Screen-detected Lung Cancer Research Articles

Community-based lung cancer screening by low-dose computed tomography in China: First round results and a meta-analysis

ObjectiveTo evaluate the efficiency of low-dose computed tomography (LDCT) screening for lung cancer in China by analyzing the baseline results of a community-based screening study accompanied with a meta-analysis. MethodsA first round of community-based lung cancer screening with LDCT was conducted in Tianjin, China, and a systematic literature search was performed to identify LDCT screening and registry-based clinical studies for lung cancer in China. Baseline results in the community-based screening study were described by participant risk level and the lung cancer detection rate was compared with the pooled rate among the screening studies. The percentage of patients per stage was compared between the community-based study and screening and clinical studies. ResultsIn the community-based study, 5523 participants (43.6% men) underwent LDCT. The lung cancer detection rate was 0.5% (high-risk, 1.2%; low-risk, 0.4%), with stage I disease present in 70.0% (high-risk, 50.0%; low-risk, 83.3%), and the adenocarcinoma present in 84.4% (high-risk, 61.5%; low-risk, 100%). Among all screen-detected lung cancer, women accounted for 8.3% and 66.7% in the high- and low-risk group, respectively. In the screening studies from mainland China, the lung cancer detection rate 0.6% (95 %CI: 0.3%–0.9%) for high-risk populations. The proportions with carcinoma in situ and stage I disease in the screening and clinical studies were 76.4% (95 %CI: 66.3%–85.3%) and 15.2% (95 %CI: 11.8%–18.9%), respectively. ConclusionsThe stage shift of lung cancer due to screening suggests a potential effectiveness of LDCT screening in China. Nearly 70% of screen-detected lung cancers in low-risk populations are identified in women.

Core needle biopsy for screening detected lung cancer—does it capture all in light of tumor heterogeneity?—a narrative review

Core needle biopsy for screening detected lung cancer—does it capture all in light of tumor heterogeneity?—a narrative review

Analysis of the baseline performance of five UK lung cancer screening programmes

IntroductionLow-dose CT (LDCT) screening reduces lung cancer specific mortality. Several countries, including the UK, are evaluating the clinical impact and cost-effectiveness of LDCT screening using the latest evidence. In this paper we report baseline screening performance from five UK-based lung cancer screening programmes. MethodsData was collected at baseline from each screening programme. Measures of performance included prevalence of screen detected lung cancer, rate of surveillance imaging for indeterminate findings and surgical resection rates. Screening related harms were assessed by measuring false positive rates, number of invasive tests with associated complications in individuals without lung cancer and benign surgical resection rates. ResultsA total of 11,148 individuals had a baseline LDCT scan during the period of analysis (2011 to 2020). Overall, 84.7% (n = 9,440) of baseline LDCT scans were categorised as negative, 11.1% (n = 1,239) as indeterminate and 4.2% (n = 469) as positive. The prevalence of screen detected lung cancer was 2.2%, ranging between 1.8% and 4.4% for individual programmes. The surgical resection rate was 66% (range 46% to 83%) and post-surgical 90-day mortality for those with lung cancer 1.2% (n = 2/165). The false positive rate was 2% (n = 219/10,898) and of those with a positive result, one in two had lung cancer diagnosed (53.3%). An invasive test was required in 0.6% (n = 61/10,898) of screening attendees without lung cancer; there were no associated major complications or deaths. The benign surgical resection rate was 4.6% (n = 8/173), equating to 0.07% of the screened population. DiscussionThe performance of UK-based lung cancer screening programmes, delivered within or aligned to the National Health Service, compares favourably to published clinical trial data. Reported harms, including false positive and benign surgical resection rates are low. Ongoing monitoring of screening performance is vital to ensure standards are maintained and harms minimised.

The Lipid Composition of Serum-Derived Small Extracellular Vesicles in Participants of a Lung Cancer Screening Study.

Simple SummaryMolecular components of extracellular vesicles present in serum are potential biomarkers of lung cancer, however, none of them have been validated in the context of an actual early detection of lung cancer. Here, we compared the lipid profiles of vesicles obtained from participants in a lung cancer screening study, including patients with screening-detected cancer and individuals with benign pulmonary nodules or without pathological changes. A few lipids whose levels were different between compared groups were detected, including ceramide Cer(42:1) upregulated in vesicles from cancer patients. Furthermore, a high heterogeneity of lipid profiles of extracellular vesicles was observed, which impaired the performance of classification models based on specific compounds.Molecular components of exosomes and other classes of small extracellular vesicles (sEV) present in human biofluids are potential biomarkers with possible applicability in the early detection of lung cancer. Here, we compared the lipid profiles of serum-derived sEV from three groups of lung cancer screening participants: individuals without pulmonary alterations, individuals with benign lung nodules, and patients with screening-detected lung cancer (81 individuals in each group). Extracellular vesicles and particles were purified from serum by size-exclusion chromatography, and a fraction enriched in sEV and depleted of low-density lipoproteins (LDLs) was selected (similar sized vesicles was observed in all groups: 70–100 nm). The targeted mass-spectrometry-based approach enabled the detection of 352 lipids, including 201 compounds used in quantitative analyses. A few compounds, exemplified by Cer(42:1), i.e., a ceramide whose increased plasma/serum level was reported in different pathological conditions, were upregulated in vesicles from cancer patients. On the other hand, the contribution of phosphatidylcholines with poly-unsaturated acyl chains was reduced in vesicles from lung cancer patients. Cancer-related features detected in serum-derived sEV were different than those of the corresponding whole serum. A high heterogeneity of lipid profiles of sEV was observed, which markedly impaired the performance of classification models based on specific compounds (the three-state classifiers showed an average AUC = 0.65 and 0.58 in the training and test subsets, respectively).

Characteristics and Outcomes of Lung Cancers Detected on Low-Dose Lung Cancer Screening CT.

Lung cancer screening (LCS) with low-dose CT (LDCT) was implemented in the United States following the National Lung Screening Trial (NLST). The real-world benefits of implementing LCS are yet to be determined with outcome-oriented data. The study objective is to investigate the characteristics and outcomes of screening-detected lung cancers. This single-institution retrospective study included LCS patients between June 2014 and December 2019. Patient demographics, number of screening rounds, imaging features, clinical workup, disease extent, histopathology, treatment, complications, and mortality outcomes of screening-detected lung cancers were extracted and compared with NLST data. LCS LDCTs (7,480) were performed on 4,176 patients. The cancer detection rate was 3.8%, higher than reported by NLST (2.4%, P < 0.0001), and cancers were most often found in patients ≥65 years (62%), older than those in NLST (41%, P < 0.0001). The patients' ethnicity was similar to NLST, P = 0.87. Most LCS-detected cancers were early stage I tumors (71% vs. 54% in NLST, P < 0.0001). Two thirds of cancers were detected in the first round of screening (67.1%) and were multifocal lung cancers in 15%. As in NLST, the complication rate after invasive workup or surgery was low (24% vs. 28% in NLST, P = 0.32). Over a median follow-up of 3.3 years, the mortality rate was 0.45%, lower than NLST (1.33%, P < 0.0001). LCS implementation achieved a higher cancer detection rate, detection of early-stage cancers, and more multifocal lung cancers compared with the NLST, with low complications and mortality. The real-world implementation of LCS has been successful for detection of lung cancer with favorable outcomes.

172 - Histological characteristics of screen-detected lung cancers: should rate of growth influence management?

172 - Histological characteristics of screen-detected lung cancers: should rate of growth influence management?

Community-based lung cancer screening adherence to Lung-RADS recommendations.

10540 Background: In the NLST and NELSON trials, most low-dose CT (LDCT) screen-detected lung cancers were not diagnosed during the first round of screening, suggesting that longitudinal adherence to lung cancer screening (LCS) recommendations is key. Adherence was as high as 95% in clinical trials, but limited data exist regarding LCS adherence in clinical practice. We aimed to determine adherence to Lung-RADS recommendations among community-based patients undergoing LCS. Methods: We performed a multicenter retrospective cohort study of patients screened for lung cancer at healthcare systems within the Lung Population-based Research to Optimize the Screening Process (PROSPR) Consortium. We included 55-80 year-old current or former smokers who received a baseline (T0) LDCT with a Lung-RADS score between January 1, 2015 and September 30, 2017 and excluded patients who were diagnosed with lung cancer prior to the T0 scan. Over a 24-month period, we calculated the proportion of patients adherent to Lung-RADS recommendations and evaluated associations with patient-level (age, sex, race, ethnicity, smoking status, body mass index, Elixhauser comorbidities, year of T0 scan, and Lung-RADS score) and census tract (median family income, level of education) data, using multivariable logistic regression with mixed effects to account for site variability. Results: Of the 6,723 patients in our cohort (median age 65 years [IQR 60-69]; 45.1% female; 73.0% white; 59.0% current smokers), 5,583 (83.0%) had Lung-RADS 1 or 2 T0 scans, 733 (10.9%) Lung-RADS 3, 274 (4.1%) Lung-RADS 4A, and 133 (2.0%) Lung-RADS 4B or 4X. Overall, 55.2% (3,709/6,723) of patients were adherent (Table). In the final multivariable model, Black patients had reduced adherence compared to white patients (adjusted odds ratio [aOR] 0.79, 95% CI 0.66-0.94), while greater adherence was observed in former smokers compared to current smokers (aOR 1.33, 95% 1.19-1.49). Compared to individuals with a negative T0 scan (Lung-RADS 1 or 2), those with Lung-RADS 3 (aOR 1.56, 95% CI 1.31-1.86), 4A (aOR 1.63, 95% CI 1.24-2.15), or 4B/4X (aOR 3.59, 95% CI 2.30-5.60) T0 scans had greater odds of adherence. Conclusions: In the largest study of real-world patients receiving LCS to date, adherence to Lung-RADS recommendations is lower than previously observed in clinical trials. Our results highlight the need for further study of system-level mechanisms to improve longitudinal LCS adherence rates.[Table: see text]

Women screened for breast cancer are dying from lung cancer: An opportunity to improve lung cancer screening in a mammography population.

Lung cancer is the leading cancer killer in women, resulting in more deaths than breast, cervical and ovarian cancer combined. Screening for lung cancer has been shown to significantly reduce mortality, with some evidence that women may have a greater benefit. This study demonstrates that a population of women being screened for breast cancer may greatly benefit from screening for lung cancer. Data from 18,040 women who were screened for breast cancer in 2015 at two imaging facilities that also performed lung screening were reviewed. A natural language-processing algorithm followed by a manual chart review identified women eligible for lung cancer screening by U.S. Preventive Services Task Force (USPSTF) criteria. A chart review of these eligible women was performed to determine subsequent enrollment in a lung screening program (2016-2019), current screening eligibility, cancer diagnoses and cancer-related outcomes. Natural language processing identified 685 women undergoing screening mammography who were also potentially eligible for lung screening based on age and smoking history. Manual chart review confirmed 251 were eligible under USPSTF criteria. By June 2019, 63 (25%) had enrolled in lung screening, of which three were diagnosed with screening-detected lung cancer resulting in zero deaths. Of 188 not screened, seven were diagnosed with lung cancer resulting in five deaths by study end. Four women received a diagnosis of breast cancer with no deaths. Women screened for breast cancer are dying from lung cancer. We must capitalize on reducing barriers to improve screening for lung cancer among high-risk women.

P41.03 Long-Term Results of Screening-Detected Lung Cancer in the Polish Cohort

P41.03 Long-Term Results of Screening-Detected Lung Cancer in the Polish Cohort

OA05.09 Volume Doubling Time and Radiomic Features Predict Tumor Behavior of Screen-Detected Lung Cancers in the National Lung Screening Trial (NLST)

OA05.09 Volume Doubling Time and Radiomic Features Predict Tumor Behavior of Screen-Detected Lung Cancers in the National Lung Screening Trial (NLST)

Do competing causes of mortality contribute to overdiagnosis in lung cancer screening?

Overdiagnosed cancers are those that are screen-detected but never would have been symptomatic during patients’ lifetimes. Indolent cancers are overdiagnosed cancers. Non-indolent cancers can be overdiagnosed when patients die of causes other than the screen-detected cancer and would have, in the absence of screening, been asymptomatic and undiagnosed at the time of death. This is termed competing cause of mortality (CCM) overdiagnosis. Deaths soon after screen detection may represent CCM overdiagnosis. We examined time from screen-detection to death among the 35 participants in the National Lung Screening Trial (NLST) low-dose computed tomography arm with screen-detected lung cancer and died of non-lung-cancer causes. Seven participants died within 6 months, and 20 died more than 24 months after diagnosis. Deaths due to non-lung cancer causes soon after screen detection were uncommon, arguing against widespread CCM overdiagnosis in the NLST. However, CCM overdiagnosis is likely more frequent in community-based screening given the higher prevalence of comorbidities.

Lung cancer screening in patients with previous malignancy: Is this cohort at increased risk for malignancy?

To determine the rate of second primary lung cancer (SPLC) and describe the clinical characteristics and radiological findings in individuals with a prior history of cancer presenting to a low-dose computed tomography (LDCT) lung cancer screening program at a tertiary cancer center. Patients with a previous history of malignancy, a life expectancy ≥ 5years referred for CT lung cancer screening between May 2, 2011, and November 28, 2018, were included. Demographics regarding risk factors including smoking history and prior history of thoracic radiation were collected. CT scan features assessed nodule size, morphologic features, and number. The Lung-CT Reporting and Data System (Lung-RADS) scoring system was retrospectively applied to studies performed before October 2014 and prospectively applied to remainder of studies. Data was collected in a Health Insurance Portability and Accountability Act (HIPAA)-compliant manner. A total of 543 patients were studied (mean age of 66years). All had a previous history of cancer, most commonly breast cancer 205 (38%), head and neck cancer 105 (19%), and lung cancer 87 (16%). Of screening CTs performed, 17.5% were positive screening study results as per Lung-RADS scoring system. SPLC was diagnosed in 35 patients (6.4%) with 21 prevalence cancers detected and 14 interval cancers detected in subsequent screening rounds. The rate of screen-detected SPLC in patients with prior malignancy is higher than reported rates seen in historical prospective screening studies. Our study suggests the need for prospective research to evaluate any mortality benefit that screening may have in this population. • The rate of screen-detected second primary lung cancer in patients with prior malignancy is higher than reported rates seen in historical prospective randomized lung cancer screening studies in a general screened population. • Patients with a prior malignancy undergoing lung cancer screening have higher rates of positive screening studies and higher rates of invasive diagnostic procedures than those reported in a general screening population. • Prospective research is required to evaluate if screening offers a mortality benefit in this population.

Spirometry performed as part of the Manchester community-based lung cancer screening programme detects a high prevalence of airflow obstruction in individuals without a prior diagnosis of COPD

BackgroundCOPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme.MethodsEver smokers,...

Does low-dose computed tomography screening improve lung cancer-related outcomes?—a systematic review

: Screening with low-dose computed tomography (LDCT) can potentially decrease the mortality rate of lung cancer by detecting tumors at earlier stages. Although a number of guidelines exist on the implementation of screening and the management of screening-detected lesions, the field has progressed since those were written in terms of the clinical data now available and the greater range of surgical options now on offer to patients. This systematic review aims to provide an updated assessment of how LDCT screening may impact lung cancer-related outcomes in light of such recent data and surgical progress. A systematic literature search was conducted to identify articles focused on the use of LDCT to screen for primary non-small cell lung cancer in asymptomatic individuals. Of 2,880 articles identified, high quality papers reporting the results of 27 major studies were selected for in-depth analysis—including 17 observational studies (15 prospective and 2 retrospective), and 11 randomised-controlled trials. LDCT screening detected lung cancer in 0–8.2% of asymptomatic adults subject. These rates were demonstrated in most studies to be significantly higher than the lung cancer detection rate with no screening. Invasive procedures for benign lesions were performed in 0.07–1.9% of LDCT-screened subjects. Most LDCT screening-detected lung cancers presented in stage I, and 52–100% of patients with LDCT-detected lung cancer received surgery. Two large randomized-controlled trials showed that LDCT screening was associated with a 20.0% reduction in mortality when compared to chest X-ray (CXR) screening, and a 26% reduction in mortality when compared to no screening. LDCT screening is associated with: higher rates of lung cancer detection; diagnosis of lung cancer at an earlier stage; greater likelihood of surgical therapy being given; and lower mortality from lung cancer. The rate of ‘unnecessary’ interventions as a result of LDCT screening is low.

Analysis of Screen-detected Lung Cancers' Genomic Traits

Analysis of Screen-detected Lung Cancers' Genomic Traits

OA02.08 Peritumoral and Intratumoral Radiomic Features Identify Aggressive Screen-Detected Early-Stage Lung Cancers

OA02.08 Peritumoral and Intratumoral Radiomic Features Identify Aggressive Screen-Detected Early-Stage Lung Cancers

IBS16.01 Lung Cancer Screening and Its Effect on Surgery

IBS16.01 Lung Cancer Screening and Its Effect on Surgery

ES08.03 The Magnitude of the Benefit

Why do people get screened? The obvious answer is so that cancer can be detected early with a view towards a higher chance of cure with early treatment. Therefore, the critical questions that must be addressed relate to the risk of cancer over time and then, how likely cure will be when screen-detected versus clinically detected. Current approaches to evaluate screening have relied on randomized controlled trials with a view towards demonstrating that a benefit actually exists but are not designed to quantify the magnitude of the benefit. Current trial designs have limited rounds of screening and long-term follow up after screening has stopped. When these parameters change, the results of the trial will also change. Several approaches currently exist to estimate that critical parameter regarding the curability of screen detected lung cancer. This includes modeling approaches which can use data extracted from a variety of sources, they can also be measured directly as was done in the I-ELCAP study which measures directly the reduction in case fatality rate by using long term survival as a measure of cure, and an additional approach would be to screen continuously in the context of a clinical trial and measure the reduction in mortality after several years of screening where the benefit of screening reaches its maximum and becomes equivalent to the reduction in case fatality rate. When applied to lung cancer it can be shown that this benefit is far greater than the 20% so commonly reported and instead is in the 60=80% range for cure. Were this to be fully understood the entire rationale behind requiring shared decision making would be called into question as it was thought that the balance between benefits and harms was so tenuous that shared decision making was necessary. When considering whether a particular type of screening is to be considered beneficial there is also a tendency to compare different types of screening and seeing how many screens are necessary to save a life. Here to, this approach suffers from the same mistake. Each of those screening exams estimates this number based on their own randomized trial and each of these differ in terms of the design parameters, therefore the comparisons are essentially meaningless. benefit, lung cancer screening

MS16.05 Optimal Treatment Selection for Screen-Detected Lung Cancers

MS16.05 Optimal Treatment Selection for Screen-Detected Lung Cancers

P1.11-08 Are Risk Prediction Models Superior Over Standard Criteria for Lung Cancer Screening in Europe? Macroscale Simulation on Large Polish Cohort

Inauguration of the national lung cancer screening programme in Poland is to take place in 2019. Yet, issues such as optimal selection criteria remain unresolved. A computational macroscale simulation of lung cancer risk prediction models’ implementation and comparison in a large lung cancer screening cohort of 5,534 individuals from a single, experienced European center was performed. A total of 5,534 healthy volunteers (aged 50-79, smoking history ≥30 pack-years) were enrolled in the Moltest Bis Programme (Moltest) between 2016 and 2017. Inclusion criteria were based on the Lung Cancer Screening National Comprehensive Cancer Network Clinical Practice Guidelines. Each participant underwent a low-dose computed chest tomography scan and selected participants underwent a further, diagnostic work-up. A computational macroscale simulation of Tammemagi PLCOm2012, Liverpool Lung Project (LLP) and Bach risk models’ implementation was applied. Jupyter notebook v.1.0 scientific environment was used to calculate lung cancer probability of all Moltest participants. Patients i) with 6-year lung cancer probability ≥1.3% were considered as high risk in PLCOm2012 model, ii) in LLP model with 5-year lung cancer probability ≥5.0%, and iii) in Bach model with 1-year lung cancer probability ≥2.0%. Such selected patients were eligible for the inclusion to the simulated lung cancer screening programme. Boolean functions were created and data frames containing patients’ epidemiological characteristics were joined using Pandas Python Library v.0.23 for Python v.3.7. In a computational macroscale simulation 3,897 (70.4%), 3,118 (56.3%) and 925 (16.7%) out of 5,534 Moltest participants met the threshold criteria of lung cancer probability in PLCOm2012, LLP and Bach models, respectively. With 199 (3.6%) Moltest individuals initially referred for diagnostic work-up in the programme, lung cancer was confirmed in 105 (1.9%) cases. Contrarily, among high-risk individuals selected based on PLCOm2012, LLP and Bach models, respectively, 103 (2.6%), 56 (1.8%) and 24 (2.6%) constituted the lung cancer cases primarily detected in the Moltest programme. Thus, in PLCOm2012, LLP and Bach models the proportions of screen-detected lung cancer cases were 98.1%, 53.3% and 22.9%, respectively. Risk prediction models provide a vast disparity in selecting lung cancer high-risk individuals. Lung cancer screening enrollment based on Tammemagi’s PLCOm2012 risk prediction model is superior over LLP, Bach models and standard selection criteria based on age and pack-years.