Low-dose Computed Tomography Screening Research Articles

Implementation of smoking cessation in the workflow of a lung cancer screening program in Germany - A Position Paper of the German Respiratory Society (DGP)

Both tobacco cessation and low-dose CT screening in at-risk individuals reduce lung cancer-specific and all-cause mortality. As part of a national screening program for the early detection of lung cancer, smoking cessation must be a mandatory part of the counseling given to participants. This increases the cost-benefit effectiveness of the screening program. As part of the initial consultation evidence-based measures for smoking cessation must be offered to smoking participants of the screening program in form of a minimal intervention. If participants do not want to participate in a quit smoking measure they must actively refuse (opt-out rule). The costs of quitting smoking, including the costs of withdrawal-inhibiting medication, have to be fully covered by statutory health insurance for participants in the lung cancer screening program.

Urinary Metabolite Diagnostic and Prognostic Liquid Biopsy Biomarkers of Lung Cancer in Nonsmokers and Tobacco Smokers.

Nonsmokers account for 10% to 13% of all lung cancer cases in the United States. Etiology is attributed to multiple risk factors including exposure to secondhand smoking, asbestos, environmental pollution, and radon, but these exposures are not within the current eligibility criteria for early lung cancer screening by low-dose CT (LDCT). Urine samples were collected from two independent cohorts comprising 846 participants (exploratory cohort) and 505 participants (validation cohort). The cancer urinary biomarkers, creatine riboside (CR) and N-acetylneuraminic acid (NANA), were analyzed and quantified using liquid chromatography-mass spectrometry to determine if nonsmoker cases can be distinguished from sex and age-matched controls in comparison with tobacco smoker cases and controls, potentially leading to more precise eligibility criteria for LDCT screening. Urinary levels of CR and NANA were significantly higher and comparable in nonsmokers and tobacco smoker cases than population controls in both cohorts. Receiver operating characteristic analysis for combined CR and NANA levels in nonsmokers of the exploratory cohort resulted in better predictive performance with the AUC of 0.94, whereas the validation cohort nonsmokers had an AUC of 0.80. Kaplan-Meier survival curves showed that high levels of CR and NANA were associated with increased cancer-specific death in nonsmokers as well as tobacco smoker cases in both cohorts. Measuring CR and NANA in urine liquid biopsies could identify nonsmokers at high risk for lung cancer as candidates for LDCT screening and warrant prospective studies of these biomarkers.

LUNG CANCER - RISK FACTORS AND PREVENTION STRATEGIES - OVERVIEW OF THE LITERATURE

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Elektronische Zeitschriftbibliotek Logo Bielefeld Academic Search Engine Logo Erfolgreich durch internationale Zusammenarbeit ONCOLOGY Cite as: Archiv EuroMedica. 2024. 14; 3. DOI 10.35630/2024/14/3.344 Received 25 April 2024; Accepted 15 June 2024; Published 19 June 2024 LUNG CANCER - RISK FACTORS AND PREVENTION STRATEGIES - OVERVIEW OF THE LITERATURE Jakub Rybak1email orcid id logo, Barbara Magiera2orcid id logo, Karol Magiera1orcid id logo, Martyna Grabowska-Szczurek3orcid id logo, Alicja Grabarczyk4 orcid id logo, Piotr Bator1 orcid id logo, Michał Razik1 orcid id logo, Patrycja Rozwadowska1 orcid id logo, Karol Wielgus5 orcid id logo 1Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland 2Prof. K. Gibiński University Clinical Center of the Medical University of Silesia in Katowice, Poland 3The Hospital of the Bonifratres of St. John Grand in Cracow, Poland 4Students’ Scientific Society, Department of Gynecology and Obstetrics in Katowice, Medical University of Silesia, Katowice, Poland 5Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland download article (pdf) rybakjak@gmail.com ABSTRACT Introduction and purpose: Lung cancer is the second most common cancer worldwide. The aim of this study is to analyze the key modifiable and non-modifiable risk factors associated with the development of lung cancer and to discuss existing prevention strategies. Materials and methods: A literature review was conducted using the "PubMed" database with the keywords "lung cancer", "lung cancer risk factors", "lung cancer prevention”. Results: Lung cancer risk factors can be divided into two groups: modifiable and non-modifiable. Modifiable risk factors include: smoking, radon, diet, chronic lung diseases, asbestos and diesel fumes. Non-modifiable risk factors include: age, race, genetic factors and gender. In primary prevention of lung cancer it is important to reduce exposure to risk factors, especially cigarette smoke. Screening using low-dose computed tomography plays a major role in secondary prevention. Conclusion: Lung cancer is one of the most frequent malignant tumors. Over the years, enormous progress has been made in the fight against lung cancer. Despite a large reduction in smoking prevalence, cigarette smoking remains the most important risk factor of lung cancer. Several other factors have been identified, with e.g. asbestosis exposure and air pollutants being among top-5 risk factors with the highest impact. Effective methods of primary and secondary prevention such as health campaigns and screening tests have led to a reduction in the incidence of lung cancer. Smoking cessation and low-dose chest CT screening were proven to be the most effective in the lung cancer prevention. However, lung cancer remains the most common cause of death in cancer patients so further research and effective and practical public health policy are crucial in decreasing incidence and mortality.

PP01.169 Promotion of Low-Dose Computed Tomography Screening and Blood Biomarkers in Minority Communities for Early Detection of Lung Cancer in Northern Illinois

PP01.169 Promotion of Low-Dose Computed Tomography Screening and Blood Biomarkers in Minority Communities for Early Detection of Lung Cancer in Northern Illinois

Yorkshire Lung Screening Trial (YLST) pathway navigation study: a protocol for a nested randomised controlled trial to evaluate the effect of a pathway navigation intervention on lung cancer screening uptake

IntroductionLung cancer is the most common cause of cancer death globally. In 2022 the UK National Screening Committee recommended the implementation of a national targeted lung cancer screening programme, aiming...

Value of circulating tumor cell assisting low-dose computed tomography in screening pulmonary nodules based on existing liquid biopsy techniques: a systematic review with meta-analysis and trial sequential analysis.

This study aims to assess the diagnostic utility of circulating tumor cells (CTCs) in conjunction with low-dose computed tomography (LDCT) for differentiating between benign and malignant pulmonary nodules and to substantiate the foundation for their integration into clinical practice. A systematic literature review was performed independently by two researchers utilizing databases including PubMed, Web of Science, The Cochrane Library, Embase, and Medline, to collate studies up to September 15, 2023, that investigated the application of CTCs in diagnosing pulmonary nodules. A meta-analysis was executed employing Stata 15.0 and Revman 5.4 to calculate the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Additionally, trial sequential analysis was conducted using dedicated TSA software. The selection criteria identified 16 studies, encompassing a total of 3409 patients. The meta-analysis revealed that CTCs achieved a pooled sensitivity of 0.84 (95% CI 0.80 to 0.87), specificity of 0.80 (95% CI 0.73 to 0.86), PLR of 4.23 (95% CI 3.12 to 5.72), NLR of 0.20 (95% CI 0.16 to 0.25), DOR of 20.92 (95% CI 13.52 to 32.36), and AUC of 0.89 (95% CI 0.86 to 0.93). Circulating tumor cells demonstrate substantial diagnostic accuracy in distinguishing benign from malignant pulmonary nodules. The incorporation of CTCs into the diagnostic protocol can significantly augment the diagnostic efficacy of LDCT in screening for malignant lung diseases.

Impact of annual trend volume of low-dose computed tomography for lung cancer screening on overdiagnosis, overmanagement, and gender disparities

BackgroundWith the increasing prevalence of nonsmoking-related lung cancer in Asia, Asian countries have increasingly adopted low-dose computed tomography (LDCT) for lung cancer screening, particularly in private screening programs. This study examined how annual LDCT volume affects lung cancer stage distribution, overdiagnosis, and gender disparities using a hospital-based lung cancer database.MethodsThis study analyzed the annual utilized LDCT volume, clinical characteristics of lung cancer, stage shift distribution, and potential overdiagnosis. At the individual level, this study also investigated the relationship between stage 0 lung cancer (potential strict definition regarding overdiagnosis) and the clinical characteristics of lung cancer.ResultsThis study reviewed the annual trend of 4971 confirmed lung cancer cases from 2008 to 2021 and conducted a link analysis with an LDCT imaging examination database over these years. As the volume of lung cancer screenings has increased over the years, the number and proportion of stage 0 lung cancers have increased proportionally.Our study revealed that the incidence of stage 0 lung cancer increased with increasing LDCT scan volume, particularly during the peak growth period from 2017 to 2020. Conversely, stage 4 lung cancer cases remained consistent across different time intervals. Furthermore, the increase in the lung cancer screening volume had a more pronounced effect on the increase in stage 0 lung cancer cases among females than it had among males. The estimated potential for overdiagnosis brought about by the screening process, compared to non-participating individuals, ranged from an odds ratio of 7.617 to one of 17.114. Both strict and lenient definitions of overdiagnosis (evaluating cases of stage 0 lung cancer and stages 0 to 1 lung cancer) were employed.ConclusionsThese results provide population-level evidence of potential lung cancer overdiagnosis in the Taiwanese population due to the growing use of LDCT screening, particularly concerning the strict definition of stage 0 lung cancer. The impact was greater in the female population than in the male population, especially among females younger than 40 years.To improve lung cancer screening in Asian populations, creating risk-based prediction models for smokers and nonsmokers, along with gender-specific strategies, is vital for ensuring survival benefits and minimizing overdiagnosis.

Impact of lung cancer screening on stage migration and mortality among the national Veterans Health Administration population with lung cancer.

Despite randomized trials demonstrating a mortality benefit to low-dose computed tomography screening to detect lung cancer, uptake of lung cancer screening (LCS) has been slow, and the benefits of screening remain unclear in clinical practice. This study aimed to assess the impact of screening among patients in the Veterans Health Administration (VA) health care system diagnosed with lung cancer between 2011 and 2018. Lung cancer stage at diagnosis, lung cancer-specific survival, and overall survival between patients with cancer who did and did not receive screening before diagnosis were evaluated. We used Cox regression modeling and inverse propensity weighting analyses with lead time bias adjustment to correlate LCS exposure with patient outcomes. Of 57,919 individuals diagnosed with lung cancer in the VA system between 2011 and 2018, 2167 (3.9%) underwent screening before diagnosis. Patients with screening had higher rates of stage I diagnoses (52% vs. 27%; p ≤ .0001) compared to those who had no screening. Screened patients had improved 5-year overall survival rates (50.2% vs. 27.9%) and 5-year lung cancer-specific survival (59.0% vs. 29.7%) compared to unscreened patients. Among screening-eligible patients who underwent National Comprehensive Cancer Network guideline-concordant treatment, screening resulted in substantial reductions in all-cause mortality (adjusted hazard ratio [aHR], 0.79; 95% confidence interval [CI], 0.67-0.92; p=.003) and lung-specific mortality (aHR, 0.61; 95% CI, 0.50-0.74; p<.001). While LCS uptake remains limited, screening was associated with earlier stage diagnoses and improved survival. This large national study corroborates the value of LCS in clinical practice; efforts to widely adopt this vital intervention are needed.

Improving LDCT screening rates within a large multidisciplinary community based practice using integrated ACR accredited imaging centers.

e13582 Background: Lung cancer remains the leading cause of cancer-related death in the US, accounting for about 22% of such deaths. Lung cancer detected by low-dose computed tomography (LDCT) screening is discovered at an early stage 64-85% of the time. The benefits of LDCT screening have been demonstrated in numerous trials, but there has been difficulty in establishing programs that screen a high percentage of eligible patients. We present data from the first 18 months of our lung cancer screening program that is designed to provide the highest quality screening, follow-up and access to prevention, diagnosis, and treatment including clinical trials within their local communities. Methods: New York Cancer and Blood Specialists (NYCBS) is a community practice with over 50 locations across NY. While most lung cancer screening programs are hospital-based, NYCBS has a series of American College of Radiology (ACR) accredited imaging centers that perform these screenings and are closely affiliated with oncology, primary care, Ob-Gyn, nephrology, urology and other specialty medical and surgical practices. These centers are strategically located in areas that have high rates of tobacco use as suggested by heat map data from the NY City Community Health Survey . Upon initial patient presentation, all NYCBS and affiliated sites screen patients with tablet-based questionnaires that prompt additional questions during follow-up appointments. Patients with positive findings are discussed during a monthly, system-wide multidisciplinary lung nodule review conference. Follow-up interventions include referrals to pulmonology, interventional radiology, or further imaging with PET/CT. Per ACR guidelines, patients not requiring acute intervention continue with follow-up CT. Results: In 2023, 29,501 patients were screened with an in-office questionnaire. Of those patients, 3,606 were eligible for screening, 225 declined, and 896 (29%) high risk patients proceeded to undergo LDCT screening. In screened patients, 128 underwent follow-up CT, 36 patients had findings requiring immediate intervention, and 6 were diagnosed with lung cancer. 5 of these patients were diagnosed with stage I and 1 patient was diagnosed with stage IV lung cancer. Conclusions: LDCT screening is a proven method to discover early stage lung cancer and improve the survival rate of diagnosed patients but has not been well adopted in practice. With access to a diverse array of multidisciplinary practices across NY and integrated accredited imaging centers, we have increased the accessibility of lung cancer screening and improved transitions to follow-up care. Nationally, only 4.5% of patients at high risk are screened, however, we found that with our approach to patient care, we have achieved among the highest reported screening rates in eligible individuals.

Use of cell-free tumor DNA in early detection of lung cancer.

e20088 Background: USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults 50-80 years with 20 pack-year smoking history or current/former smoking in the past 15 years. This prospective study evaluated whether we could detect lung cancer at the time of LDCT screening from cell-free tumor DNA using Guardant Health’s LUNAR-2 assay. Methods: Kaiser Permanente Colorado (KPCO) members with upcoming LDCT screenings were invited via email/phone and recruited into two groups, (1) suspicious lung nodules or (2) no lung nodules. We limited enrollment to patients whose LDCT results were classified under the Lung-RADS (version 1.0) categories of 1-3 (recommended follow-up at 12-month intervals) or category 4 (“suspicious”; recommended follow-up at 3-month intervals). We excluded members with lung nodules &gt; 30mm, those with a history of any hematologic malignancy, history of invasive malignancy within the past 5 years, currently pregnant, or known dementia or cognitive impairment. After informed consent, Guardant Health LUNAR test collection kits were mailed to the participant with sample collection instructions provided. Participants were asked to have their blood drawn on the day of their LDCT visit, or no more than 14 days of the scan. We also collected survey and EHR data on smoking history, LDCT, and other associated factors. The KPCO tumor registry confirmed all reported cancers. Results: The study initiated in September 2020 and ended in 08/2022 with 982 individuals consented and blood samples collected. Participants were on average 68 years old, 56% female, 58% former smokers, and 85% had no personal history of cancer. A total of 15 lung cancer cases and 22 other cancer cases were diagnosed. Data analysis is ongoing and expected to be completed early 2024. Conclusions: This study will demonstrate sensitivity and specificity of the LUNAR-2 assay to detect lung cancer relative to standard of care screening modalities in high-risk populations. We will also evaluate whether factors such as comorbidities, pack year history, or medications affect assay accuracy. The impact of this research can inform blood-based early detection of lung cancer.

Artificial intelligence–aided lung cancer screening in routine clinical practice: A pilot of LungFlag at Geisinger.

e13604 Background: Use of low-dose computed tomography (LDCT) in lung cancer screening is recommended for early detection and can reduce mortality. LungFlag (Medial-EarlySign) is a machine-learning risk prediction model that identifies individuals at high risk of non-small cell lung cancer so their care team may recommend LDCT screening. The LungFlag model was developed using data from Kaiser Permanente Southern California and is being implemented in a pilot at Geisinger. Here we provide an overview of the clinical workflow for the LungFlag pilot. Methods: Geisinger has implemented LungFlag into routine clinical practice via integration with the electronic medical record system. This pilot is examining the performance and clinical impact of LungFlag in the first year. LungFlag runs every month to provide risk evaluation for individuals 50 to 80 years old who are eligible for annual lung cancer screening according to US Preventive Services Task Force recommendations. Eligible individuals have a 20 pack-year smoking history, no lung cancer history, and currently smoke or quit within the past 15 years. Patients with cancer history in the past 5 years and those screened or scheduled for screening in the past year are excluded. LungFlag identifies the top 30 individuals with the highest LungFlag scores per month (high-risk patients) and refers them for targeted outreach from a lung cancer screening program nurse navigator. A positive LungFlag result prompts nurse navigator chart review, patient outreach, and coordination with the primary care provider. Flagged individuals are contacted (up to 3 phone calls) and encouraged to receive lung cancer screening. Individuals not flagged by the model (non–high-risk patients) receive usual care consisting of reminders for lung cancer screening during primary care visits without additional targeted outreach and high-risk prioritization. Results: The LungFlag pilot was initiated in August 2023 and will continue until August 2024. As of January 2024, risk profiles of &gt;12,000 patients were analyzed and 180 high-risk patients were identified. Conclusions: This pilot is the first evaluation of the implementation process for the LungFlag model in routine clinical practice. After the pilot, a retrospective observational study is planned to further assess the impact of LungFlag and the associated clinical workflow in identifying high-risk individuals and increasing compliance with LDCT screening among high-risk individuals.

Improving lung cancer health equity by applying deep learning to low dose CT screening of minority and disadvantaged patients.

1584 Background: In the US, disparities in lung cancer mortality exist for African American, Hispanic, and other minorities. Standard of care low dose CT screening (LDCT) detects early-stage disease and improves mortality, yet disparities are perpetuated in screening by eligibility criteria derived from cohorts underrepresenting these minorities. One such cohort is the National Lung Screening Trial (NLST) cohort which is 92% White. Consequently, guidelines for lung cancer screening may be insufficient to address the unique needs of diverse populations. We hypothesize that Artificial Intelligence prediction of future lung cancer risk from an individual’s LDCT can partially mitigate racial and ethnic disparities and improve health system practice guidelines by individualizing screening risk as compared to current general guidelines. Here, we benchmark a Resnet18 3D neural network trained on NLST LDCT images, Sybil, on the diverse patient population of the University of Illinois Health system (UIH) which is 20% White and 60% African American. Methods: A real-world cohort from UIH consisting of 1,450 CT studies was evaluated alongside 60,378 CT studies from the NLST cohort. All CT studies evaluated by the model were not used in model training. Using Youden’s J index as a probability cutoff, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were evaluated. Receiver operating characteristic (ROC) and precision-recall (PR) curves were generated to assess model performance between cohorts. NLST data were truncated to achieve equivalent incidence of lung cancer with UIH when generated PR curves. Results: Multi-year prediction performance (ROC-AUC and PR-AUC) between cohorts are summarized (Table). For prediction of lung cancer within 1-year of LDCT in the UIH cohort, the model respectively demonstrated sensitivity, specificity, positive predictive value, and negative predictive value among White (0.80, 0.77, 0.54, 0.92), African American (0.84, 0.78, 0.39, 0.97) races and Hispanic (0.75, 0.73, 0.60, 0.84) and non-Hispanic (0.87, 0.77, 0.42, 0.97) ethnicities. Conclusions: Model performance was similar between the NLST (92% White) and a diverse, real-world cohort at UIH (20% White) though decreases in ROC-AUC performance in year 1 predictions and may be due to insufficient representation of minority populations during model training. Prospective studies involving larger and more representative patient populations should be conducted to further optimize the model and evaluate its clinical utility to improve lung cancer health equity in minority populations.[Table: see text]

Analysis of diagnosis patterns and implications on cancer stage in patients with lung cancer: A single-institution experience.

e22508 Background: Lung cancer is the most common cause of cancer-related death in the US. Patients are often diagnosed at advanced stages, challenging treatment and improving life expectancy. There has been tremendous progress in developing newer treatments; however, it is crucial to emphasize low-dose CT (LDCT) screening as it may improve earlier diagnosis and ultimately lead to better outcomes. Research Question What is the utilization of LDCT for lung cancer screening in newly diagnosed lung cancer patients? Do patients with lung cancer diagnosed after LDCT have earlier-stage disease when compared to patients who did not have LDCT? Methods: We conducted an observational cohort study on all new lung cancer patients seen in our clinic from January 2022 to July 2023 (18 months). Data collected included the age, type of lung cancer (NSCLC/SCLC), reason and method of initial identification of lung mass/nodule, methodology of biopsy, cancer stage, and if the patient was eligible for LDCT. Results: Over the study duration, 143 newly diagnosed lung cancer patients were seen in our oncology clinic. Of these, only 12% (18) patients had LDCT before diagnosis. Amongst these 18 patients, 44% (8) were diagnosed with stage I, two patients were diagnosed with stage II, and 44% (4+4) were diagnosed with stages III and IV. A total of 56% of patients (combined stage I/II) were eligible for curative treatment in this group. The remaining 82% of patients were diagnosed with lung cancer after imaging for other reasons (non-LDCT group). In this group, the most common stage at diagnosis was stage IV, constituting 39% (56) of the patients, followed by patients diagnosed at stage III with 24% (34). Only 37% (combined stage I/II) were eligible for curative treatment in this group. Conclusions: The USPSTF recommends annual lung cancer screening with LDCT for adults aged 50 to 80 years who have a 20-pack-year smoking history and are current smokers or have quit within the past 15 years. In an observational study conducted in 2021 from our institution, we identified a lower utilization of LDCT in eligible patients. We improved the screening rates by more than 50% from baseline with lung navigation intervention. In this study, we show that patients are getting diagnosed with lung cancer from X-rays and CTs performed for reasons including but not limited to chest pain, shortness of breath, workup for pulmonary embolism, and preoperative X-rays. Most patients diagnosed after LDCT (44%) had stage I disease compared to only 18% of patients in the non-LDCT group. We also observed that a significantly higher percentage (56% vs 37%) of patients are eligible for curative treatment (stage I/II) when diagnosed with LDCT. We highlight the importance of LDCT screening potentially offering a curable treatment in patients with lung cancer.

LDCT lung cancer screening implementation in a Veterans Affairs hospital: A quality initiative.

e23238 Background: Lung cancer is the number one cause of cancer related deaths worldwide. United States Preventive Services Task Force (USPSTF) recommends annual Lung Cancer Screening (LCS) with Low Dose Computerized Tomography (LDCT) for adults who are current smokers aged 50 to 80 years with at least 20 pack year smoking history or have quit smoking within the past 15 years. Although LCS is a national initiative for Veteran Affairs (VA) Hospitals, there are several barriers in practice. Methods: The LCS program was established with a dedicated coordinator to provide better access to high-quality in-house screening, while reducing the dependance on expensive community care services and referrals. Smoking history in Tobacco Pack Years (TPY) is updated during a Primary Care Physician (PCP) visit, which triggers a clinical reminder in the electronic medical record for LCS. The LCS coordinator would then receive a consult. After shared decision-making with the patient, physician and coordinator, the patients are scheduled for LDCT. If the results are Lung-RADS 1 (negative), 2 or 3 (benign appearing nodules) the patients are notified of the findings and provided with subsequent follow ups. All Lung RADS 4 (suspicious findings) are discussed in the lung tumor board, which includes radiologist, oncologist, pulmonologist, pathologist, cardio-thoracic surgeon, and fellows in training. The committee determines the follow-up scan interval and/or additional investigations. Results: The performance of our LCS Program from June 2022 to January 2024 was reviewed. 5941 patients were assessed for TPY, of those 1127 patients were eligible for LCS scans and 1032 (93.3%) were enrolled into the LCS Program. 951 LDCT scans have been conducted thus far, this includes 598 annual initial screenings, the remaining are follow ups. 57 patients (6.81%) had Lung-RADS 3 findings and are undergoing nodule tracking. 16 patients (1.91%) required diagnostic work-up which includes a PET scan or biopsy. 14 patients (1.67%) have been diagnosed with cancer. Conclusions: Our LDCT Program showed a high acceptance rate of 93.3%, much of which can be attributed to the multiple layers of screening and shared decision-making processes. Patients received three phone calls and a letter as a reminder of their LDCT appointments. Our radiology department has four dedicated slots for LDCT screening each day which allows for further compliance. TPY documentation was identified as a limiting factor in this process. The LCS coordinator verified the TPY history with the patients which helped overcome this shortcoming. Overall a multidisciplinary team approach contributed to the success of our program.

Lung cancer among patients with secondhand smoke exposure: A systematic review.

e22506 Background: Smoking tobacco is recognized as the leading cause of lung cancer. However, it is imperative to note that 10–15% of lung cancer patients have no history of smoking, and that lung cancer remains the leading cause of cancer deaths among non-smokers. Since passive smokers are exposed to many carcinogenic compounds in the exhaled smoke, it is naturally plausible that secondhand smoking (SHS) is a risk factor for lung cancer. However, current USPSTF screening guidelines for lung cancer with low dose CT (LDCT) do not include patients exposed to SHS. We performed a systematic review to highlight SHS as an etiology of lung cancer and insights for inclusion in cancer screening criteria. Methods: We utilized the PubMed, Medline, Science Direct, and ClinicalTrials.gov databases to search for relevant literature using keywords ('low Dose CT,' 'secondhand smoke,' 'lung cancer'). The search strategy was designed to ensure a comprehensive retrieval of pertinent literature, minimizing the possibility of omitting articles due to insignificant spelling and/or semantic variations. Eligible studies had to be published between 2010 and 2023 and focused on examining the effect of SHS in populations at risk of lung cancer or those undergoing lung cancer screening. Articles not available in English were excluded from this systematic review. In total, 239 relevant articles were retrieved from all databases, narrowing down to 14 articles after the initial screening and further reducing to 4 articles after the second round of screening. Results: Three of the four articles included in our systemic review were conducted in Asia. A study by He et al. showed a substantial increase in the relative risk of lung cancer among SHS (RR 2.00; 95% CI, 0.62-6.40), with significant dose-response relationships between cumulative SHS exposure at home and work and the increased risk of cause-specific and total mortality. Another observational study on the use of LDCT in Japan has interestingly shown a shifting landscape of lung cancer demographics, with 49.6% of patients identified as never-smokers and 70.0% of the never-smoker lung cancer patients having SHS exposure. Secondhand smoking has also been reported to increase the risk of pulmonary nodules (HR 1.17; 95% CI, 1.01-1.35) and pulmonary emphysema (OR 13.6; 95% CI, 1.70-106.1) in those with moderate-to-high SHS exposure, which was the population where lung cancer was more prevalent. Conclusions: Our findings suggest a critical gap in current healthcare recommendations, specifically addressing the absence of guidelines for LDCT screening in individuals with moderate-to-high SHS exposure despite established evidence linking SHS to a significant increase in the risk of lung cancer development. More studies are needed to formulate evidence-based guidelines for lung cancer screening and detection in this population, given the expected mortality reduction benefit.

Non-invasive diagnosis of nature of pulmonary nodules using the whole genome methylation sequencing of circulating cell-free DNA.

e20038 Background: The frequent false-positive results of lung cancer screening of low-dose computed tomography (LDCT) remains a challenge. In this study, we aimed to establish a novel panel of cancer-specific methylated regions detected from circulating cell-free DNA (cfDNA) for differentiating malignant pulmonary nodules (PNs) from benign lesions in high-risk patients. Methods: We performed DNA methylation profiling by high throughput DNA bisulfite sequencing in tissue samples (nodule size &lt; 3 cm in diameter) to learn methylation patterns that differentiate cancerous tumors from benign lesions. Then we filtered out differential methylation patterns in circulating cfDNA that are consistent with tissue expression patterns and built an assay for plasma sample classification. Area under the curve was computed for each receiving operation curve, and 95% confidence intervals were also estimated by bootstrapping with 1,000 iterations. Results: We first performed the whole genome methylation sequencing of 100 tissue samples from PNs to learn cancer-specific methylation patterns, and obtained 2,406 differential hypermethylated regions and 16,028 differential hypomethylated regions. These tissue-derived DNA methylation markers were further filtered using a training set of 42 plasma samples and 11 markers were ultimately identified to build a diagnostic prediction model. This methylation panel provided promising results in an independent validation set of additional 17 plasma samples, with a sensitivity of 66.67% (95% CI: 0.25–1.00) and a specificity of 79.17% for differentiating patients with malignant tumor (N = 12) from patients with benign lesions (n = 5). A further validation study of this methylation panel in the cancer genome atlas data set demonstrated significant discriminatory performance in distinguishing patients with lung cancer from subjects without malignancy (area under the curve = 0.88). Conclusions: Our model based on the measurement of circulating cfDNA methylation provide a minimally invasive procedure for differentiation of early-stage lung cancer and nonmalignant pulmonary nodules, and may guide management of positive LDCT screening results. Additional clinical studies with larger sample size are needed to establish the robustness of this model.

EE329 Budget Impact of Low-Dose Computed Tomography Screening for Lung Cancer in Argentina

EE329 Budget Impact of Low-Dose Computed Tomography Screening for Lung Cancer in Argentina

Predicting Lung Cancer Survival to the Future: Population-Based Cancer Survival Modeling Study.

Lung cancer remains the leading cause of cancer-related mortality globally, with late diagnoses often resulting in poor prognosis. In response, the Lung Ambition Alliance aims to double the 5-year survival rate by 2025. Using the Taiwan Cancer Registry, this study uses the survivorship-period-cohort model to assess the feasibility of achieving this goal by predicting future survival rates of patients with lung cancer in Taiwan. This retrospective study analyzed data from 205,104 patients with lung cancer registered between 1997 and 2018. Survival rates were calculated using the survivorship-period-cohort model, focusing on 1-year interval survival rates and extrapolating to predict 5-year outcomes for diagnoses up to 2020, as viewed from 2025. Model validation involved comparing predicted rates with actual data using symmetric mean absolute percentage error. The study identified notable improvements in survival rates beginning in 2004, with the predicted 5-year survival rate for 2020 reaching 38.7%, marking a considerable increase from the most recent available data of 23.8% for patients diagnosed in 2013. Subgroup analysis revealed varied survival improvements across different demographics and histological types. Predictions based on current trends indicate that achieving the Lung Ambition Alliance's goal could be within reach. The analysis demonstrates notable improvements in lung cancer survival rates in Taiwan, driven by the adoption of low-dose computed tomography screening, alongside advances in diagnostic technologies and treatment strategies. While the ambitious target set by the Lung Ambition Alliance appears achievable, ongoing advancements in medical technology and health policies will be crucial. The study underscores the potential impact of continued enhancements in lung cancer management and the importance of strategic health interventions to further improve survival outcomes.

Screening for lung cancer using thin-slice low-dose computed tomography in southwestern China: a population-based real-world study.

Lung cancer is one of the most common malignant tumors threatening human life and health. At present, low-dose computed tomography (LDCT) screening for the high-risk population to achieve early diagnosis and treatment of lung cancer has become the first choice recommended by many authoritative international medical organizations. To further optimize the lung cancer screening method, we conducted a real-world study of LDCT lung cancer screening in a large sample of a healthy physical examination population, comparing differences in lung nodules and lung cancer detection between thin and thick-slice LDCT scanning. A total of 29 296 subjects who underwent low-dose thick-slice CT scanning (5 mm thickness) from January 2015 to December 2015 and 28 058 subjects who underwent low-dose thin-slice CT scanning (1 mm thickness) from January 2018 to December 2018 in West China Hospital were included. The positive detection rate, detection rate of lung cancer, pathological stage of lung cancer, and mortality rate of lung cancer were analyzed and compared between the two groups. The positive rate of LDCT screening in the thin-slice scanning group was significantly higher than that in the thick-slice scanning group (20.1% vs. 14.4%, p < 0.001). In addition, the lung cancer detection rate in the thin-slice LDCT screening positive group was significantly higher than that in the thick-slice scanning group (78.0% vs. 52.9%, p < 0.001). The screening positive rate of low-dose thin-slice CT scanning is higher and more early-stage lung cancer (IA1 stage) can be detected in the screen-positive group.

Smartphone application versus written material for smoking reduction and cessation in individuals undergoing low-dose computed tomography (LDCT) screening for lung cancer: a phase II open-label randomised controlled trial

Counseling, nicotine replacement, and other cessation medications have been proven effective in smoking cessation. The wide-scale adoption of smartphones and other mobile devices has opened new possibilities for scalable and personalized smoking cessation approaches. The study investigated whether a smartphone application would be more effective than written material for smoking cessation and reduction in smoking in individuals undergoing low-dose computed tomography (LDCT) screening for lung cancer (NCT05630950). This randomized controlled trial enrolled 201 current smokers with marked smoking history (smoked ≥15 cigarettes/day for ≥25 years or smoked ≥10 cigarettes/day for ≥30 years). Participants were stratified by age and pack-years and randomized in 1:1 fashion to the developed smartphone application (experimental arm) or written material (standard of care). All the subjects underwent LDCT screening. Self-reported smoking cessation at three and six months were the primary endpoints of the study. The smoking-related secondary endpoints of the study were the percentage of individuals who had reduced the number of smoked cigarettes/d from the baseline. Between Nov 18, 2022, and Apr 14, 2023, 201 patients were screened at Oulu University Hospital, Finland, of whom all were randomly assigned to smartphone application (n=101) or written cessation material (n=100); 200 were included in the full analysis set. Study arms were well-balanced for all the studied demographic factors. Subjects randomized to the smartphone application arm had significantly higher rates for self-reported smoking cessation at three (19.8 versus 7.1%; OR 3.175 CI 95% 1.276-7.899) and six months (18.8 versus 7.1%; OR 2.847 CI 95% 1.137-7.128). In the experimental arm, individuals with a frequent use of the application had a higher chance for smoking cessation at three (p<0.001) and six months (p=0.003). The study showed that the developed smartphone application increases the likelihood for smoking cessation in individuals undergoing lung cancer LDCT screening. AstraZeneca, Roche, and Cancer Foundation Finland.