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CT Screening for Lung Cancer: We’re not there yet. Jyoti D. Patel, MD Division of Hematology/Oncology Feinberg School of Medicine, Northwestern University Chicago, IL . Free Screening?. FACT :  Lung cancer is the leading cause of cancer death among both men and women worldwide

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ct screening for lung cancer we re not there yet

CT Screening for Lung Cancer:We’re not there yet

Jyoti D. Patel, MD

Division of Hematology/Oncology

Feinberg School of Medicine,

Northwestern University

Chicago, IL

free screening
Free Screening?

FACT:  Lung cancer is the leading cause of cancer death among both men and women worldwide

FACT:  There is no routine screening for lung cancer

FACT:Lahey Clinic is trying to change that

If you are between the ages of 50 and 74, currently a smoker (or have quit within the past 15 years) and have a history of smoking at least a pack of cigarettes a day for 20 years, you may qualify for a free low-dose CT lung screening.

The screening is quick and painless and you do NOT have to be a Lahey patient to receive this free screening. However, your primary care doctor must order the test.

To learn more, please call 1-855-CT-CHEST between 8:30am–4:30pm, Monday through Friday to complete a screening questionnaire.

Thank you!

many stakeholders
Many Stakeholders
  • People who have smoked
  • Families of smokers
  • People with Lung Disease
  • Health care professionals involved in the care of people at risk for lung cancer
  • Organizations involved in public health and clinical issues
  • Policy makers within government
  • Healthcare organizations
recommendation by risk status
Recommendation by Risk Status

Bach, JAMA, 5/2/2012

http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#detection

http://www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-guidelines/lung-cancer-screening.pdf

quantifying benefits explaining risk and probability
Quantifying Benefits:Explaining Risk and Probability
  • Relative Risk
    • Gives a comparison or ratio
    • Shows the strength of the relationship between a risk factor and particular type of cancer
    • Risk seems greater when put in terms of relative risk
  • Absolute Risk
    • The actual numerical chance of developing cancer during a time period
    • Lifetime Risk: the probability that an individual will develop cancer during the course of a lifetime

20% relative decrease in deaths from lung cancer!

The chance of dying of lung cancer was 0.33% less over the study period in pts with LDCT.

310 individuals are screened to prevent 1 lung cancer death.

quantifying harm
Quantifying Harm
  • Detection of Abnormalities
  • Complications of Diagnostic Procedures
  • Overdiagnosis
  • Radiation Exposure
  • Quality of Life

deGonzales. Lancet. 2004 363:345

nccn high risk individual
NCCN: High Risk Individual*
  • In addition to age > 50 and > 20 pack year history of smoking tobacco, one additional factor (second hand smoke does not count): consider screening(2B)
    • Occupational Exposure
    • Residential Radon Exposure
    • Cancer History
    • Family History of Lung Cancer
    • History of Lung Disease
  • Moderate risk--age > 50 and > 20 pack year history of smoking tobacco, no risk factors-- no screening (2A)

NCCN Guidelines on Lung Cancer Screening

relative risk of developing lung cancer
Relative Risk of Developing Lung Cancer

1 MMWR 2008; 2 Surgeon General, 2010; 3 Peto, BMJ, 2000; 4 Driscoll, Ma J Ind Med 2005; 5 Lubin, J Natl Cancer Inst, 1997; 6 Brenner, PLoS 2011 7 Hubbard, Am J RespirCrit Care Med 2000

relative risk of developing lung cancer with history of cancer
Relative Risk of Developing Lung Cancer with History of Cancer

1 Tucker, J Natl Cancer Inst, 1997; 2 Travis, J Natl Cancer Inst, 2002; 3 Matakidou, Br J Cancer, 2005

former smokers
Former Smokers

Peto, R., Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two-case control studies. BMJ, 2000

duration of screening
Duration of Screening?
  • ASCO/ACCP—not known
  • NCCN—NLST cohort—annually until patients are 74

Brenner, NEJM 2007

lung cancer risk prediction
Lung Cancer Risk Prediction

Etzel and Bach, Seminars in Reps and Crit Care Med, 2011;

Bach J Natl Cancer Inst. 2003 Mar; Spitz Cancer Prev Res (Phila). 2008 ; Cassidy. Int J Oncol. 2006 May

areas of uncertainty
Areas of Uncertainty
  • Currently, screening needs to be in a center similar to those where NLST was conducted
  • Screened individuals should be entered into a registry to assess long term impact
  • Quality metrics need to be developed
  • Demonstration projects need to planned to evaluate implementation
  • Establishment of task forces to assess ever changing technology
  • Develop better predictors of lung cancer risk
screening is a process not a test
Screening is a PROCESS, not a test
  • Complete health history, assessment of comorbidities
  • Smoking cessation
  • Benefits/risks of screening, possible procedures
  • Costs—health insurance reimbursement, time, and personal costs
  • Center with multidisciplinary approach
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