Presentation on theme: "BME 1300 Problem 1 Newstetter Group Haval Amedi Mollie Bryan Eric Flynn Peymaun Ghafouri-Kia Ryan Gleber Walter Kim Chelsea Proffitt Laini Whitton."— Presentation transcript:
BME 1300 Problem 1 Newstetter Group Haval Amedi Mollie Bryan Eric Flynn Peymaun Ghafouri-Kia Ryan Gleber Walter Kim Chelsea Proffitt Laini Whitton
Problem Currently, non-small cell lung cancer is being detected at stages III and IV, causing a five year mortality rate of 86%. This is due to a lack of widespread lung cancer screening methods that have sensitivity and specificity greater than 60%.
Evaluation of Current Methods Data suggests no current implementation of screening High mortality rate Caught after symptoms develop—stages III and IV X-rays and sputum cytology - have been proven ineffective in lowering mortality rate Physical exam - ineffective for screening in early stages due to lack in symptoms CT Scan – has only been proven effective for high risk patients Bronchoscopy and biopsy – overly invasive and used primarily for detection Humphrey et al., Annals of Internal Medicine, 2004
Evaluation of Screening Procedure Practically no screening done Patients assessed for risk Smoker (10 pack years), occupation, family history If patient is high risk, some will screen, others will wait for symptoms X-rays followed by CT scans if abnormalities present CT followed by biopsy/treatment Sputum occasionally used Doctors very negative about screening situation Cayelli, et al., Phone Interview, 2011.
Recommendations for Current Methods Annual CT for high risk age with 30 pack years Biannual CT for other high risk patients not in 55-74/30 pack year category Mathematical modeling available soon for other risk groups 1 Eliminate X-rays for high risk groups Add PET to CT scan when available 2 Cell block and smear with sputum cytology 3 1. Peres, Journal of the National Cancer Institute, Pastorino, British Journal of Cancer, Erkiliç et al., Acta Cytol, 2003
Evaluation Numbers For Future Methods Grading Scale for Future Methods 2 x Sensitivity 2 x Specificity 1 x Invasiveness 1 x Risk of Injury from Test Complications 1 x Practicality (Ease of Analyzing and Collecting Data) 1 x Implementation (Ease of Achieving Widespread Usage) Each Ranked 1-5 with 5 being the highest rating
Evaluation Numbers For Future Methods Sputum Biomarkers – 21/40 Methylation of tumor suppression genes 64% sensitivity and specificity 4 PPV = 11.72% CriteriaRating Sensitivity (x2)4 Specificity (x2)4 Invasiveness4 Risk4 Practicality5 Implementation4 Total Score21 Serum Based miRNA – 28/40 Both miR-1254 and miR-547-5p significantly increased in early stage NSCLC 78% sensitivity/75% specificity 5 CriteriaRating Sensitivity (x2)6 Specificity (x2)4 Invasiveness4 Risk5 Practicality5 Implementation4 Total Score Keller et al., BMC Cancer, 2009
Evaluation Numbers For Future Methods Breath Biomarkers – 31/40 Analyzes biomarkers in exhaled breath 84% sensitivity/92% specificity 7 Circulating Tumor Cells – 29/40 Blood test 71% sensitivity/83% Specificity 6 CriteriaRating Sensitivity (x2)4 Specificity (x2)6 Invasiveness4 Practicality5 Risk5 Implementation5 Total Score29 CriteriaRating Sensitivity (x2)6 Specificity (x2)8 Invasiveness5 Risk5 Practicality5 Implementation3 Total Score Tanaka et al., Clin Cancer Res, 2009
Evaluation Numbers For Future Methods Protein Blood Biomarkers – 33/40 Uses aptamers 91% sensitivity/84% specificity 6 Bronchoscopy (Epithelial Cells) – 34/40 Genetic testing of epithelial cells from endobronchial brushings 95% sensitivity and specificity 7 CriteriaRating Sensitivity (x2)8 Specificity (x2)6 Invasiveness4 Practicality5 Risk5 Implementation5 Total Score31 CriteriaRating Sensitivity (x2)10 Specificity (x2)10 Invasiveness3 Practicality4 Risk3 Implementation4 Total Score34
Proof of Concept Given a random population of 100,000 people, 6,950 9 will be diagnosed with lung cancer. 6, of these people will die. With our proposed future method of genetic testing in epithelial cells from endobronchial brushings, our new mortality rate is 53.07% 7,10,11, saving 2,357 lives Problem Statement 11. Minna, Harrison’s Prin of Int Med, 2005
Final Recommendations Screening methods in distant future Partial Wave Spectroscopy 12 Urine Test Proteomics Spirometry 12. Backman, et al., Cancer Research, 2010