Abstract 6347A: Promotion of low-dose computed tomography for early-stage lung cancer detection
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Abstract Background: Lung cancer is the leading cause of cancer-related deaths in the United States. In 2021, it is anticipated that there will be 235,760 cases and 131,880 deaths due to lung cancer in the US, accounting for close to 22% of all cancer related deaths. Lung cancer's high mortality rate is largely due to the fact that approximately 75% of new cases are diagnosed in late stages. On a local level, Winnebago County has 17% higher incidence and mortality rates due to lung cancer than the corresponding national rates. Low-dose computed tomography (LDCT) is a valuable lung screening technique that utilizes 90% less ionizing radiation than a conventional chest CT scan. Hypothesis/Aims: Increased awareness of LDCT in clinical and community settings will lead to increased detection of lung cancer at its early stages and decreased mortality rates attributed to the disease. Study Design: This project harnessed the power of education, specifically through informational seminars and booths at community events, to promote LDCT screening in our community. We spread information on the new U.S. Preventive Services Task Force guidelines to both smokers and physicians in Winnebago County. We evaluated the number of LDCT screenings in Winnebago County between June 2015 and October 2021, and we recorded the number and stage classifications of lung cancer cases detected as a result of these screenings. Lastly, we created a Facebook page (Northern Illinois Lung Cancer Screening Project) to continue promoting LDCT screening in a socially distanced manner. Results: 16 seminars and 42 public awareness booths targeting an estimated 400 physicians and 2,000 smokers were conducted to increase knowledge of LDCT. 4,170 patients underwent LDCT screening at local hospitals during the timeframe of our study. 90 patients were diagnosed with lung cancer, with 50 cases being early stage. 1,264 additional individuals were found to have small lung nodules and are being followed up on in accordance with Lung RADS Criteria on pulmonary nodules detected using LDCT. These studies are being done in Boone, Ogle, and Stephenson Counties, which are also characterized by alarmingly high incidence and mortality rates attributed to lung cancer. In an alternative effort to promote lung cancer screening in Northern Illinois, we created a Facebook page where we publish posts weekly and have reached over 2,177 people and garnered 176 engagements from Facebook users. Conclusions: 50 local community members were diagnosed with early stage lung cancer, thus improving their prognosis and increasing therapy options. Physicians and smokers in the community are more educated on the clinical benefits of LDCT. These community-based studies are being expanded to surrounding areas, and new screening techniques are being implemented to expand the reach and effectiveness of our studies. Citation Format: Shruti Gautam, Roberto E. DeVera IV, Meet Patel, Neelu Puri. Promotion of low-dose computed tomography for early-stage lung cancer detection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6347A.Parallel and often unrelated developments in health care and technology have all been necessary to bring about early detection of lung cancer and the opportunity to decrease mortality from lung cancer through early detection of the disease by computed tomography. Lung cancer screening programs provide education for patients and clinicians, support smoking cessation as primary prevention for lung cancer, and facilitate health care for tobacco-associated diseases, including cardiovascular and chronic lung diseases. Guidelines for lung cancer screening will need to continue to evolve as additional risk factors and screening tests are developed. Data collection from lung cancer screening programs is vital to the further development of fiscally responsible guidelines to increase detection of lung cancer, which may include small groups with elevated risk for reasons other than tobacco exposure.
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To study the mortality rate and its trend in lung cancer patients in Yanting County, Sichuan, P.R.China, during 1969-1997.According to the surveillance death data of the residents in Yanting County, the time series of mortality rates of lung cancer, the average changing speed of mortality rate every year and the proportion of death from lung cancer among all malignant diseases were analyzed. The relationship between the age and the death of lung cancer was explored by birth cohort analysis.The mortality rate of lung cancer increased year by year (Chi-square=457.51, P=0.000). The proportion of death from lung cancer among all malignant diseases remarkably increased year by year (Chi-square=273.29, P=0.000). Both in male and female lung cancer patients, the mortality rate increased with age. And in the later birth group, the mortality rate increased more quickly.The mortality rate of lung cancer patients in Yanting County has significantly gone up during the past 28 years. The prevention and treatment of malignant tumor should be focused on lung cancer.
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This pilot study conducted in Switzerland aims to assess the implementation, execution, and performance of low-dose CT lung cancer screening (LDCT-LCS). With lung cancer being the leading cause of cancer-related deaths in Switzerland, the study seeks to explore the potential impact of screening on reducing mortality rates. However, initiating a lung cancer screening program poses challenges and depends on country-specific factors. This prospective study, initiated in October 2018, enrolled participants meeting the National Lung Cancer Study criteria or a lung cancer risk above 1.5% according to the PLCOm2012 lung cancer risk-model. LDCT scans were assessed using Lung-RADS. Enrollment and follow-up are ongoing. To date, we included 112 participants, with a median age of 62 years (IQR 57–67); 42% were female. The median number of packs smoked each year was 45 (IQR 38–57), and 24% had stopped smoking before enrollment. The mean PLCOm2012 was 3.7% (±2.5%). We diagnosed lung cancer in 3.6% of participants (95%, CI:1.0–12.1%), with various stages, all treated with curative intent. The recall rate for intermediate results (Lung-RADS 3,4a) was 15%. LDCT-LCS in Switzerland, using modified inclusion criteria, is feasible. Further analysis will inform the potential implementation of a comprehensive lung cancer screening program in Switzerland.
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Tumor-associated autoantibodies are considered promising markers for early lung cancer detection; so far, however, their capacity to detect cancer has been tested mostly in a clinical context, but not in population screening settings. This study evaluates the early detection accuracy, in terms of sensitivity and specificity, of EarlyCDT®-Lung-a test panel of seven tumor-associated autoantibodies optimized for lung cancer detection-using blood samples originally collected as part of the German Lung Cancer Screening Intervention Trial.The EarlyCDT®-Lung test was performed for all participants with lung cancer detected via low-dose computed tomography and with available blood samples taken at detection, and for 180 retrospectively selected cancer-free participants at the end of follow-up: 90 randomly selected from among all cancer-free participants (baseline controls) and 90 randomly selected from among cancer-free participants with suspicious imaging findings (suspicious nodules controls). Sensitivity and specificity of lung cancer detection were estimated in the case group and the two control groups, respectively.In the case group, the test panel showed a sensitivity of only 13.0% (95% CI: 4.9-26.3%). Specificity was estimated at 88.9% (95% CI: 80.5-94.5%) in the baseline control group, and 91.1% (95% CI: 83.2-96.1%) among controls presenting CT-detected nodules.The test panel showed insufficient sensitivity for detecting lung cancer at an equally early stage as with low-dose computed tomography screening.
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地方性甲状腺腫は臨床, 病理学的に複雑な経過を示し, 疫学的, 病理学的発生論や治療の選択に多くの難題が残されている. 著者は本症の病期検討および妥当な病期分類がこれらの検索, 解明にきわめて有用であると着目し, 甲状腺剔出を行なった地方性甲状腺腫336例を臨床, 病理学的に精査し下記の結果をえた. 1) 地方性甲状腺腫は臨床的, 病理学的経過からStage 1;過形成期, Stage 2;腫大期, Stage 3;結節形成期と分類できた. 2) 本症は病期の進行に伴い病悩期間は長くなり, 甲状腺腫は増大し種々の局所圧迫症状をみるが, 合併症がなければ全身的, 臨床生化学的所見はほぼ正常である. 3) 臨床, 病理学的に本症はStage 1からStage 2さらにStage 3に進行し, Stage 3は終末期である. 4) 病変の占居部位はStage 1では両葉性, Stage 2では両葉性と単葉性がほぼ等しく, Stage 3では単葉性が多い点からもStageの進行度を裏付けられる. 5) 336例のうち男性39例, 女性297例, 男女比1:7.6で, 発生のピークは女性では20才から30才代, 男性は30才から40才代であった. 6) 手術適応例は若年者より成人に多く, 女性は男性より著しく多い. ヨード治療の効果が若年者ほど良好で, 男性は女性よりもヨード感受性が高いためである. 7) Stage 3の9.4%に甲状腺機能亢進症 (4.03%), 腺腫 (1.34%), 甲状腺癌 (4.03%) などの共存疾患がみられた. 8) ヨード治療はStage 1では効果的であるがStage 2では無効でStage 3に進行し, 種々の合併症を起こすこともあり, Stage 2における手術が望ましい.
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Screening for lung cancer is somewhat controversial in that very few evaluations of the screening process have been made, and even fewer have involved the use of concomitant, unscreened controls.This report of the Mayo Lung Project provides evaluation of a randomly selected 4500 clinic patients, offered screening for lung cancer at four-month intervals for six years.Another 4500 randomly selected controls not offered screening were merely observed.Good screening is defined, the Mayo project is evaluated, and puzzling results are presented and discussed.From the screened group, 98 new cases of lung cancer have been detected, 67 by study screening and 31 by spontaneous reporting of symptoms (15) or by x-ray examinations (16) done in other than study circumstances.From the controls, 64 new lung cancer cases have been detected, 43 by symptoms and 21 by other methods.Lung cancer mortality is 39 for study patients and 41 for controls.There is thus no evidence at this time that early case finding has decreased mortality from lung cancer.
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lung cancer screening: lung cancer screeningNew research finds that low-dose computed tomography (LDCT) lung cancer screening and lung nodule detection and reporting programs are complementary. Combining the two could expand access to early lung cancer detection and curative treatment to different-risk populations, as well as alleviate emerging disparities in access to early lung cancer detection. In a study recently published in the Journal of Clinical Oncology, researchers evaluated two approaches to early lung cancer detection—LDCT and program-based management of incidentally detected lung nodules (2022; doi: 10.1200/JCO.21.02496). “Although lung cancer screening saves lives, implementing low-dose CT lung cancer screenings has been very challenging,” noted Raymond Osarogiagbon, MD, Chief Scientist and Director of the Multidisciplinary Thoracic Oncology Program at Baptist Memorial Health Care, and lead author of the study. Osarogiagbon and his colleagues hypothesized that program-based establishment of guideline-concordant management of incidental lung nodules provides an alternative pathway to early diagnosis of lung cancer. They also noted that the characteristics of lung cancer diagnosed through such programs would be similar to LDCT-detected lung cancer, but “there would be synergy between programs by providing access to different-risk populations.” The authors also hypothesized that lung cancer diagnosed through the two early detection programs—LDCT and incidental lung nodule—would have earlier stage and better outcomes than lung cancer diagnosed outside them, according to Osarogiagbon. He noted that the researchers used Baptist Memorial's multidisciplinary thoracic oncology program to provide lung cancer patients with diagnosis outside these early-detection programs. Study Details The authors conducted a prospective observational study that enrolled patients in the early detection programs. For context, the researchers compared them with patients managed in a multidisciplinary care program, comparing clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer. From 2015 to May 2021, 22,886 patients were enrolled in the study, with nearly 5,700 in LDCT, more than 15,000 in lung nodule, and close to 1,800 in multidisciplinary care. Overall, the researchers found that less than half of patients diagnosed with lung cancer (46%) would have been eligible to receive LDCT based on the U.S. Preventive Services Task Force (USPSTF) 2013 criteria. Fifty-four percent would have been eligible using the 2021 criteria. Still, the team found that the lung nodule program would have been able to identify 20 percent of Stage I and Stage II lung cancer cases among all participating patients diagnosed with the disease, even if all patients deemed eligible for LDCT according to the USPSTF's 2021 recommendation had received the exam. In comparison to those undergoing LDCT, patients diagnosed with lung cancer who participated in the lung nodule program were more likely to be Black, uninsured, and have given up smoking. And, eligibility for lung cancer screening increased across all three programs with the 2021 USPSTF recommendations. There has been a steep rise in the CT scans for diagnostics across North America and Europe since the 1970s, noted Osarogiagbon, adding that these scans often reveal lesions, some of which turn out to be lung cancer. By starting from the point of lesion detection, incidental lung nodule programs avoid several barriers that impair access to LDCT, including limitations of the eligibility criteria, recruitment of eligible patients, and insurance barriers, he noted. “A lot of the patients enrolled into the lung nodule program, for example, had their lesion-detecting CT scan performed in the ED for other reasons. A high proportion of such patients may never otherwise have presented for preventive care services,” Osarogiagbon stated. Ultimately, these results help illustrate the way in which LDCT screening and lung nodule programs can work together to increase patient access to early lung cancer detection and treatment, as well as impact how radiology teams provide care for these patients, he noted. “In terms of sheer volume of diagnosis, for every one lung cancer diagnosed through the LDCT program, five were diagnosed through the lung nodule program; 60 percent of patients in both programs had Stage I/II lung cancer,” Osarogiagbon said. Noting that fewer than 50 percent of the patients diagnosed with lung cancer in the nodule program would have been eligible for LDCT even by the new 2021 USPSTF criteria, “the key intervention with the incidental lung nodule program was to develop an automated means of using the electronic health record system to capture the radiology reports in which the radiologist expressed concern about the presence of a potentially malignant or premalignant lesion,” he explained. “This digital health approach improved the probability of guideline-concordant care, overcoming human errors in the hand off from radiologist to subsequent care delivery teams.” Mark McGraw is a contributing writer.
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