patients). The 2013 USPSTF criteria excluded 950 control participants (65%), while the PLCOm2012 criteria excluded 843 control participants (58%), and the 2021 USPSTF criteria excluded 709 control participants (49%). The 2013 USPSTF criteria excluded fewer White control participants than African American control participants (514 of 838 [61%] vs 436 of 619 [70%]). This racial disparity is again absent when using 2021 USPSTF criteria (401 of 838 [48%] White patients vs 308 of 619 [50%] African American patients) and PLCOm2012 guidelines (475 of 838 [57%] White patients vs 368 of 619 [60%] African American patients).Conclusions and RelevanceThis study suggests that the USPSTF 2021 guideline changes improve on earlier, fixed screening criteria for lung cancer, broadening eligibility and reducing the racial disparity in access to screening.

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Protocol and Rationale for the International Lung Screening Trial

Cited by 63 publications

References 46 publications

Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

Screening for Lung Cancer

Comparison Between the 2021 USPSTF Lung Cancer Screening Criteria and Other Lung Cancer Screening Criteria for Racial Disparity in Eligibility

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