1. Cancer Education Day Lung Cancer Screening Update Kirenza Francis, MD, FRCPC, DABR Windsor Radiological Associates May 13, 2016

2. NO DISCLOSURES

3. Recent Changes in Recommendations due to National Lung Screening Trial 2002-2010 53,454 participants Participants: 55-74 yo, 30 pack year smoking history current or former smokers Low Dose Chest CT versus Chest X-ray for 3 years Followed for and average for an average of 6.5 years

4. NATIONAL LUNG CANCER SCREENING RESULTS Low-dose helical CT scans had a 20 percent lower risk of dying from lung cancer than participants who received standard chest X- rays 3 fewer deaths per 1,000 people screened in the CT group compared to the chest X-ray group over a period of about 7 years of observation (17.6 per 1,000 versus 20.7 per 1,000, respectively

6. US PREVENTATIVE SERVICES TASK FORCE 2013 The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

7. CANDADIAN TASK FORCE ON PREVENTATIVE HEALTH CARE 2016 For adults aged 55–74 years with at least a 30 pack-year smoking history who currently smoke or quit less than 15 years ago, we recommend annual screening with low-dose computed tomography (LDCT) up to three consecutive times. Weak recommendation It is possible that longer or more intensive screening might yield additional benefits, but there is not strong evidence (from an RCT) to support such a recommendation.

8. Canadian Task Force on Preventative Health Care

9. AMERICAN COLLEGE OF RADIOLOGISTS SOCIETY OF THORACIC RADIOLOGIST PRACTICE PARAMETERS “Maximum intensity projection (MIP) reconstruction is a technique that may be useful to increase the sensitivity for lung nodule detection.”

10. LUNG CANCER SCREENING CONSIDERATIOINS Pros Reduction in cancer death Earlier Stage Detection Safe, Noninvasive Discovery of ancillary findings (NLST All cause mortality was not different if lung cancer deaths excluded) Cons Cost High False Positive – (When the NLST screening test was positive 96.4% of the LDCT and 94.5% of CXR exams were false- positive, Patient Anxiety Incidental Findings Radiation Risk

11. RADIATION RISK MEASUREMENT An estimate of the uniform, whole-body equivalent dose that would produce the same level of risk for adverse effects that results from the non-uniform partial body irradiation. The unit for the effective dose is also the sievert (Sv)

12. RADIATION RISK –COMMON DOSES CT Low Dose Chest for Lung Cancer Screening 1-1.5 mSv Lumbar Spine X-rays 1.5 mSv Normal Background Radiation 2-3 mSv/yr – Toronto 1.6 mSv/yr – Winnipeg 4.1 mSv/yr Yearly Exposure Domestic Airline Crew 3 mSv/yr Routine CT Chest 7 mSv CT Abdomen and Pelvis 10 mSv Occupational Radiation Limits 50 mSv/yr

13. THANK YOU