J Thorac Dis 2013;5(S5)

Estimated 10 year survival 88%, regardless of treatment Survival rate 92% if surgical resection in 1 month

“In a population at risk for lung cancer, such screening could prevent some 80% of deaths from lung cancer.” Conclusion: Annual spiral CT screening can detect lung cancer that is curable

Arch Intern Med Nov 26;167(21):

“Study Sees Gain on Lung Cancer” 2006 “Cigarette Company Paid for Lung Cancer Study” Disclosure line reported no conflicts of interest “Review Casts More Doubts on a Lung Cancer Study” 90% of consent forms cannot be located Authors received royalties from GE, makes CT scanners (2007) Stock ownership and consulting for company that makes biopsy needles for lung cancer diagnosis Inventors on 27 patents and applications: Lung cancer (2006) screening technology embedded in I-ELCAP protocol

J Natl Cancer Inst Jul 6;103(13): “I believe that in the case of ELCAP data, the findings cannot be properly interpreted without understanding the basis of some of the conflicting, improbable, and outlier findings.”

Longitudinal analysis 3246 current or former smokers Annual CT scans, comprehensive evaluation and treatment of detected nodules Compared predicted to observed number of new cases, lung cancer resections, advanced lung cancer cases, and deaths from lung cancer 144 cases of lung cancer compared to 44.5 expected cases (RR 3.2) 109 lung resections compared to 10.9 expected (RR 10) No decline in number of advanced lung cancer or deaths from lung cancer “Screening for lung cancer with LDCT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer.”

Vital status known for 97% of patients Median duration of follow-up 6.5 years Maximum duration 7.4 years Adherence to screening high 95% LDCT 93% CXR Trial stopped early by DSMB on October 20, Definitive result reached for primary end point.

At least one positive result during screening LDCT 39.1% CXR 16% Clinically significant abnormality other than suspicious for lung cancer LDCT: 7.5% CXR: 2.1%

Complications

Stage I at Diagnosis LDCT: 50% CXR: 31.1% Stage III or IV at Diagnosis LDCT: 32.9% CXR: 40.9%

Risk of radiation? Effects on quality of life, anxiety? Cost? Role for smoking cessation? Who should really be screened? How does this compare to other accepted screening tools? Can we do this on a local level? Infrastructure? Who’s in charge?

Cancer Apr 1;119(7): J Thorac Dis 2013;5(S5)

PLoS One 2013 Aug 7;8(8)

NCI, USPSTF Mammography is socially and economically accepted. Is this a model to follow in lung cancer?

J Thorac Dis 2013;5(S5)

More than just a CT scan, and the potential public health impact is large and requires a multidisciplinary approach to patient care.