Screening for Early Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease (the Big-3) Using Low-dose Chest Computed Tomography

Abstract

Lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease are highly prevalent in the general population and expected to cause most deaths by 2050. For these "Big-3," treatment might cure, delay, or stop the progression of disease at a very early stage. Lung nodule growth rate (a biomarker for lung cancer), emphysema/air trapping (a biomarker for chronic obstructive pulmonary disease), and coronary artery calcification (a biomarker for cardiovascular disease) are imaging biomarkers of early stages of the Big-3 that can be acquired with low-dose computed tomography (CT). We hypothesize that a (combined) lowdose CT examination for detection of all 3 diseases may significantly improve the cost-effectiveness of screening in the future. We review the current evidence of the imaging biomarkers for the detection of the Big-3 diseases and present the potential health economic potential of Big-3 screening. Furthermore, we review the low-dose CT protocols to acquire these biomarkers and describe the technical considerations when combining the CT protocols for the different biomarkers.

Computed Tomography Screening for Early Lung Cancer, COPD and Cardiovascular Disease in Shanghai: Rationale and Design of a Population-based Comparative Study

“…Namely, volume-based management for lung nodules is associated with a far lower rate of unnecessary referral as compared to diameter-based management, with a comparable lung cancer detection rate in a European population 18 . Besides, a review indicated that screening for COPD and CVD, in addition to lung cancer, may significantly increase the benefits of low-dose CT lung cancer screening 19 . Given the large disease burden caused by the Big-3 in China, a developing country with limited medical resources 20 , introducing quantitative CT screening for Big-3 diseases could have a positive impact on the Chinese healthcare and society by reducing the rate of unnecessary referrals for further investigation in terms of lung nodules detection and increasing screening benefits.…”

Improved trends of lung cancer mortality‐to‐incidence ratios in countries with high healthcare expenditure

“…Developed countries are able to spend more money on screening tools such as computed tomography (CT), perform more kinds of advanced surgeries involving, for example, videoassisted techniques, and provide more precise therapies such as image-guided radiotherapy (IGRT) and immunotherapy. 7,12,13 All these therapies show benefits on survival. 7 The incidence and mortality rates for lung cancer are relatively high in developed countries such as North America.…”

Prevent Cancer Foundation quantitative CT imaging workshop XVI: lung cancer, COPD and cardiovascular disease - on the cusp of transformation, Arlington, VA

“…Could implementation of lung cancer screening implementation be hindered due to concerns with the complex management of two other leading causes of death (CAD and COPD) in this heavily tobacco-exposed cohort? Fortunately, this appears unlikely as integrating care for the three leading causes of tobacco-related chronic disease is already happening at leading screening centers [38]. A more inclusive approach with thoracic CT imaging in tobacco-exposed cohorts will be disseminated through existing support for lung cancer screening, which is already federally reimbursed.…”

“…In this fashion, routinely acquiring additional information about the two other leading causes of premature death (COPD and heart disease) can be done at an incremental cost within the screening effort. Leading screening programs already have considerable experience in performing this multi-disease screening, with clinicians already integrating this complex imaging information into productive discussions with individuals undergoing such screening [38].…”