Low-dose Computed Tomography Screening Research Articles

Which is a real valuable screening tool for lung cancer and measure thoracic diseases, chest radiography or low-dose computed tomography?: A review on the current status of Japan and other countries.

Chest radiography (CR) has been used as a screening tool for lung cancer and the use of low-dose computed tomography (LDCT) is not recommended in Japan. We need to reconsider whether CR really contributes to the early detection of lung cancer. In addition, we have not well discussed about other major thoracic disease detection by CR and LDCT compared with lung cancer despite of its high frequency. We review the usefulness of CR and LDCT as veridical screening tools for lung cancer and other thoracic diseases. In the case of lung cancer, many studies showed that LDCT has capability of early detection and improving outcomes compared with CR. Recent large randomized trial also supports former results. In the case of chronic obstructive pulmonary disease (COPD), LDCT contributes to early detection and leads to the implementation of smoking cessation treatments. In the case of pulmonary infections, LDCT can reveal tiny inflammatory changes that are not observed on CR, though many of these cases improve spontaneously. Therefore, LDCT screening for pulmonary infections may be less useful. CR screening is more suitable for the detection of pulmonary infections. In the case of cardiovascular disease (CVD), CR may be a better screening tool for detecting cardiomegaly, whereas LDCT may be a more useful tool for detecting vascular changes. Therefore, the current status of thoracic disease screening is that LDCT may be a better screening tool for detecting lung cancer, COPD, and vascular changes. CR may be a suitable screening tool for pulmonary infections and cardiomegaly.

Clinical application of serum seven tumour-associated autoantibodies in patients with pulmonary nodules

BackgroundThe incidence of pulmonary nodules is increasing because of the promotion and popularisation of low-dose computed tomography (LDCT) screening for populations with suspected lung cancer. However, a high rate of false positives and concerns regarding the radiation-related cancer risk of repeated CT scanning remain major obstacles to its wide application. This study aimed to investigate the clinical value of seven tumour-associated autoantibodies (7-TAAbs) in the differentiation of malignant pulmonary tumours from benign ones and the early detection of lung cancer in routine clinical practice. MethodsWe included 377 patients who underwent both the 7-TAAbs panel test and LDCT screening, and were diagnosed with pulmonary nodules using LDCT. An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels antibodies for P53, PGP9.5, SOX2, GAGE7, GBU4-5, CAGE, and MAGE-A1. The relationships between the positive rates of the 7-TAAbs and the patient sex, and age, and the number, size, and composition of pulmonary nodules were analysed. We then statistically evaluated the clinical application value. ResultsThe positive rates of the 7-TAAbs did not correlate with sex, age, number, size, or composition of pulmonary nodules. The serum antibody level of GBU4-5 in patients with pulmonary nodules tended to increase with age; the serum antibody level of SOX2 tended to increase with nodule size and was the highest among patients with mixed ground-glass opacity (mGGO) nodules. The antibody positive rate for CAGE in female patients with pulmonary nodules was significantly higher than that in male patients (P<0.05). The positive rate of GBU4-5 antibody in patients aged 60 years and above was higher than that in younger patients (P<0.05). The positive rate of GAGE7 antibody in patients with pulmonary nodules sized 8–20 mm was also significantly higher than that in patients with pulmonary nodules sized less than 8 mm (P<0.01). Significant differences were observed in the GAGE7 antibody levels of patients with pulmonary nodules of different compositions (P<0.01). The positive rate of the 7-TAAbs panel test in patients with lung cancer was significantly higher than in patients with pulmonary nodules (P<0.01). Serum levels of P53, SOX2, GBU4-5, and MAGE-A1 antibodies were significantly higher in patients with lung cancer than in those with pulmonary nodules (P<0.05). ConclusionThe low positive rates of serum 7-TAAbs in patients with lung cancer and pulmonary nodules may be related to different case selection, population differences, geographical differences, different degrees of progression, and detection methods. The combined detection of 7-TAAbs has some clinical value for screening and early detection of lung cancer.

Geographic Accessibility and Completion of Initial Low-Dose CT-Based Lung Cancer Screening in an Urban Safety-Net Population.

Recent modifications to low-dose CT (LDCT)-based lung cancer screening guidelines increase the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between travel time and initial LDCT completion within an integrated, urban safety-net health care system. Using Esri's StreetMap Premium, OpenStreetMap, and the r5r package in R, we determined projected private vehicle and public transportation travel times between patient residence and the screening facility for LDCT ordered in March 2017 through December 2022 at Parkland Memorial Hospital in Dallas, Texas. We characterized associations between travel time and LDCT completion in univariable and multivariable analyses. We tested these associations in a simulation of 10,000 permutations of private vehicle and public transportation distribution. A total of 2,287 patients were included in the analysis, of whom 1,553 (68%) completed the initial ordered LDCT. Mean age was 63 years, and 73% were underrepresented minorities. Median travel time from patient residence to the LDCT screening facility was 17 minutes by private vehicle and 67 minutes by public transportation. There was a small difference in travel time to the LDCT screening facility by public transportation for patients who completed LDCT versus those who did not (67 vs 66 min, respectively; P=.04) but no difference in travel time by private vehicle for these patients (17 min for both; P=.67). In multivariable analysis, LDCT completion was not associated with projected travel time to the LDCT facility by private vehicle (odds ratio, 1.01; 95% CI, 0.82-1.25) or public transportation (odds ratio, 1.14; 95% CI, 0.89-1.44). Similar results were noted across travel-type permutations. Black individuals were 29% less likely to complete LDCT screening compared with White individuals. In an urban population comprising predominantly underrepresented minorities, projected travel time is not associated with initial LDCT completion in an integrated health care system. Other reasons for differences in LDCT completion warrant investigation.

Interpretation of global lung cancer statistics

Lung cancer remains one of the leading cause of global cancer-related mortality, posing a significant burden of disease. Tobacco exposure stands as the foremost risk factor for lung cancer. Since the 1960, global efforts have gradually been implemented to control tobacco exposure, consequently reducing tobacco exposure levels within populations. This shift in exposure levels may have altered the epidemiological characteristics of lung cancer globally. This study aims to describe global lung cancer incidence data across five dimensions: age, gender, region, stage at diagnosis, and survival status, using global cancer registry data and relevant research findings. The objective is to elucidate the current epidemiological features of lung cancer worldwide, providing a scientific basis for lung cancer prevention and control. Furthermore, this study offers corresponding measures and recommendations for lung cancer prevention and control, aligning with the three-tiered cancer prevention strategy. Findings indicate that the incidence and mortality burden of lung cancer is significantly higher among the elderly population (aged 65 years and above) compared to the working-age population (aged 15-64 years). The aged-standardized incidence rate of lung cancer remains higher in males than in females, but the overall aged-standardized incidence rate of lung cancer in males shows a declining trend, while that in females shows an increasing trend. Regions with high and very high human development index (HDI) exhibit a substantially higher incidence and mortality burden of lung cancer compared to regions with low and very low HDI. Japan ranks highest in the diagnosis of stage Ⅰ lung cancer, with a diagnosis rate of 38.6%. Its age-standardized 5-year net survival rate is relatively high at 32.9%. Despite improvements in the survival status of lung cancer in certain countries like China and Japan, the overall prognosis for lung cancer remains pessimistic. Given the current epidemiological characteristics of lung cancer, reinforcing tobacco control measures and reducing female-specific lung cancer risk factors stand as significant goals for primary prevention. Promoting low-dose computed tomography screening for high-risk population, minimizing false-positive rates in lung cancer screening, and promoting medical system reforms and standardized treatment constitute principal measures for secondary and tertiary lung cancer prevention, respectively.

A Retrospective Analysis: Investigating Factors Linked to High Lung-RADS Scores in a Nonsmoking, Non-Family History Population.

Low-dose computed tomography screening for lung cancer is currently targeted at heavy smokers or those with a family history of lung cancer. This study aimed to identify risk factors for lung cancer in individuals who do not meet the current lung cancer screening criteria as stipulated by the Taiwan Health Promotion Agency's low-dose computed tomography (LDCT) screening policy. A cohort analysis was conducted on 12,542 asymptomatic healthy subjects aged 20-80 years old who voluntarily underwent LDCT scans from January 2016 to December 2021. Logistic regression demonstrated that several factors, including age over 55 years, female gender, a body mass index (BMI) less than 23, a previous history of respiratory diseases such as tuberculosis or obstructive respiratory diseases (chronic obstructive pulmonary disease [COPD], asthma), and previous respiratory symptoms such as cough or dyspnea, were associated with high-risk lung radiology scores according to LDCT scans. These findings indicate that risk-based assessments using primary data and questionnaires to identify risk factors other than heavy smoking and a family history of lung cancer may improve the efficiency of lung cancer screening.

Uptake and 4-week quit rates from an opt-out co-located smoking cessation service delivered alongside community-based low-dose computed tomography screening within the Yorkshire Lung Screening Trial.

Up to 50% of those attending for low-dose computed tomography screening for lung cancer continue to smoke and co-delivery of smoking cessation services alongside screening may maximise clinical benefit. Here we present data from an opt-out co-located smoking cessation service delivered alongside the Yorkshire Lung Screening Trial (YLST). Eligible YLST participants were offered an immediate consultation with a smoking cessation practitioner (SCP) at their screening visit with ongoing smoking cessation support over subsequent weeks. Of 2150 eligible participants, 1905 (89%) accepted the offer of an SCP consultation during their initial visit, with 1609 (75%) receiving ongoing smoking cessation support over subsequent weeks. Uptake of ongoing support was not associated with age, ethnicity, deprivation or educational level in multivariable analyses, although men were less likely to engage (adjusted OR (ORadj) 0.71, 95% CI 0.56-0.89). Uptake was higher in those with higher nicotine dependency, motivation to stop smoking and self-efficacy for quitting. Overall, 323 participants self-reported quitting at 4 weeks (15.0% of the eligible population); 266 were validated by exhaled carbon monoxide (12.4%). Multivariable analyses of eligible smokers suggested 4-week quitting was more likely in men (ORadj 1.43, 95% CI 1.11-1.84), those with higher motivation to quit and previous quit attempts, while those with a stronger smoking habit in terms of cigarettes per day were less likely to quit. There was high uptake for co-located opt-out smoking cessation support across a wide range of participant demographics. Protected funding for integrated smoking cessation services should be considered to maximise programme equity and benefit.

Abstract 1062: Clinical validation: A blood-based biomarker for early lung cancer detection based on circulating DNA fragmentomics

Abstract PURPOSE: Screening for lung cancer using a biomarker blood test has the potential to overcome the currently low adherence rates in the US, offering patients a convenient and accessible option. Integrating routine blood draws into lung cancer screening could boost participation, mirroring the success of non-invasive tests in colorectal screening. Numerous proof-of-concept studies indicate that analyzing genome-wide cfDNA fragmentation patterns can effectively distinguish between individuals with and without lung cancer. We conducted a multi-institutional case-control study to train and validate a fragmentome based cfDNA classifier for lung cancer early detection. METHODS: The DELFI-L101 study (NCT04825834) is a prospective, multi-site, observational case-control study designed to develop and validate an early detection test for lung cancer. The DELFI (DNA Evaluation of Fragments for Early Interception) method utilizes low-pass whole genome sequencing, a cost-effective approach that examines cell-free DNA (cfDNA) fragmentation patterns associated with lung cancer. Enrolled participants were aged ≥50 y, smoking history of ≥20 pack-years, and had undergone or had planned chest CT imaging. Medical histories were documented, and blood samples were collected for DELFI analysis. A classifier, developed through supervised machine learning, was created to distinguish between samples from individuals with lung cancer and those without. Performance was assessed through repeated 10-fold cross-validation in the training set and then subsequently assessed in an independent split-study clinical validation set. The classifier was optimized for the sensitivity detection of lung cancer in the screening-eligible population. Performance was evaluated across patient and tumor characteristics, adjusting the stage distribution to match that of LDCT screening populations. RESULTS: In an analysis of 958 participants from both the lung cancer and non-cancer control groups, the sensitivity of the test remained consistent across various participant demographics, comorbidities, and tumor characteristics, increasing with higher group, T, and N stages. The stage weighted sensitivity for the screening population was 80% (95% CI: 75%-86%), with a specificity of 53% (95% CI: 43%-64%). At a prevalence of 0.7%, the negative predictive value was 99.7%. CONCLUSIONS: Clinical validation of the DELFI-based blood test demonstrates its potential to detect lung cancer within the screening eligible population. A negative result is associated with a high negative predictive value. Given the limited adoption of low-dose computed tomography (LDCT) screening, especially among socio-economically disadvantaged individuals, this clinically validated, blood-based cfDNA test could significantly increase LDCT screening participation. Citation Format: Peter Mazzone, Peter B. Bach, Lindsey B. Cotton, Caitlin A. Schonewolf. Clinical validation: A blood-based biomarker for early lung cancer detection based on circulating DNA fragmentomics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1062.

Abstract 4781: Evaluation of a TP53 biomarker for lung cancer risk in nasal brushings and peripheral blood

Abstract Background and Purpose: Early detection of lung cancer through annual screening with low-dose computed tomography (LDCT) scans enables potentially curative surgical or stereotactic body radiation therapy (SBRT) treatment and thereby significantly reduces mortality. However, LDCT screening among those currently eligible based primarily on age and smoking criteria yields a large number of false-positive findings and many lung cancers occur among individuals who currently are ineligible. A biomarker that identifies lung cancer risk independent from that caused by age and cigarette smoking might increase specificity and increase the number of people eligible for LDCT screening. Recently we demonstrated that a biomarker measuring TP53 somatic mutations in bronchial brush biopsy specimens from grossly normal airway epithelium was significantly associated with cancer status independent of age and smoking status. Additionally, the TP53 biomarker was synergistic with traditional risk score models (e.g. PLCOM2012 risk score). The goal of this pilot study was to test the TP53 biomarker in nasal brush biopsy specimens, a potential surrogate tissue obtained using less invasive collection methods. Methods: Nasal brushings from 10 lung cancer and 11 control subjects were collected at the University of Toledo and Vanderbilt University Medical Center under approved institutional protocols. Genomic DNA (gDNA) was extracted with the Qiagen AllPrep DNA/RNA kit using a modified protocol. Amplifiable copies of gDNA were measured using quantitative PCR. For each test a sample comprising 25,000 amplifiable copies of gDNA was combined with 50,000 copies of a TP53 internal standard and a complexity control, then PCR amplified, purified and barcoded. Samples were pooled to create two NGS libraries, each with approximately equal numbers of cases and controls, and sequenced on an Illumina MiSeq (Two V3 flow cells, 2 x 250 paired-end). Bioinformatic analysis was conducted using Qiagen CLC Workbench. Variants were called using the Basic Variant Detection Tool. Poisson Exact Test was utilized to determine the significance of endogenous variants relative to internal standard variants at the same base position and a Bonferroni correction was applied to minimize false discovery. Comparison of variant numbers between cases and controls was conducted using an f-test followed by a paired t-test. Results and Conclusions: Consistent with previous results in airway epithelium, in this pilot study the TP53 mutation biomarker measured in nasal brushing was associated with lung cancer (p=0.0085). Measurement of the TP53 biomarker in nasal brush specimens in a larger case-control study currently is underway along with a pilot study in gDNA from peripheral blood. Citation Format: Erin L. Crawford, Daniel J. Craig, Patrick T. Gorman, Mohamed Omballi, Rami Ahmad, Eric L. Grogan, Stephen A. Deppen, James C. Willey. Evaluation of a TP53 biomarker for lung cancer risk in nasal brushings and peripheral blood [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4781.

Abstract 6104: EDRN Lung Team Project 2 validation of molecular biomarkers for the early detection of lung cancer in the setting of indeterminate pulmonary nodules

Abstract Background: The goal of the Early Detection Research Network (EDRN) Lung Team Project #2 (LTP-2) is to establish a cohort (n= 300) of high-risk people with indeterminate pulmonary nodules (6mm-30mm) to clinically validate the diagnostic accuracy of existing molecular and imaging biomarkers discovered and analytically validated through the EDRN program. These biomarkers comprise signals measured in serum (glycan or cytokine), plasma (protein, miRNA, RNA, or methylated circulating tumor DNA), airway epithelial cells (RNA or DNA), nasal brush cells (RNA or DNA), and/or chest CT images. Methods: Eligible participants had an indeterminate nodule discovered incidentally or through low-dose CT screening within 14 months prior to enrollment and were aged 45-90 years, with 20 pack-years or more cigarette smoking history, free of lung cancer, and willing to provide blood, nasal brushing, and optionally bronchoscopic brush biopsy specimens. Baseline medical and demographic data were collected from each subject. Baseline and years 1 and 2 follow-up CT images were obtained. Each specimen at each respective site was labeled with a 2-D barcode provided by the DMCC and specimen information was entered into the Validation Study Information Management System (VSIMS) developed by the EDRN Data Management and Coordinating Center (DMCC). Aliquots of blinded specimens from selected cases and controls will be dispensed to each EDRN site for biomarker analysis. Analysis plan: Primary endpoint: The positive diagnostic likelihood ratio (DLR+) will be used to measure biomarker performance within values of DLR+ &amp;gt;= 2 or DLR- &amp;lt;= 0.5, a range considered clinically useful for any patients with indeterminate lung nodules. The sample size calculation targeted &amp;gt;80% power to test the null hypotheses that a) a positive biomarker does not alter risk across a range of specificities, and b) a negative biomarker does not alter risk across a range of sensitivities. The EDRN Data Management and Coordinating Center (DMCC) will unblind and complete analysis and report results. Exploratory endpoint: The diagnostic accuracy of combined biomarkers will be calculated using a logistic regression model with flexible functional forms. Results and Discussion: More than 300 subjects were enrolled into the LTP2 cohort including a sufficient number of cases and controls (cohort size n&amp;gt;300) to reach power according to calculated estimates. Chest CT images were collected and are in the process of transfer to a central database. Plasma specimens have been distributed to test sites. RNA and DNA extraction from NBC and AEC is in process and based on results thus far the specimen quality and quantity is more than sufficient from the number of subjects needed to reach power for the primary endpoint and to conduct the planned exploratory analyses. Citation Format: James C. Willey, Eric L. Grogan, Stephen A. Deppen, James G. Herman, Michael N. Kammer, Matthew B. Schabath, Lynn Sorbara, Harvey I. Pass, Jun-Chieh J. Tsay, Ziding Feng, Avrum Spira, Erin L. Crawford, Jackie Dahlgren, Steven M. Dubinett, Kimberly R. Rieger-Christ, Marc E. Lenburg. EDRN Lung Team Project 2 validation of molecular biomarkers for the early detection of lung cancer in the setting of indeterminate pulmonary nodules [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6104.

Abstract 6075: Most cancer deaths are unaddressed by current screening paradigms

Abstract Cancer is the leading cause of death at ages ≤80 in the US. To understand the burden of cancer death potentially addressable by new or improved screening approaches, we estimated the proportion of US cancer deaths without recommended guideline-based screening, especially after accounting for lung cancer screening eligibility and adherence. Using 2018-2019 mortality data from the National Center for Health Statistics and published estimates of the proportion of screening-eligible lung cancer patients, we estimated that 31.4% of nearly 600,000 annual cancer deaths were from colorectal, female breast, cervical, and smoking-eligible lung cancers (Table). Further accounting for adherence to lung cancer screening guidelines reduced the estimated proportion of screened cancer deaths to 17.4%; thus, 82.6% of cancer deaths may not be addressed by current guideline-based screening. Among the cancers not covered by guideline-based screening are uncommon cancer types, which (as defined by the National Cancer Institute) comprised 30.4% of cancer deaths. According to incidence-based mortality data from Surveillance, Epidemiology, and End Results registries, 24.7% of all cancer deaths were from stage 4 cancer types without guideline-based screening. These estimates, based on population data without patient-level information on mode of diagnosis, almost certainly underestimate the percentage of cancer deaths missed by currently available screening efforts. The large proportion of cancer deaths unaddressed by guideline-based screening represents a vast opportunity for new cancer screening technologies that are safe, effective, accessible, and affordable to enable earlier detection and successful treatment of the full spectrum of cancer types that contribute to the overall cancer burden. Table. Deaths from cancer by primary type in 2018-2019, US National Center for Health Statistics, with eligibility for and adherence to guideline-based low-dose computed tomography screening for lung cancer All cancer types Lung Colon/rectum Breast (female) Uterine cervix Total screened % of all All cancer deaths 1,198,854 281,681 104,059 84,745 8,290 478,775 39.9% Eligible for screening based on smoking (63.7% of lung)* 179,431 104,059 84,745 8,290 376,525 31.4% Adherent to smoking-guideline-based screening (6.6% of lung)† 11,842 104,059 84,745 8,290 208,936 17.4% *Modeled estimate of proportion of lung cancer patients eligible for screening (Landy et al. 2023). †Lung cancer screening receipt from 2019 American College of Radiology Lung Cancer Screening Registry (Fedewa et al. 2022). Citation Format: Ellen T. Chang, Anuraag Kansal, Earl A. Hubbell, Graham A. Colditz, Allison W. Kurian, Christina A. Clarke. Most cancer deaths are unaddressed by current screening paradigms [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6075.

A pragmatic randomized clinical trial of multilevel interventions to improve adherence to lung cancer screening (The Larch Study): Study protocol

BackgroundIn real-world settings, low adherence to lung cancer screening (LCS) diminishes population-level benefits of reducing lung cancer mortality. We describe the Larch Study protocol, which tests the effectiveness of two patient-centered interventions (Patient Voices Video and Stepped Reminders) designed to address barriers and improve annual LCS adherence. MethodsThe Larch Study is a pragmatic randomized clinical trial conducted within Kaiser Permanente Washington. Eligible patients (target n = 1606) are aged 50–78 years with an index low-dose CT (LDCT) of the chest with negative or benign findings. With a 2 × 2 factorial-design, patients are individually randomized to 1 of 4 arms: video only, reminders only, both video and reminders, or usual care. The Patient Voices video addresses patient education needs by normalizing LCS, reminding patients when LCS is due, and encouraging social support. Stepped Reminders prompts primary care physicians to order patient's repeat screening LDCT and patients to schedule their scan. Intervention delivery is embedded within routine healthcare, facilitated by shared electronic health record components. Primary outcome is adherence to national LCS clinical guidelines, defined as repeat LDCT within 9–15 months. Patient-reported outcomes are measured via survey (knowledge of LCS, perception of stigma) approximately 8 weeks after index LDCT. Our mixed-methods formative evaluation includes process data, collected during the trial, and interviews with trial participants and stakeholders. DiscussionResults will fill an important scientific gap on multilevel interventions to increase annual LCS adherence and provide opportunities for spread and scale to other healthcare settings.Registration: Trial is registered at clinicaltrials.gov (#NCT05747443).

Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study

BackgroundAnnual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT screening. This study examines the benefit–harm and cost-effectiveness of risk-based screening in heavy smokers and determines the optimal risk threshold for screening and risk-stratified screening intervals.MethodsWe conducted a comparative cost-effectiveness analysis in China, using a cohort-based Markov model which simulated a lung cancer screening cohort of 19,146 heavy smokers aged 50 ~ 74 years old, who had a smoking history of at least 30 pack-years and were either current smokers or had quit for < 15 years. A total of 34 risk-based screening strategies, varying by different risk groups for screening eligibility and screening intervals (1-year, 2-year, 3-year, one-off, non-screening), were evaluated and were compared with annual screening for all heavy smokers (the status quo strategy). The analysis was undertaken from the health service perspective with a 30-year time horizon. The willingness-to-pay (WTP) threshold was adopted as three times the gross domestic product (GDP) of China in 2021 (CNY 242,928) per quality-adjusted life year (QALY) gained.ResultsCompared with the status quo strategy, nine risk-based screening strategies were found to be cost-effective, with two of them even resulting in cost-saving. The most cost-effective strategy was the risk-based approach of annual screening for individuals with a 5-year risk threshold of ≥ 1.70%, biennial screening for individuals with a 5-year risk threshold of 1.03 ~ 1.69%, and triennial screening for individuals with a 5-year risk threshold of < 1.03%. This strategy had the highest incremental net monetary benefit (iNMB) of CNY 1032. All risk-based screening strategies were more efficient than the status quo strategy, requiring 129 ~ 656 fewer screenings per lung cancer death avoided, and 0.5 ~ 28 fewer screenings per life-year gained. The cost-effectiveness of risk-based screening was further improved when individual adherence to screening improved and individuals quit smoking after being screened.ConclusionsRisk-based screening strategies are more efficient in reducing lung cancer deaths and gaining life years compared to the status quo strategy. Risk-stratified screening intervals can potentially balance long-term benefit–harm trade-offs and improve the cost-effectiveness of lung cancer screenings.

Analysis of screening outcomes and factors influencing compliance among community-based lung cancer high-risk population in Nanchang, China, 2018-2020.

To investigate the screening results and compliance of low-dose computed tomography (LDCT) screening among the high-risk lung cancer populations in Jiangxi Province from 2018 to 2020, and to explore the related influencing factors of compliance. From November 2018 to October 2020, permanent residents in Nanchang City were selected and their demographic data and lung cancer risk factor data were collected to screen high-risk groups, and LDCT screening was performed on high-risk groups with diagnostic reports by 2 chief physicians. Descriptive analysis method was used to analyze the basic information of screening, screening results and screening compliance. χ2 and logistic regression test were used to conduct single and multi-factor analysis of screening compliance. A total of 26,588 people participated in this screening, of which 34.4% (n=9,139) were at high risk of lung cancer, 3,773 participants were completed LDCT screening, and the screening compliance rate was 41.3%. Screening results showed that 389 participants were positive for suspected pulmonary tumor or lung nodules, the screening positive rate of 10.3%. The logistic multivariable results of screening compliance showed that the compliance was better in males, those who quit smoking, those with chronic respiratory diseases and family history of cancer, and those who have primary education, those with a history of occupational harmful exposure had a poor compliance. Compliance with lung cancer screening in Jiangxi Province, China still needs to be improved, and gender, education level, harmful occupational exposure, smoking, chronic respiratory diseases, and family history of tumors cancer play an important role on screening compliance.

"ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer." E.L. O'Dowd, I. Tietzova, E. Bartlett, et al. Eur Respir J 2023; 62: 2300533.

"ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer." E.L. O'Dowd, I. Tietzova, E. Bartlett, et al. Eur Respir J 2023; 62: 2300533.

Impact of Structured Reporting For Lung Cancer Screening Low-Dose CT Scan Incidental Findings on Physician Management

Impact of Structured Reporting For Lung Cancer Screening Low-Dose CT Scan Incidental Findings on Physician Management

Opportunistic lung cancer screening with low-dose computed tomography in National Cancer Center of China: The first 14 years' experience.

In China, over 50% of lung cancer cases occur in nonsmokers. Thus, identifying high-risk individuals for targeted lung cancer screening is crucial. Beyond age and smoking, determining other risk factors for lung cancer in the Asian population has become a focal point of research. Using 30,000 participants in the prospectively enrolled cohort at China's National Cancer Center (NCC) over the past 14 years, we categorized participants by risk, with an emphasis on nonsmoking females. Between November 2005 and December 2019, 31,431 individuals voluntarily underwent low-dose computed tomography (LDCT) scans for lung cancer screening at the NCC. We recorded details like smoking history, exposure to hazards, and family history of malignant tumors. Using the 2019 NCCN criteria, participants were categorized into high-, moderate-, and low-risk groups. Additionally, we separated non-high-risk groups into female never smokers (aged over 40) exposed to second-hand smoke (SHS) and others. Any positive results from initial scans were monitored per the I-ELCAP protocol (2006), and suspected malignancies were addressed through collaborative decisions between patients and physicians. We analyzed and compared the detection rates of positive results, confirmed lung cancers, and cancer stages across risk, age, and gender groups. Out of 31,431 participants (55.9% male, 44.1% female), 3695 (11.8%) showed positive baseline LDCT scans with 197 (0.6%; 106 females, 91 males) confirmed as lung cancer cases pathologically. Malignancy rate by age was 0.1% among those aged under 40 years, 0.4% among those aged 40-49 years, 0.8% among those aged 50-59 years, and 1.2% among those aged 60 years and older. From the 25,763 participants (56.9% male, 43.1% female) who completed questionnaires, 1877 (7.3%) were categorized as high risk, 6500 (25.2%) as moderate risk, and 17,386 (67.5%) as low risk. Of the 23,886 in the non-high-risk category, 8041 (33.7%) were females over 40 years old exposed to SHS. The high-risk group showed the highest lung cancer detection rate at 1.4%. However, females exposed to SHS had a notably higher detection rate than the rest of the non-high-risk group (1.1% vs. 0.5%; p < 0.0001). In this cohort, 84.8% of the detected lung cancers were at an early stage. In our study, using LDCT for lung cancer screening proved significant for high-risk individuals. For non-high-risk populations, LDCT screening could be considered for nonsmoking women with exposure to SHS.

A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score

IntroductionSeveral studies have proved that Polygenic Risk Score (PRS) is a potential candidate for realizing precision screening. The effectiveness of low-dose computed tomography (LDCT) screening for lung cancer has been proved to reduce lung cancer specific and overall mortality, but the cost-effectiveness of diverse screening strategies remained unclear.MethodsThe comparative cost-effectiveness analysis used a Markov state-transition model to assess the potential effect and costs of the screening strategies incorporating PRS or not. A hypothetical cohort of 300,000 heavy smokers entered the study at age 50–74 years and were followed up until death or age 79 years. The model was run with a cycle length of 1 year. All the transition probabilities were validated and the performance value of PRS was extracted from published literature. A societal perspective was adopted and cost parameters were derived from databases of local medical insurance bureau. Sensitivity analyses and scenario analyses were conducted.ResultsThe strategy incorporating PRS was estimated to obtain an ICER of CNY 156,691.93 to CNY 221,741.84 per QALY gained compared with non-screening with the initial start age range across 50–74 years. The strategy that screened using LDCT alone from 70–74 years annually could obtain an ICER of CNY 80,880.85 per QALY gained, which was the most cost-effective strategy. The introduction of PRS as an extra eligible criteria was associated with making strategies cost-saving but also lose the capability of gaining more LYs compared with LDCT screening alone.ConclusionThe PRS-based conjunctive screening strategy for lung cancer screening in China was not cost-effective using the willingness-to-pay threshold of 1 time Gross Domestic Product (GDP) per capita, and the optimal screening strategy for lung cancer still remains to be LDCT screening for now. Further optimization of the screening modality can be useful to consider adoption of PRS and prospective evaluation remains a research priority.

Analysis of Lung Cancer Disparities in Northwest Indiana

Background and Hypothesis: Lung cancer is the first leading cause of cancer death worldwide (~1.8 million deaths pa.). Low-Dose Computed Tomography (LDCT) screening is a preventative measure to diagnose lung cancer at an early stage, which increases the chance of survival. Northwest Indiana is a diverse region (830,000 pop.) that faces unique challenges to equitable health outcomes and access to preventative treatments, particularly within minoritized communities from a low socioeconomic status. We investigated whether the vulnerable populations of Northwest Indiana have a higher incidence of lung cancer, low LDCT screening rates, and a late stage of diagnosis, in order to identify potential gaps in healthcare access and delivery.&#x0D; Methods: We used LDCT screening (n = 2,481), lung cancer incidence (n = 268) and staging (n = 257) data from ZIP Codes of six cities/towns in Northwest Indiana, provided by an urban hospital system in Northwest Indiana between 2018 and 2023. The cities/towns were grouped into ‘lower’ and ‘upper’ income according to median household income level reported by 2020 U.S. census data. Chi-Squared tests were used to determine significance.&#x0D; Results: There is no significant difference in the incidence of lung cancer between upper and lower income cities/towns (p= 0.163). However, there is a significant difference in stage I, II, and IV diagnoses between the two income groups (p = 0.021, 0.007, and 0.013 respectively), which demonstrates an inverse relationship between income level and stage of diagnosis. The lower income group is diagnosed at a younger age (p = 0.02) with advanced stage lung cancer, despite similar rates of lung cancer incidence.&#x0D; Conclusion and Potential Impact: Barriers to screening for vulnerable populations in urban areas include patient-provider mistrust, health illiteracy, and lack of healthcare services. Late stage diagnosis necessitates the development of local interventions to increase early screening.

Quantifying the Value of Reduced Health Disparities: Low-Dose Computed Tomography Lung Cancer Screening of High-Risk Individuals Within the United States

ObjectiveThis study aimed to measure the value of increasing lung cancer screening rates for high-risk individuals and its impact on health disparities. MethodsThe model estimated changes in health economic outcomes if low-dose computed tomography screening increased from current to 100% compliance, following clinical guidelines. Current low-dose computed tomography screening rates were estimated by income, education, and race, using 2017-2019 Behavioral Risk Factor Surveillance System data. The model contained a decision tree module to segment the population by screening outcomes and a Markov chain module to estimate cancer progression over time. Model parameters included information on survival, quality of life, and costs related to cancer diagnosis, treatment, and adverse events. Distributional cost-effectiveness analysis estimated the net monetary value from reduced health disparities—measured using quality-adjusted life expectancy—across income, education, and race groups. Outcomes were assessed over 30 years. ResultsLung cancer screening eligibility using US Preventive Services Task Force guidelines was higher for individuals with income <$15 000 (47.2%) and without a high-school education (46.1%) than individuals with income >$50 000 (16.6%) and with a college degree (13.5%), respectively. Increasing lung cancer screening to 100% compliance was cost-effective ($64 654 per quality-adjusted life-year) and produced economic value by up to $560 per person ($182.1 billion for United States overall). Up to 32.2% of the value was due to reductions in health disparities. ConclusionsSignificant value in increasing lung cancer screening rates derived from reducing health disparities. Policy makers and clinicians may not be appropriately prioritizing cancer screening if value from reducing health disparities is unconsidered.

Inhalable point-of-care urinary diagnostic platform.

Although low-dose computed tomography screening improves lung cancer survival in at-risk groups, inequality remains in lung cancer diagnosis due to limited access to and high costs of medical imaging infrastructure. We designed a needleless and imaging-free platform, termed PATROL (point-of-care aerosolizable nanosensors with tumor-responsive oligonucleotide barcodes), to reduce resource disparities for early detection of lung cancer. PATROL formulates a set of DNA-barcoded, activity-based nanosensors (ABNs) into an inhalable format. Lung cancer-associated proteases selectively cleave the ABNs, releasing synthetic DNA reporters that are eventually excreted via the urine. The urinary signatures of barcoded nanosensors are quantified within 20 min at room temperature using a multiplexable paper-based lateral flow assay. PATROL detects early-stage tumors in an autochthonous lung adenocarcinoma mouse model with high sensitivity and specificity. Tailoring the library of ABNs may enable not only the modular PATROL platform to lower the resource threshold for lung cancer early detection tools but also the rapid detection of chronic pulmonary disorders and infections.