Benefits Of Lung Cancer Screening Research Articles

An Enhanced Shared Decision Making Model to Address Willingness and Ability to Undergo Lung Cancer Screening and Follow-Up Treatment in Minority Underserved Populations.

Failure to address willingness and ability to undergo lung cancer treatment before lung cancer screening could cause patients unnecessary anxiety, cost and care. We employed an enhanced shared decision making (SDM) model to address willingness and ability to undergo lung cancer screening of low dose CT (LDCT) scanning. We hypothesized that enhanced SDM was feasible and did not discourage patients from undergoing lung cancer screening. We performed a prospective study of patients referred for lung cancer screening. We measured adherence to the LCS protocol, including consent to discuss lung cancer treatment if cancer is found and direct questions to patients about willingness and ability to undergo lung cancer treatment. We measured race, gender, adherence to the consent process and questions regarding willingness and ability to undergo lung cancer treatment and subsequent uptake of LDCT. All 190 patients have a documented SDM visit addressing the risks and benefits of lung cancer screening and consented to discuss lung cancer treatment if lung cancer is diagnosed. One hundred and seventy-nine (179) of 190 (94%) answered yes to being willing and able to undergo lung cancer treatment. One hundred and eighty-seven (187) patients underwent LDCT (98.4%). Discussion about willingness and ability to undergo lung cancer treatment should be an essential component of a SDM discussion prior to LDCT. This study demonstrated that an enhanced SDM experience is feasible in a clinical setting. Furthermore, patients proceeded with LDCT following the enhanced SDM process.

Abstract PR16: Effect of cancer risk and patient preferences on net benefit of lung cancer screening: A personalized lung cancer screening model

Abstract Background: Most low-dose computed tomography (LDCT) lung cancer screening guidelines recommend shared-decision making (SDM) before initiating screening. Indeed, Medicare requires evidence of SDM for reimbursement. The clinical benefit of screening, however, varies dramatically across eligible patients. Also, the harms of LDCT, such as fear and unnecessary procedures incurred by false positive results, can be quite substantive. Clinicians and health systems, therefore, need individually tailored screening guidance, depending on the extent of benefit. To this end, we developed the Personalized Lung Cancer Screening Model, a microsimulation model that estimates individual-specific health gain from LDCT screening. This model evaluates the potential effects of patient preferences on health gains across low- and high-benefit groups. Methods: We estimated the effects of LDCT screening on lung cancer outcomes and quality-adjusted life years (QALYs). Our natural history model was built based on previously validated lung cancer models, constructed by utilizing different data sources: two large randomized lung cancer screening trials (NLST and PLCO) and the Surveillance, Epidemiology and End-Results cancer registry. For this study, we simulated a nationally representative sample of 1 million patients eligible for LDCT screening, whose risk profiles mimic adult smokers participated in the National Health Interview Study (NHIS) from 2010 to 2014. We quantified patient preferences using literature-derived utilities (e.g., the burden of testing, false-positive diagnoses, treatment, and complications that result from the screening and treatment process). Besides inherent uncertainty in some utility measures, our primary aim was to understand the effect of varying patient preferences on the net benefit of screening. Therefore, we performed a further analysis by varying utilities over a plausible range. Results: Our model predictions of lung cancer incidence and mortality rates in the NLST and PLCO participants matched well to the observed rates. Similarly, average incremental QALY gains were consistent with that found in a previous NLST-based cost-effectiveness analysis. Among the simulated NHIS population, incremental QALY gains varied significantly across differing baseline risk of developing lung cancer (range in base-case analysis: 2 QALYs lost per 100 people screened to 6 QALYs gained per 100 screened). Our analysis for patient preferences showed that the magnitude of net benefit from LDCT screening is not very sensitive to patient's views of the burdens and harms of testing and treatment if the patient's baseline lung cancer risk was above the third decile. That is, even assuming unfavorable preferences, those above 3rd decile of risk generally experienced net benefit, while the less than 3rd decile of baseline risk was a more preferences sensitive zone. Conclusion: Results from our Personalized Lung Cancer Screening Model demonstrate the importance of an individual's estimated baseline lung cancer risk in determining net benefit from LDCT screening. In addition, we found that patient preferences play an important role to determine the extent of net benefit. These findings support the use of a decision-support tool through shared decision making, rather than recommending screening uniformly. This abstract is also being presented as Poster B19. Citation Format: Pianpian Cao, Tanner Caverly, Rodney Hayward, Rafael Meza. Effect of cancer risk and patient preferences on net benefit of lung cancer screening: A personalized lung cancer screening model. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr PR16.

Abstract B19: Effect of cancer risk and patient preferences on net benefit of lung cancer screening: A Personalized Lung Cancer Screening Model

Abstract This abstract is being presented as a short talk in the scientific program. A full abstract is printed in the Proffered Abstracts section (PR16) of the Conference Proceedings. Citation Format: Pianpian Cao, Tanner Caverly, Rodney Hayward, Rafael Meza. Effect of cancer risk and patient preferences on net benefit of lung cancer screening: A Personalized Lung Cancer Screening Model. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr B19.

Lung cancer screening on YouTube: Difficulty of finding balanced information.

162 Background: Lung cancer (LC) is the leading cause of cancer mortality in the US, the ACS estimates upwards of 220,000 new cases will be diagnosed this year. Recently, the Center for Medicare/Medicaid Services (CMS) agreed to cover LC screening with low-dose CT for patients however, CMS requires prior documentation of a shared-decision making (SDM) visit between the patient and the referring clinician to inform them about risks of screening. LC Screening programs have begun to use YouTube for patient recruitment, education and marketing of screening. The objective of this study is to shed light on the role of YouTube in lung cancer screening in terms of guidelines, screening options, target population, steps after screening, and risks and benefits of screening. Methods: We searched YouTube.com to identify videos dealing with lung screening using the keywords: lung cancer screening. Videos without sound, uploaded before 2009, longer than 20 minutes, duplicates and videos in a language other than English were excluded. This method yielded 124 videos that fit criteria. Videos were coded for inclusion of LC screening process, risks and benefits of screening, screening guidelines, risk factors for LC, and treatment options after LC diagnosis. Results: 124 videos had a cumulative 262753 views. 38.7% of the videos included no mention of CMS guidelines. Only 30% included any mention of the risks associated with screening; 14% mentioned false positives, 12% radiation; 4% anxiety associated with screening though 92% of all videos sampled were intended for patients. 91% of videos explained the benefits associated with cancer screening however, only 26% explained the actual process of screening. The majority of videos were created by medical institutions (66%). No videos sampled included false information. Conclusions: While most videos highlighted the benefits of LC screening, YouTube can’t serve as a replacement for SDM visits due to inadequate discussion of risks of screening. A substantially low number of videos (30%) discussed the risks of lung cancer screening. Given the high rate of false positives, radiation and anxiety associated with screening, patients need to be made aware of these risks so they can make an informed decision.

Second primary lung cancer in the United States: 1992–2008.

309 Background: Tobacco smoke is a known risk factor for both bladder and lung cancer. We hypothesized that bladder cancer survivors are at high risk for second primary lung cancers (SPLC), and sought to describe the incidence and mortality attributable to SPLC among survivors of bladder cancer as well as other common cancers in the United States. Methods: We identified adult patients diagnosed with a localized primary malignancy from 8 of the most common non-pulmonary cancer sites in Surveillance, Epidemiology, and End Results (SEER) data from 1992–2008. We explored factors associated with the incidence and mortality from SPLC using bivariable and multivariable models. Finally, we compared standardized incidence rates (SIRs) for SPLC in our cohort with the control arm of the National Lung Screening Trial (NLST), a large lung cancer screening trial in patients at high risk for lung cancer. Results: We identified 1,431,809 survivors of common non-pulmonary cancers, of whom 24,477 (1.7%) developed SPLC at a mean (SD) follow-up of 5.7 (3.6) years. Bladder cancer survivors developed SPLC at twice the rate of other cancer survivors, with 10% developing SPLC in the 20 years following their bladder cancer diagnosis. Increasing age and male gender were independent risk factors for SPLC, irrespective of the primary cancer type. Of patients who developed SPLC, 19,059 (78%) died during follow-up. Lung cancer was responsible for 73% of these deaths, such that over half (57%) of the cancer survivors who develop SPLC ultimately died of lung cancer. Bladder cancer survivors demonstrated a SIR of 512 cases/100,000 person-years, which approaches the rate (572 cases/100,000 person-years) seen in the control arm of the NLST. Conclusions: Over half of patients who develop SPLC died of their disease. Almost 10% of bladder cancer survivors develop SPLC in the 20-years following their diagnosis. This rate approaches that seen in the control arm of the NLST, suggesting that the incidence in bladder cancer survivors could justify lung cancer screening in this population. Further efforts to better define the potential risks and benefits of lung cancer screening in bladder cancer survivors is warranted.

P1.03-060 Lung Cancer Screening: A Qualitative Study Exploring the Decision to Opt Out of Screening

Lung cancer screening (LCS) with annual low-dose computed tomography is relatively new for long-term smokers in the US supported by a US Preventive Services Task Force Grade B recommendation. As LCS programs are more widely implemented and providers engage patients about LCS, it is critical to understand what influences the decision to screen, or not, for lung cancer. Understanding LCS behavior among high-risk smokers who opt out provides insight, from the patient perspective, about the shared decision-making (SDM) process. This study explored LCS-eligible patients’ decision to opt out of LCS after receiving a provider recommendation. New knowledge will inform intervention development to enhance SDM processes between high-risk smokers and their provider, and decrease decisional conflict about LCS. Semi-structured qualitative interviews were performed with 18 LCS-eligible men and women who were members of an integrated healthcare system in Seattle about their decision to opt out of screening. Participants met LCS criteria for age, smoking and pack-year history. Audio-recorded interviews were transcribed verbatim. Two researchers with cancer screening and qualitative expertise conducted data analysis using thematic content analytic procedures. Participant mean age was 66 years (SD 6.5). Majority were female (61%), Caucasian (83%), current smokers (61%). Five themes emerged: 1) Knowledge Avoidance; 2) Perceived Low Value; 3) False Positive Worry; 4) Practical Barriers; and 5) Misunderstanding. Representative thematic example quotes are presented in the Table below.Tabled 1Knowledge Avoidance“It’s fear of the unknown…if I know, you have to follow through and do more and more.”Perceived Low Value“It could show me if I had lung cancer…what are they going to do?...screening doesn’t really make any difference...”False Positive Worry“I did schedule one…then after I read the print out, I canceled it…the false positives were so high. I thought why… that would be so stressful…”Practical Barriers“I really didn’t have time to get over there.”Misunderstanding“I wasn’t hurting or having any problems breathing…wasn’t a top priority for me” [reflecting misunderstanding of the concept of screening] Open table in a new tab Many screening-eligible smokers opt out of LCS. Participants in our study provided new insights into why some patients make this choice. LCS is effective in early lung cancer detection among high-risk patients. However, LCS has associated risks and harms making the SDM process critical. Understanding why people decide not to screen will enhance future efforts to improve knowledge transfer from providers to patients about the risks and benefits of LCS and ultimately enhance SDM about screening.

Lung cancer screening.

Lung cancer screening with low-dose chest computed tomography is now recommended for high-risk individuals by the US Preventive Services Task Force. This recommendation was informed by several randomized controlled trials, the largest of which, the National Lung Screening Trial, demonstrated a 20% relative reduction in lung cancer mortality with annual low-dose chest computed tomography compared with chest radiography. The benefit of lung cancer screening must be balanced against potential harms, including a high false-positive rate with consequent further evaluative studies and invasive testing. It is critical that harms be minimized as screening generalizes to the broad community. Informed decision making between providers and patients should include individualized risk assessment, a discussion of both potential benefit and harm, and tobacco treatment. Given the multiple components required for high quality, screening should ideally occur in the context of a multidisciplinary program. We are in the early days of lung cancer screening, still with much to learn. Ongoing studies are necessary to refine the definition of a positive screen and develop better methods of distinguishing between true positive and false-positive results. Novel approaches, including the development of multicomponent lung cancer biomarkers, will likely inform and improve our future screening practice.

Lung Malignancies in HIV Infection.

Pulmonary malignancies are a major source of morbidity and mortality in HIV-infected persons. Non-AIDS-defining lung cancers (mostly non-small cell lung cancers) are now a leading cause of cancer death among HIV-infected persons. HIV-associated factors appear to affect the risk of lung cancer and may adversely impact cancer treatment and outcomes. HIV infection also may modify the potential harms and benefits of lung cancer screening with computed tomography. AIDS-defining lung malignancies include pulmonary Kaposi sarcoma and pulmonary lymphoma, both of which are less prevalent with widespread adoption of antiretroviral therapy.

Do perceived barriers to lung cancer screening differ between attending physicians and residents?

192 Background: In February 2015, legislation went into effect requiring Medicare to cover lung cancer (LC) screening with low dose computed tomography (LDCT) for high risk patients. Despite this, much debate and uncertainty exist among physicians about LC screening best practices. We aim to compare perceived barriers to LC screening between resident and attending physicians in Family and Internal Medicine, two departments selected for their high likelihood of seeing patients eligible for LC screening. Methods: Between February and July of 2015, a 23 question Qualtrics survey was conducted among physicians and residents at a large academic hospital to assess knowledge and beliefs of LC screening. In the Family and Internal Medicine departments, we surveyed 100 residents (30% response rate) and 86 attendings (49% response rate). Responses from the two departments were combined and stratified by attending or resident status. Results: Most respondents were White and non-Hispanic. Attendings were older (mean age 47, range 32-64) and mostly male (54%), while residents were younger (mean age 30, range 28-35) and mostly female (63%). The majority of attendings (62%) and residents (78%) agreed that limited time during patient visits requires presenting problems take priority over LC screening. Other barriers cited by both groups included cost to patients (74% attendings and 83% residents), potential for complications (53% and 70%), and too many false positives (67% and 73%). Over half of both groups agreed that inconsistent recommendations make it difficult to decide whether or not to screen for LC. In addition, the majority of both groups indicated that they were undecided about the benefit of LC screening for patients (43% attendings and 55% residents). No statistically significant differences were found. Conclusions: Regardless of resident or attending status, respondents identified inconsistent recommendations, time restrictions during visits, cost to patients, potential complications, and a high false positive rate as barriers to LC screening. Both groups reported being undecided about the utility of LC screening. These findings suggest a need for alternative strategies for future LC screening implementation.

Timeliness of Recommended Follow-Up After an Abnormal Finding on Diagnostic Chest CT in Smokers at High Risk of Developing Lung Cancer

PurposeDiagnostic chest CT frequently results in abnormal findings that require follow-up. We assessed the timeliness of follow-up after CT abnormalities were identified in symptomatic smokers at high risk for developing lung cancer. MethodsIn an academic primary care network, we identified current smokers aged 55-79 years who received a diagnostic chest CT to evaluate symptoms during 2012. Medical chart abstraction identified radiologist recommendations and follow-up care. The outcome was the proportion of patients who received timely follow-up (within 30 days of recommendation) after an abnormal chest CT. We assessed for predictors of compliance with recommended follow-up. ResultsOf 3,257 eligible smokers, 446 (14%) had a chest CT during 2012. We excluded 70 patients who already had lung cancer, died, had imaging done elsewhere, or left the practice. Of the remaining 376 patients, 337 (90%) had abnormal chest CT findings, and 184 (55%) had a specific follow-up recommendation. Among those with recommended follow-up, only 102 of 184 (55%) had timely follow-up. Those who had a CT performed to evaluate pulmonary disease and those receiving care in community health centers were more likely to receive timely follow-up. Of 27 patients newly diagnosed with lung cancer, 18 (67%) had their first oncology visit within 30 days of diagnosis. ConclusionsAmong patients undergoing diagnostic chest CTs, most received follow-up for abnormal findings, but it was often delayed. Systems to support patients in obtaining recommended follow-up are needed to ensure that the benefits of lung cancer screening translate into usual clinical practice.

Overcoming perceived hurdles in lung cancer screening: the low risk of complications of image-guided transthoracic needle biopsy.

Overcoming perceived hurdles in lung cancer screening: the low risk of complications of image-guided transthoracic needle biopsy.

Pitfalls in Pulmonary Nodule Characterization

Annual LDCT lung cancer screening is recommended by the United States Preventive Services Task Force (USPSTF) for high-risk population based on the results from the National Lung Cancer Screening Trial (NLST) that showed a significant (20%) reduction in lung cancer-specific mortality rate with the use of annual low-dose computed tomography (LDCT) screening. More recently, the benefits of lung cancer screening were confirmed by the Dutch- Belgian NELSON trial in Europe. With the implementation of lung screening in large scale, knowledge of the limitations related to false positive, false negative and other potential pitfalls is essential to avoid misdiagnosis. This review outlines the most common potential pitfalls in the characterization of screen-detected lung nodules that include artifacts in LDCT, benign nodules that mimic lung cancer, and causes of false negative evaluations of lung cancer with LDCT and PET/CT studies. Awareness of the spectrum of potential pitfalls in pulmonary nodule detection and characterization, including equivocal or atypical presentations, is important for avoiding misinterpretation that can alter patient management.

Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis.

Lung cancer screening with annual chest computed tomography (CT) is recommended for current and former smokers with a ≥30-pack-year smoking history. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lung cancer and may benefit from screening at lower pack-year thresholds. We used a previously validated simulation model to compare the health benefits of lung cancer screening in current and former smokers ages 55-80 with ≥30 pack-years with hypothetical programs using lower pack-year thresholds for individuals with COPD (≥20, ≥10, and ≥1 pack-years). Calibration targets for COPD prevalence and associated lung cancer risk were derived using the Framingham Offspring Study limited data set. We performed sensitivity analyses to evaluate the stability of results across different rates of adherence to screening, increased competing mortality risk from COPD, and increased surgical ineligibility in individuals with COPD. The primary outcome was projected life expectancy. Programs using lower pack-year thresholds for individuals with COPD yielded the highest life expectancy gains for a given number of screens. Highest life expectancy was achieved when lowering the pack-year threshold to ≥1 pack-year for individuals with COPD, which dominated all other screening strategies. These results were stable across different adherence rates to screening and increases in competing mortality risk for COPD and surgical ineligibility. Current and former smokers with COPD may disproportionately benefit from lung cancer screening. A lower pack-year threshold for screening eligibility may benefit this high-risk patient population.

The Importance of Lung Cancer Screening With Low-Dose Computed Tomography for Medicare Beneficiaries

The National Lung Screening Trial has provided convincing evidence of a substantial mortality benefit of lung cancer screening with low-dose computed tomography (CT) for current and former smokers at high risk. The United States Preventive Services Task Force has recommended screening, triggering coverage of low-dose CT by private health insurers under provisions of the Affordable Care Act. The Centers for Medicare & Medicaid Services (CMS) are currently evaluating coverage of lung cancer screening for Medicare beneficiaries. Since 70% of lung cancer occurs in patients 65 years or older, CMS should cover low-dose CT, thus avoiding the situation of at-risk patients being screened up to age 64 through private insurers and then abruptly ceasing screening at exactly the ages when their risk for developing lung cancer is increasing. Legitimate concerns include false-positive findings that lead to further testing and invasive procedures, overdiagnosis (detection of clinically unimportant cancers), the morbidity and mortality of surgery, and the overall costs of follow-up tests and procedures. These concerns can be mitigated by clear criteria for screening high-risk patients, disciplined management of abnormalities based on algorithms, and high-quality multidisciplinary care. Lung cancer screening with low-dose CT can lead to early diagnosis and cure for thousands of patients each year. Professional societies can help CMS responsibly implement a program that is patient-centered and minimizes unintended harms and costs.

Subsolid Pulmonary Nodule Management and Lung Adenocarcinoma Classification: State of the Art and Future Trends

Annual LDCT lung cancer screening is recommended by the United States Preventive Services Task Force (USPSTF) for high-risk population based on the results from the National Lung Cancer Screening Trial (NLST) that showed a significant (20%) reduction in lung cancer-specific mortality rate with the use of annual low-dose computed tomography (LDCT) screening. More recently, the benefits of lung cancer screening were confirmed by the Dutch- Belgian NELSON trial in Europe. With the implementation of lung screening in large scale, knowledge of the limitations related to false positive, false negative and other potential pitfalls is essential to avoid misdiagnosis. This review outlines the most common potential pitfalls in the characterization of screen-detected lung nodules that include artifacts in LDCT, benign nodules that mimic lung cancer, and causes of false negative evaluations of lung cancer with LDCT and PET/CT studies. Awareness of the spectrum of potential pitfalls in pulmonary nodule detection and characterization, including equivocal or atypical presentations, is important for avoiding misinterpretation that can alter patient management.

When the Average Applies to No One: Personalized Decision Making About Potential Benefits of Lung Cancer Screening

This commentary discusses computed tomography screening of patients at risk for lung cancer, examining the magnitude of benefit for prototypical persons who may be offered screening. It concludes t...

Abstract 1162: MicroRNA expression profiles of tumors, normal lung tissues and plasma samples from spiral-computed tomography (CT) trial for early lung cancer detection

Abstract The benefits of lung cancer screening by spiral CT are still controversial: in contrast with an up to three-fold increase in the number of lung cancer diagnoses, there is not apparent decrease in advanced cancers and no substantial reduction of mortality in smokers. Changes relating to the (early) invasive and aggressive phenotype acquired by some of the CT-detected lesions might represent the crucial players to define novel prognostic/predictive markers and, potentially, novel therapeutic targets. In this study we explored miRNA expression profile in tissues and plasma samples of 28 patients developing lung cancer, identified in a spiral-CT screening trial performed in our Institution on 1035 heavy smokers observed for 5 years. 5µg of total RNA from tissues samples were used for labeling and hybridization on miRNA microarray chip (Ohio State microRNA microarray version 2.0) containing 460 probes in quadruplicate. By class comparison and prediction analyses we identify significant miRNAs (P<0.001) that discriminate normal lung versus cancer tissues. This list included miRNAs previously identified (i.e. mir-21) and unidentified (i.e. miR-486) in symptomatic lung cancer patients. In both tumors and normal lung tissues possible association of microRNA expression profiles with clinical-pathological characteristics of the patients was then investigated. A set of miRNA significantly discriminated tumor histotype, growth rate and clinical outcome of the patients. Interestingly, miRNA expression profile of patients who developed tumors in the first two years of the trial was found to be different from the profile of those detected after the 2nd year. We also analyzed miRNAs expression profiles in plasma samples of the patients collected before and in presence of the disease and compared to those of disease-free heavy smokers controls enrolled in the screening trial. In this analysis 100 miRNAs were detectable by simple qReal Time PCR assay in plasma samples, with a number of miRNAs able to predict lung cancer development up to 2 years before its clinical appearance (P<0.05). These data have been validated in an independent cohort of 27 individuals developing lung cancer in a second CT-screening trial ongoing in our Institution, where the signatures identified in the training set showed a good sensitivity and an optimal specificity. In conclusion in tumor and normal lung tissues specific miRNA profiles characterize aggressive and lethal lung cancers. Moreover, mirRNAs can be easily detectable in plasma samples and are able to identify aggressive lung cancer before its clinical appearance indicating a potential role of miRNAs in plasma as molecular predictors of high risk disease. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1162. doi:10.1158/1538-7445.AM2011-1162

Healthcare use after screening for lung cancer

To evaluate the benefits of lung cancer screening, all effects of screening need to be considered. The aim of this study was to determine whether screening had an effect on healthcare use, specifically whether use increased for those with a false-positive or indeterminate screening result. Recruited were 400 individuals participating in a lung cancer screening study at the University of Pittsburgh. Self-reported outpatient healthcare use information was collected for the 6 months before, 0 to 6 months after, and 6 to 12 months after screening. The screening outcomes were negative, indeterminate, and suspicious. Repeated-measures Poisson regression models were used to examine changes in use over time and how changes over time varied among the screening outcome groups. Approximately 58% of participants had a negative screening result, 36% had an indeterminate result, and approximately 6% had a suspicious result. The percentage of individuals who had any incidence of each type of outpatient use increased after screening, with the greatest increase noted for those with a suspicious screening result. Adjusted mean use significantly increased for nearly all types of use and for all 3 screening results categories in the 6 months after screening, but mostly declined to prescreening levels in the next 6 months. Outpatient healthcare use was found to increase after screening for all individuals who were screened for lung cancer, regardless of the screening finding. The cost of the lung-related visits alone was substantial. Therefore, if lung cancer screening prevalence is increased, attendant follow-up healthcare costs are also likely to increase.

Abstract 3021: MicroRNA expression profile of CT screening detected lung cancer

Abstract The benefits of lung cancer screening by spiral CT are still controversial and ongoing randomized trials will demonstrate the real impact of early detection on mortality of high risk individuals. Since the nature and life-threatening potential of CT-detected nodules is currently debated due to the potential issue of overdiagnosis, the study of molecular features of these tumors would allow for a better definition of those genetic signatures that are associated with invasiveness and metastatic potential. MicroRNAs (miRNAs), small regulatory non-coding molecules that silence gene expression by either cleaving target mRNAs or inhibiting their translation, offered new insight into the biology of tumors and miRNA expression profiles have been shown to be potential tools for cancer diagnosis, prognosis and therapeutic strategy. In this study we explored miRNA expression profile of 28 lung tumors detected in the 5 years of our pilot spiral-CT screening trial on 1035 heavy smokers, and compared the miRNAs signatures of the tumors with those of the paired normal lung tissues using a miRNA microarray platform and validation of the differentially expressed miRNAs using quantitative real-time PCR. Possible association of microRNA expression profiles with clinical-pathological characteristics of the patients were also investigated. 5 µg of total RNA was used for labeling and hybridization on miRNA microarray chip (Ohio State microRNA microarray version 2.0) containing 460 probes in quadruplicate. By class comparison analyses of paired and unpaired normal/tumor samples 54-66 miRNAs were significant at the nominal 0.001 level of the univariate test. The top ten deregulated miRNAs that discriminate normal lung versus early lung cancer were: mir-7, mir-21, mir-200, mir-210, mir-219, mir-324 (upregulated) and mir-451, mir-486, mir-126 (downregulated). This list included miRNAs previously identified (i.e. miR-21, mir-200 family known to be involved in specific pathways such as survival, apoptosis, epithelial-mesenchymal transition) and unidentified (i.e. downregulation of miR-486 and miR-451) in symptomatic lung cancer patients. Two miRNAs (mir-205, mir-106) significantly discriminated adenocarcinoma from squamous carcinoma histotypes. The miRNA expression profile of tumors detected in the first two years of the trial, including mainly Stage Ia adenocarcinoma with excellent survival, and that detected in the more advanced stage and lethal tumors found after the second year, showed nine differentially expressed miRNAs between the two groups: mir-128, mir-129, mir-369-3p, mir-193, mir-339-3p, mir-185, mir-346, mir-340, mir-206. Functional studies are ongoing to establish the role of these miRNas in the invasive phenotype of lung tumors in order to use them as biomarkers for molecular prediction of subjects at higher risk for tumors with worse prognosis and as potential therapeutic targets. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3021.

Lung cancer screening update

Lung cancer is a health problem of global proportions. Despite intensive research over many years, the prognosis is still very poor. For the surgery to be effective, tumours need to be recognized early. Computed tomography (CT) is significantly more sensitive than chest radiograph for identifying small, asymptomatic lung cancers. Although low-dose CT screening observational trials have demonstrated that survival for all tumour types and sizes detected were extremely high, there is no clear evidence that low-dose CT screening reduces deaths from lung cancer. Only the results of ongoing randomized controlled trials can reveal a real benefit of screening in terms of mortality reduction. We summarize the protocols and the preliminary results of the lung cancer screening randomized controlled trial and the problems linked to the detection of suspected early cancer. Today, we cannot already prove the ultimate mortality benefit of lung cancer screening with low-dose CT nor we can confirm that this approach is not harmful. We are waiting the final analysis of randomized controlled trials for lung cancer mortality. Even if is widely accepted that pooling data of randomized controlled trials could be of help to get powerful results in terms of mortality reduction in shorter follow-up time, this opportunity is still under evaluation.