Ct screening for lung cancer we re not there yet
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CT Screening for Lung Cancer: We’re not there yet PowerPoint PPT Presentation


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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

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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


Nlst preliminary results 10 2010 dsmb stopped trial based on pre specified monitoring plan

NLST: Preliminary Results10/2010—DSMB stopped trial based on pre-specified monitoring plan


Guidelines for screening

Guidelines for Screening


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


Perception six blind men and the elephant an indian tale

Perception: Six Blind Men and The Elephant—An Indian Tale


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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