Radiation Risks in Lung Cancer Screening Programs

McCunney, Robert J.; Li, Jessica

doi:10.1378/chest.13-1420

Cited by 101 publications

(47 citation statements)

References 37 publications

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“…FDG binding can also remain for up to 2 years post-scan, and histologic confirmation of recurrence is still required [57]. Furthermore, the availability of PET-CT scans is limited in some regions of the world, and the frequent use of current imaging techniques in the followup of potentially cured early stage NSCLC patients is confounded by cost and repeated radiation exposure [18][19][20]. Given this, there is a need for convenient, cost-effective, and safe alternative approaches for follow-up monitoring in these patients to reduce reliance on imaging techniques.…”

Section: Discussionmentioning

confidence: 99%

“…repeat testing 4 weeks after an abnormal level) could potentially improve the test performance, as shown with other solid tumors [58,59], without substantially increasing cost. Moreover, given the frequency of recurrence in NSCLC [6,7], the need for patients to be closely monitored after initial treatment [9,10], and the limitations of current follow-up imaging techniques outlined earlier [14][15][16][17][18][19][20], a biomarker-based monitoring approach could be particularly useful in this setting.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrence monitoring for NSCLC is based on both a clinical exam and imaging, which can be chest x-ray (CXR), computed tomography (CT), or positron emission tomography (PET) CT scan [11][12][13], with CT scans used most widely in the Western world [12,14]. However, there are limitations to all of these imaging techniques, including variations in sensitivity [14] and specificity [15], high costs [16,17], variable availability, and the risks associated with repeated exposure to radiation [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Potential for the blood-based biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymal protein 4 (HE4) to detect recurrence during monitoring after surgical resection of adenocarcinoma of the lung

Muley

Rolny

et al. 2019

Lung Cancer

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The biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymis protein 4 (HE4) are useful in the diagnosis, prognosis, and monitoring of non-small cell lung cancer (NSCLC), but their combination has not been investigated yet. The objective of this analysis was to evaluate the ability of CYFRA 21-1 and HE4 to predict recurrence as part of follow-up monitoring in patients with adenocarcinoma (ADC) of the lung. Materials and methods: Serum samples were collected from patients with stage I-IIIA ADC preoperatively and during follow-up at 3, 6, 12, 18, and 24 months and then every 6-12 months up to 5 years post-R0 resection. Samples were analyzed for CYFRA 21-1 and HE4 via electrochemiluminescence immunoassay. All cases of disease recurrence were verified by imaging. The diagnostic performance of CYFRA 21-1, HE4, and their combination to predict recurrence was assessed by Receiver Operating Characteristic (ROC) and corresponding area under the curve (AUC). Results: 115 patients with ADC were included (N = 612 biomarker measurements); median age was 63 years; most had stage I-II disease (n = 97; 84.3%). All patients underwent surgical resection; 44 patients (38%) also received adjuvant chemotherapy and 16 (14%) received radiation therapy. At the median timepoint for the last blood sample collection (37 months), 31 patients (27%) had experienced recurrence. Both CYFRA 21-1 and HE4 were able to detect recurrence (AUC and 95% confidence interval [CI]): 75.9% (66.0-85.8%) and 75.4% (65.9-84.8%), respectively, but this increased with the combination (78.8% [69.0-88.6%]). At a sensitivity of 80%, the respective specificities (95% CI) for CYFRA 21-1, HE4, and the combination were 57.1% (53.0-61.2%), 57.1% (53.0-61.2%), and 69.7% (65.8-73.4%). Conclusion: Serial measurements of serum CYFRA 21-1 and HE4 levels could provide a valuable method for follow-up monitoring of patients with ADC to detect recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Potential for the blood-based biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymal protein 4 (HE4) to detect recurrence during monitoring after surgical resection of adenocarcinoma of the lung

Muley

Rolny

et al. 2019

Lung Cancer

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“…In one analysis, the authors estimated the lifetime attributable risk of radiation-related lung cancer mortality, assuming annual LDCT examinations from age 55 to age 74 years, with a technique like that of the NLST, to be approximately 0.07% for males and 0.14% for females. 77 Other estimates of cumulative radiation exposure and health impact include: one cancer death caused by radiation per 2,500 persons screened with the NLST protocol 78 ; cumulative radiation doses exceeding lifetime radiation exposures of nuclear power workers and atomic bomb survivors 79 ; lower expected lung cancer mortality reduction when radiation risk is incorporated into models of the benefit of LDCT screening 80 ; and the need for substantial mortality reduction from LDCT screening to overcome the radiation risk (eg, 25% for female never smokers aged 50-52 years, 2% for male active smokers aged 50-52 years). 81…”

Section: Cost-effectiveness: Picomentioning

confidence: 99%

Screening for Lung Cancer

Mazzone

Silvestri

Patel

et al. 2018

Chest

285

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“…Radiation risk grows strongly if follow-up scans are performed using standard clinical protocols (old equipment 4–18 mSv, new equipment 2–4 mSv [ 61 ]) instead of screening with LDCT settings (new equipment 0.2 mSv [ 56 ]). For this reason, the work-ups of screen-detected nodules should remain within the screening programme as long as possible [ 62 ].…”

Section: Overdiagnosismentioning

confidence: 99%

ESR/ERS white paper on lung cancer screening

Bonomo²,

et al. 2015

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Lung cancer is the most frequently fatal cancer, with poor survival once the disease is advanced. Annual low-dose computed tomography has shown a survival benefit in screening individuals at high risk for lung cancer. Based on the available evidence, the European Society of Radiology and the European Respiratory Society recommend lung cancer screening in comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. Minimum requirements include: standardised operating procedures for low-dose image acquisition, computer-assisted nodule evaluation, and positive screening results and their management; inclusion/exclusion criteria; expectation management; and smoking cessation programmes. Further refinements are recommended to increase quality, outcome and cost-effectiveness of lung cancer screening: inclusion of risk models, reduction of effective radiation dose, computer-assisted volumetric measurements and assessment of comorbidities (chronic obstructive pulmonary disease and vascular calcification). All these requirements should be adjusted to the regional infrastructure and healthcare system, in order to exactly define eligibility using a risk model, nodule management and a quality assurance plan. The establishment of a central registry, including a biobank and an image bank, and preferably on a European level, is strongly encouraged.Key points• Lung cancer screening using low dose computed tomography reduces mortality.• Leading US medical societies recommend large scale screening for high-risk individuals.• There are no lung cancer screening recommendations or reimbursed screening programmes in Europe as of yet.• The European Society of Radiology and the European Respiratory Society recommend lung cancer screening within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres.• High risk, eligible individuals should be enrolled in comprehensive, quality-controlled longitudinal programmes.

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Radiation Risks in Lung Cancer Screening Programs

Cited by 101 publications

References 37 publications

Potential for the blood-based biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymal protein 4 (HE4) to detect recurrence during monitoring after surgical resection of adenocarcinoma of the lung

Potential for the blood-based biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymal protein 4 (HE4) to detect recurrence during monitoring after surgical resection of adenocarcinoma of the lung

Screening for Lung Cancer

ESR/ERS white paper on lung cancer screening

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