LUNG CANCER SCREENING WHAT S THE IMPACT? Nitra Piyavisetpat, MD Department of Radiology Chulalongkorn University
|
|
- Shannon Walton
- 5 years ago
- Views:
Transcription
1 LUNG CANCER SCREENING WHAT S THE IMPACT? Nitra Piyavisetpat, MD Department of Radiology Chulalongkorn University
2 Objective LDCT lung cancer screening (LCS) Potential Benefits & Harms Recommendation of LCS
3 What s the LDCT? No strict definition Usually ~ 10-30% of standard dose CT Modification of tube current : mainstay of reduced radiation dose Limited nodule detection in Large patients GGOs
4 What s the LDCT Screening Protocol? Parameter ITALUNG DLCST NLST NCCN Voltage (kvp) Tube current time product (mas) Slice thickness (mm) Reconstruction interval (mm) /60 (BMI) < < ST
5 What s the LDCT Screening Protocol? 3D & CAD application: Collimation < 1.5 mm Scan interval 50% overlap Nodule size measurement: affected by Slice thickness Reconstruction algorithms Post processing filters Same technical parameters
6 National Lung Screening Trial Randomized trial: 53,454 LDCT: 26,722 CXR: 26,732 Collaborative effort of Lung Screening Study (LSS) American College of Radiology Imaging Network (ACRIN) 33 participating medical institutions
7 Potential Benefits of Screening National Lung Screening Trial (NLST) 20% decreased lung cancer-specific mortality 6.9% decreased all-cause mortality The number needed to screen to prevent 1 death from CA lung = 320
8 Opportunity to Evaluate Other Diseases Coronary calcium scoring Chronic obstructive pulmonary disease (COPD) Osteopenia/Osteoporosis Mets et al. JAMA 2012
9 LUNG CANCER SCREENING THE TIME HAS COME!
10 NCCN Recommendation of LCS High risk: Category 1 Age Smoking > 30 pack year Smoking cessation < 15 years High risk: Category 2 Age > 50 Smoking > 20 pack year 1 additional risk factor e.g. Radon exposure, Occupational exposure, COPD, pulmonary fibrosis, cancer Hx or FH of lung cancer
11 NCCN Recommendation of LCS Not recommend LCS Moderate risk: Age > 50 Smoking > 20 pack year 2 nd hand smoke No additional risk factor Not recommend LCS Low risk: Age < 50 Smoking < 20 pack year
12 The American Association for Thoracic Surgery (AATS) Recommendation Age & a 30 pack year smoking Age > 50 with a 20 pack year smoking history 5% risk of developing a CA lung over the next 5 years COPD with FEV1 < 70% Environmental & occupational exposure Any prior cancer / thoracic radiation A genetic or family history Lung cancer survivors starting 5 years after treatment Jaklitsch et al. J thorac Car diovasc Surg 2012
13 ACCP & ASCO Recommendation Recommend annual LCS in Age > 30 pack year history of smoking Smoking cessation < 15 years Not recommend LCS in Age < 55, > 74 < 30 pack year history of smoking Smoking cessation > 15 years Severe comorbidities
14 LUNG CANCER SCREENING? READY
15 ?? Benefits of Screening DLCST: screening vs control Lung cancer mortality: 0.73% vs 0.54% All cause mortality: 2.97% vs 2.05% DANTE & DLCST No difference of lung cancer specific mortality and all-cause mortality between LDCT & usual care Infante et al. Am J Respir Crit Care Med 2009 Saghir et al. Thorax2012
16 Potential Harms of Lung Cancer Screening
17 Potential Harms of Screening High false positive rate Overdiagnosis Radiation-induced cancer Health care costs related to the entire screening process?? Cost effectiveness
18 Interpretation: NLST Positive, suspicious for lung cancer LDCT: noncalcified nodule > 4 mm Others: adenopathy, effusion 3 rd round of screening (T2) Stable nodule from T0 minor abnormalities
19 False Positive Screening: NLST LDCT CXR T0 T1 T2 T0 T1 T2 Positive CA lung 270 (3.8) 168 (2.4) 211 (5.2) 136 (5.7) 65 (4.4) 78 (6.6) Positive Rate: 24.2% in LDCT, 6.9% in CXR False positive: 96.4% in LDCT, 94.5% in CXR
20 False Positive in LDCT Avr. nodule detection rate/round 20% > 90% of positive screening led to a diagnostic evaluation Further imaging Invasive procedure Significant anxiety & expense > 90% of nodules = Benign
21 False Positive in LDCT Further imaging Most often Management protocol - inconsistent Increased radiation dose Invasive procedure Potential risk, particularly in Non-specialty care settings Population at highest risk i.e. those with smoking-related comorbid conditions
22 Source No. Nodule at T0 Additional Nonsurgical Bx procedure Surgical procedure CT PET No. Benign No. Benign NLST / (25) 8807 (33) 1471 (5.5) 402 (1.5) 293 (73) 673 (2.6) 164 (24) NELSON / (21) NR (3.4) 138 (54) 153 (2.0) 45 (30) DLCST / (9) NR NR NR NR 25 (1.2) 8 (32) ITALUNG / (30) NR 59 (4.2) 16 (1.1) 1 (6) 16 (1.1) 1 (6)
23 ? Reduced False Positive Use different criteria for positive result Larger nodule diameter Volume measurement
24 NELSON: Volume measurement Baseline scan Positive: >500 mm 3 (>9.8 mm) Indeterminate: mm 3 ( mm) 2. Nonsolid nodule > 8 mm in diameter Follow-up indeterminate nodule at 3 mo. Positive: VDT < 400 days Negative: VDT > 400 days Van Klaveren et al. NEJM 2009
25 NELSON: Volume measurement 2 nd round New nodule: same as baseline Positive: >500 mm 3 (>9.8 mm) Indeterminate nodule: Follow-up at 6 weeks Previously detected nodule Positive: 1. VDT < 400 days 2. Solid component emerging in nonsolid nodule Negative: No growth or VDT > 600 days Indeterminate: VDT days, FU at 1 year Van Klaveren et al. NEJM 2009
26 NELSON: Volume measurement 1 st round Positive: 196 (2.6%) o 70 CA lung (FP 64%) o 64% stage I Sensitivity 94.6% Specificity 98.3% PPV 35.7% NPV 99.9% 2 nd round Positive: 128 (1.8%) o 57 CA lung (FP 56%) o 73.7% stage I Sensitivity 96.4% Specificity 99% PPV 42.2% NPV 99.9% Van Klaveren et al. NEJM 2009
27 NELSON: Volume measurement need to follow-up Chances of findings lung cancer after negative screening test in o 3 months = 0 o 1 st year = 1 in 1000 o 2 nd year = 3 in 1000 Van Klaveren et al. NEJM 2009
28 Pitfalls in Follow-up CT Mayo Lung Project: 4 of 48 CA lung Smaller Decreased in attenuation More smoothly margin on follow-up Should not negate follow-up Lindell et al. Radiology 2007
29
30 Overdiagnosis Detect indolent cancers that would Never cause symptoms Never be Dx in the absence of screening Have no impact on the patients life expectancy if undiagnosed Illusion of a cure
31 Overdiagnosis Overdiagnosed cancers: VDT > 400 days Would not be expected to cause death for 10 years Mayo Lung Project: 48 lung cancer, mean VDT = 518 days 27% VDT > 400 days, 85% - female May be substantial concern in lung cancer screening, especially in women Yankelevitz et al. Cancer 2003 Lindell et al. Radiology 2007
32 Lindell et al. Radiology 2007 Hasegawa et al, Br J Radiology 2000 Adenocarcinoma Mean VDT = days
33 Small cell lung cancer Mean VDT days Jan 2010 Apr 2011 Lindell et al. Radiology 2007 Hasegawa et al, Br J Radiology 2000
34 National Lung Screening Trial LDCT (%) CXR (%) BAC 110 (10.5) 35 (3.8) Adenocarcinoma 380 (36.3) 328 (35.2) Squamous cell CA 243 (23.2) 206 (22.1) Large-cell CA 41(3.9) 43 (4.6) NSCLC & others 131 (12.5) 158 (17) Small cell CA 137 (13.1) 159 (17.1) Carcinoid 6 (0.6) 2 (0.2)
35 Stage Distribution: NLST LDCT CXR Stage +ve n 649 -ve n 44 No n 367 Total n ve n 279 -ve n 137 No n 525 Total n 941 IA IB IIA IIB IIIA IIIB IV
36 Overdiagnosis Stage LDCT Control Early stage (I-II) 48 (70) 8 (33) Late stage (III-IV) 21 (30) 16 (67) Early stage in LDCT > control 6 times No significant difference in the absolute numbers of late stage CA in both groups No absolute stage shift Saghir et al. Thorax2012
37 False Negative LDS : NLST LDCT CXR Positive screening Negative screening Missed the screening or after ended screening Total Negative screen: NOT preclude lung cancer development
38 Radiation in LDCT
39 Procedure VS Effective dose (msv) Study type Effective dose PA chest radiograph 0.05 HRCT with 10 mm gap 0.7 Spiral CT pitch Single low-dose screening 1.5* Screening mammography 3.0 Annual natural background radiation 2.5 Mayo et al, Radiology 2003 *NLST, NEJM 2011
40 Radiation-Induced Lung Cancer Only important radiation-related hazard from LDCT Single LDCT = mgy to the lung Avr mgy at setting of 60 mas Single baseline CT screening: risk < 0.06% Lung cancer risk not negligible Brenner DJ. Radiology 2004
41 Estimated excess cancer mortality by age at exposure to a radiation dose of 50 msv 2004 by Radiological Society of North America Brenner DJ. Radiology 2004
42 Radiation-Induced Lung Cancer Cumulative effects of radiation from multiple CT scans Radiation damage & smoking damage interact synergistically Excess risk for radiation-induced lung cancer highest at age of 55 at exposure Brenner DJ. Radiology 2004
43 Lung Cancer Risks: Women VS Men Smoker with annual screening at yrs Female Male Expected lung cancer risk 16.9% 15.8% Estimated excess lung cancer risk 0.85% 0.23% Increase in risk 5% 1.5% Brenner DJ. Radiology 2004
44
45 Radiation-Induced Lung Cancer NLST : The estimated mean 3-year radiation exposure in the screening group = 8 msv 1 cancer death may caused by radiation from imaging per 2500 persons screened Occurs years later Benefit in preventing lung cancer death > radiation risk Bach et al. JAMA 2012
46 How to Decreased Radiation-Induced Lung Cancer Radiation dose: Change in technique to lowest setting possible Frequency for screening Minimum age at screening Brenner DJ. Radiology 2004
47
48 Conclusion: LCS Multidisciplinary expertise in diagnostic workup & treatment Discussing potential & harms False positive results Unnecessary invasive diagnostic procedure and treatments Complication from screening
49 Conclusion: LCS Overdiagnosis, esp. in women Some lung cancers may not be amenable to detection by CT Negative screen: not preclude lung cancer development
50 Conclusion Tobacco smoke: the single most important etiologic factor in the development of lung cancer LCS VS Smoking cessation programs : significantly more expensive
51 Thank You
52 Bias in Screening Prospective nonrandomized trials Lead time bias Length time bias Overdiagnosis bias Randomized control trial Sticky diagnosis bias Slippery linkage bias
53 Lead-Time Bias Earlier detection of slow-growing tumors Earlier Diagnosis Apparent survival advantage No effect on the disease-specific mortality
54 Lead Time Bias A B C D Preclinical Screening +ve Lead Time Clinical Onset of disease Screening Develop S&S Death Screening Survival No screening Survival
55 Lead-Time Bias Eliminated by using mortality rather than survival I-ELCAP : (n = 31567) Estimated 10-year lung-cancer-specific survival rate = 80% I-ELCAP, NEJM 2006
56 Screening: Length-Time Bias Indolent tumors - more likely to be detected Aggressive tumors - more likely to be detected by symptoms, not by screening Intervention in more indolent disease results in the appearance of a survival benefit
57 Length-Time Bias I-ELCAP: 484 CA lung (n = 31567) 294 (60.7%) Adenocarcinoma 21: BAC 273: other subtype Mayo Lung Project: 61 CA lung (n = 1520) 34 (55.7%) adenocarcinoma 9: BAC 25: non-bac adenocarcinoma I-ELCAP, NEJM 2006 Lindell et al, Radiology 2007
58 Length-Time Bias Bach et al : 144 CA lung (n = 3246) 67%: stage I Majority of participants died from CA lung: not detected in an early stage 38 patients died from lung cancer 34% - initial stage III, IV non-small cell 18% - small cell lung cancer 16% - no documented Dx of CA lung prior death Bach et al. JAMA 2007
59 Biases Related Disease-Specific Mortality Disease-specific mortality : Most widely accepted end point Fundamental assumption: accurately determine cause of death Biases related disease-specific mortality Sticky-diagnosis bias Slippery linkage bias Black WC et al. J Natl Cancer Inst 2002
60 Sticky Diagnosis Bias Screened gr.: Wrongly attributed deaths from other causes to the target cancer Control gr.: Wrongly attributed to death from target cancer to other causes Disease-specific mortality in the screened group This bias favors the control group Black WC et al. J Natl Cancer Inst 2002
61 Slippery Linkage Bias Deaths from screening-related intervention or treatment falsely attributed to other causes disease-specific mortality in the screened group This bias favors the screened group Black WC. Cancer 2007
62 Biases affecting disease-specific mortality Black WC et al. J Natl Cancer Inst 2002
63 Biases Affecting Disease-Specific Mortality Net effect of biases: favor screening Slippery linkage more important than sticky diagnosis Screening could cause death as well as to prevent it All-cause mortality: not affected by these biases
64 Participants Inclusion: Age years Smoking 30 pack-years Ex-smoker quit within 15 years Exclusion: Recent hemoptysis Unexplained weight loss > 6.8 kg in preceding year Previous diagnosed of lung cancer Underwent chest CT within 18 months
65 Duration Screening from Aug 2002-Sep 2007 LDCT: 26,722 CXR: 26,732 annual screens: T0, T1 and T2 Follow-up through Dec 31, 2009 Median 6.5 years Maximum 7.4 years
66 Results: Positive screening test LDCT CXR T0 27.3% 9.2% T1 27.9% 6.2% T2 16.8% 5.0% Total in 3 rounds 24.2% 6.9% > 1 positive in any rounds 39.1% 16.0% Clinically sig. abnormality other than lung cancer 7.5% 2.1%
67 Lung Cancer in each Round LDCT CXR +ve CA lung (%) +ve CA lung (%) T (3.8) (5.7) T (2.4) (4.4) T (5.2) (6.6) Total (3.6) (5.5)
68 Histology Type of Lung Cancer LDCT CXR +ve n 649 -ve n 44 N0 n 367 Total n1060 +ve n 279 -ve n 137 N0 n 525 Total n 941 BAC AdenoCA Squamous Large cell NSCLC* Small cell Carcinoid
69 Complication LDCT CXR At least 1 complication 1.4% 1.6% Major complication non lung cancer 0.06% 0.02% lung cancer 11.2% 8.2% Death w/i 60 days after invasive Dx procedure non lung cancer 6 0 lung cancer 10 10
70 Lung-Cancer-Specific Mortality 20% decrease in mortality in LDCT LDCT: 437 deaths 247 deaths per 100,000 person-years CXR 503 deaths 309 deaths per 100,000 person-years The number needed to screen to prevent one death from CA lung = 320
71 Lung Cancer VS All-Cause Mortality 20% decrease in mortality in LDCT LDCT: 437 deaths CXR: 503 deaths 6.9% reduction in all-cause mortality LDCT: 1877 deaths CXR: 2000 deaths
72 LDCT in Lung Cancer Screening Many questions? Optimal risk populations Screening frequency & duration Criteria for positive results Cost-effectiveness of LDCT screening Benefits-Harms (FP, overdiagnosis, cost)
73 California Technology Assessment Forum (CTAF) Use of LDCT screening cannot currently be recommended outside of the investigational setting
74 The National Comprehensive Cancer Network (NCCN) Strongly recommend regular annual LDCT for heavy smoker years of age
75 Result of 3 Rounds of Screening Much higher rate of positive screening test in LDCT
76 Histology Type of Lung Cancer LDCT CXR BAC AdenoCA Squamous cell CA Large cell CA NSCLC Small cell CA Carcinoid 6 2 Unknown 12 10
77 Overdiagnosis Overdiagnosed cancers: VDT > 400 days Mayo Lung Project: 48 lung cancer, mean VDT = 518 days 27% VDT > 400 days; 85% - female Would not be expected to cause death for 10 years Yankelevitz et al. Cancer 2003 Lindell et al. Radiology 2007
78 Overdiagnosis May be substantial concern in lung cancer screening, especially in women May account for the improved survival rate without improved mortality rate Lindell et al. Radiology 2007
79 Overall Mortality 6.7% decrease in mortality in LDCT LDCT: 1877 deaths CXR: 2000 deaths 3.2% decreased in mortality in LDCT if excluded death from CA lung
80 All-Cause Mortality DANTE: (age > 60, exclusively men) LDCT (n = 1,276)(%) Control (n = 1,196)(%) Lung cancer death 20 (1.6) 20 (1.7) Other causes 26 (2.0) 25 (2.1) Total deaths 46 (3.6) 45 (3.8) The mortality benefit from lung cancer screening far smaller than anticipated Infante et al, AJRCCM 2009
81 Workload Screened group: 3-folds diagnosis of lung cancer 10 folds thoracic resection Smoking ส ำน กงำนสถ ต แห งชำต พ.ศ ,486,311 Cigarette smokers Male 9,068,002, Female 418, % บ หร มวนเอง, บ หร ข โย 2,701,565 คน, Age > 50 years Bach et al. JAMA 2007
82 Expected Workload 2,701,565 Cigarette smokers age > Thoracic surgeons in Thailand / surgeon
83 Expense in Thailand CT 5000 Baht Screening CT: 2,700,000 x 5000 = 13,500 ล ำนบำท Follow-up CT (13.2%) 356,400 x 5000 = 1,782 ล ำนบำท Lung Biopsy: Lung resection: Pathology : Baht Baht 500+ Baht
84
CT screening for lung cancer. Should it be done in the Indian context?
CT screening for lung cancer Should it be done in the Indian context? Wilson and Jungner screening criteria 1. The condition sought should be an important health problem. 2. There should be an accepted
More informationLung Cancer Screening: To screen or not to screen?
Lung Cancer Screening: To screen or not to screen? Dan J. Raz, M.D. Co Director, Lung Cancer Screening Program Co Director, LungCancer and Thoracic OncologyProgram Assistant Professor, Thoracic Surgery
More informationGoals of Presentation
Goals of Presentation Review context of lung cancer screening why is it important? Review data from NLST supporting screening with lowdose CT (LDCT) scanning Discuss the pros and cons of LDCT screening
More informationExample of lung screening
Justification of the use of CT for individual health assessment of asymptomatic people How to obtain evidence for IHA - Example of lung screening Mathias Prokop, MD PhD Professor of Radiology Radboud University
More informationLung Cancer Screening: To Screen or Not to Screen?
Lung Cancer Screening: To Screen or Not to Screen? Lorriana Leard, MD Co-Director of UCSF Lung Cancer Screening Program Vice Chief of Clinical Activities UCSF Pulmonary, Critical Care, Allergy & Sleep
More informationChristine Argento, MD Interventional Pulmonology Emory University
Christine Argento, MD Interventional Pulmonology Emory University Outline Lung Cancer Statistics Prior Studies for Lung Cancer Screening NLST Studies Following NLST Future Directions Lung Cancer American
More informationLung Cancer Screening: Benefits and limitations to its Implementation
Lung Cancer Screening: Benefits and limitations to its Implementation Rolando Sanchez, MD Clinical Assistant Professor Pulmonary-Critical Care Medicine University of Iowa Lung cancer - Epidemiology Cancer
More informationLUNG CANCER SCREENING
LUNG CANCER SCREENING Christopher Lettieri MD, FACP, FCCP, FAASM Pulmonary/Critical Care Consultant to the Surgeon General Professor of Medicine Walter Reed National Military Medical Center American College
More informationLung Cancer screening :
Lung Cancer screening : Pro-Contra SAMO interdisciplinary workshop on chest tumors 27 and 28 january 2017 Prof L.P.Nicod Sevice de pneumologie CHUV-Lausanne -CH Lung Cancer How big is the problem? Epidemiology
More informationA Comprehensive Cancer Center Designated by the National Cancer Institute
N C I C C C A Comprehensive Cancer Center Designated by the National Cancer Institute Screening and Early Detection of Lung Cancer: Ready for Practice? David S. Ettinger, MD, FACP, FCCP Alex Grass Professor
More informationEarly Detection of Lung Cancer. Amsterdam March 5 th 2010
Early Detection of Lung Cancer Amsterdam March 5 th 2010 Rob J van Klaveren, MD, PhD Dept. of Pulmonology Erasmus MC Rotterdam, the Netherlands Early Detection and Screening - Questions to be addressed
More informationSCREENING FOR EARLY LUNG CANCER. Pang Yong Kek
SCREENING FOR EARLY LUNG CANCER Pang Yong Kek Lecture Outline Why performing screening? How to improve early detection? Benefits and Risks of screening Challenges in screening Conclusion Why Performing
More informationWhat to know and what to make of it
Lung Cancer Screening: What to know and what to make of it J. Matthew Reinersman, MD Assistant Professor of Surgery Division of Thoracic and Cardiovascular Surgery Department of Surgery University of Oklahoma
More informationLung Cancer Screening: Now What?
Lung Cancer Screening: Now What? Gerold Bepler, M.D., Ph.D. Director, President & CEO Michigan Cancer Consortium, 2013 Annual Meeting, Lansing, MI, 11/20/13 Lung Cancer #1 Cause of Cancer Death for & *
More informationLung Cancer Screening In High Risk Populations:
Lung Cancer Screening In High Risk Populations: Michael Jaklitsch, M.D. Co-Chair of AATS Task Force on Lung Cancer Screening and Surveillance From the Brigham and Women s Hospital Harvard Medical School.
More informationDisclosures. Overview. Selection the most accurate statement: Updates in Lung Cancer Screening 5/26/17. No Financial Disclosures
Updates in Lung Cancer Screening Disclosures No Financial Disclosures Neil Trivedi, MD Associate Professor of Clinical Medicine SF VAMC Pulmonary and Critical Care Director, Bronchoscopy & Interventional
More informationPulmonologist s Perspective
Low-dose CT for lung cancer screening Pulmonologist s Perspective Literature Review Kang-Yun Lee, MD PhD Department of Thoracic Medicine Taipei Medical University- Shuang Ho Hospital Taiwan Local vs. Advanced
More informationScreening for Lung Cancer - State of the Art
Screening for Lung Cancer - State of the Art Rohit Kumar, MD Assistant Professor of Medicine Fox Chase Cancer Center Temple University School of Medicine Philadelphia, PA Objectives Review current evidence
More informationLung Cancer Screening: Radiologic and Clinical Implications. Katherine R. Birchard, M.D. University of North Carolina at Chapel Hill
Lung Cancer Screening: Radiologic and Clinical Implications Katherine R. Birchard, M.D. University of North Carolina at Chapel Hill Nothing to disclose Objectives In context of NLST: Review Imaging Techniques
More informationPULMONARY NODULES AND MASSES : DIAGNOSTIC APPROACH AND NEW MANAGEMENT GUIDELINES. https://tinyurl.com/hmpn2018
PULMONARY NODULES AND MASSES : DIAGNOSTIC APPROACH AND NEW MANAGEMENT GUIDELINES Heber MacMahon MB, BCh Department of Radiology The University of Chicago https://tinyurl.com/hmpn2018 Disclosures Consultant
More informationLUNG CANCER SCREENING Anthony C. Campagna, M.D.
LUNG CANCER SCREENING 2012 Anthony C. Campagna, M.D. Attending Physician, Pulmonary and Critical Care Medicine Lahey Clinic, Burlington, MA Assistant Clinical Professor of Medicine Harvard Medical School,
More informationProfessor John K Field PhD, FRCPath University of Liverpool Cancer Research Centre, UK.
Professor John K Field PhD, FRCPath University of Liverpool Cancer Research Centre, UK. J.K.Field@liv.ac.uk 1.8 million new cases in 2012 Bender Nature Outlook 2014 Probability of survival: ALL participants
More informationWill CT screening reduce overall lung cancer mortality? Associate Professor of Radiology Department of Medical Imaging UHN / MSH / WCH
Will CT screening reduce overall lung cancer mortality? Heidi Roberts MD FRCP(C) Heidi Roberts, MD, FRCP(C) Associate Professor of Radiology Department of Medical Imaging UHN / MSH / WCH Screening - Requirements
More informationLUNG CANCER: LDCT DISCLOSURES NONE. Erika Swanson, MD Radiation Oncologist Ascension Columbia-St. Mary s February 1, /9/2018
LUNG CANCER: LDCT Erika Swanson, MD Radiation Oncologist Ascension Columbia-St. Mary s February 1, 2018 DISCLOSURES 2 NONE 1 OBJECTIVES 3 Rationale and evidence for LDCT for lung cancer screening Review
More informationLung Cancer and CT Screening
Lung Cancer and CT Screening Samer Kanaan, MD February 17 th, 2012 Goals Understand the Societal impact of Lung Cancer Identify Risk Factors for Lung Cancer List Diagnostic Tests Available for Lung Cancer
More informationDISCLOSURE. Lung Cancer Screening: The End of the Beginning. Learning Objectives. Relevant Financial Relationship(s) Off Label Usage
Peninsula Regional Medical Center 12 th Annual Lung Cancer Conference March 9, 2017 Lung Cancer Screening: The End of the Beginning David E. Midthun M.D. Professor of Medicine College of Medicine, Mayo
More informationCurrent Approach to Screening for Lung Cancer. James R Jett M.D.
Current Approach to Screening for Lung Cancer James R Jett M.D. Potential Conflicts of Interest I am Chief Medical Officer for Oncimmune Ltd (Biomarkers of Cancer) Co-Editor of Lung Cancer Section of UP-TO-DATE
More informationMayo Clinic College of Medicine, Rochester, Minnesota, USA
The Oncologist Lung Cancer Commentary: CT Screening for Lung Cancer Caveat Emptor JAMES R. JETT,DAVID E. MIDTHUN Mayo Clinic College of Medicine, Rochester, Minnesota, USA Key Words. CT screening Early
More informationCT Screening for Lung Cancer for High Risk Patients
CT Screening for Lung Cancer for High Risk Patients The recently published National Lung Cancer Screening Trial (NLST) showed that low-dose CT screening for lung cancer reduces mortality in high-risk patients
More informationGUIDELINES FOR PULMONARY NODULE MANAGEMENT : RECENT CHANGES AND UPDATES
Venice 2017 GUIDELINES FOR PULMONARY NODULE MANAGEMENT : RECENT CHANGES AND UPDATES Heber MacMahon MB, BCh Department of Radiology The University of Chicago Disclosures Consultant for Riverain Medical
More informationCharles Mulligan, MD, FACS, FCCP 26 March 2015
Charles Mulligan, MD, FACS, FCCP 26 March 2015 Review lung cancer statistics Review the risk factors Discuss presentation and staging Discuss treatment options and outcomes Discuss the status of screening
More informationLung Cancer Screening
Lung Cancer Screening Preston Wright, DO University of Kansas School of Medicine- Wichita Family Medicine Residency at Via Christi Hospitals 1 Objectives Identify patients who need screened for lung cancer
More informationLung Cancer Screening: Evidence and current recommendations
Lung Cancer Screening: Evidence and current recommendations 20 th March 2018 Dr Annette McWilliams Fiona Stanley Hospital University of Western Australia WA Cancer & Palliative Care Network I have no financial
More informationMEDICAL POLICY SUBJECT: LOW-DOSE COMPUTED TOMOGRAPHY (LDCT) FOR LUNG CANCER SCREENING. POLICY NUMBER: CATEGORY: Technology Assessment
MEDICAL POLICY SUBJECT: LOW-DOSE COMPUTED CANCER SCREENING 05/18/05, 03/16/06, 12/21/06, 08/16/07, PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria
More informationLung Cancer Screening:
Lung Cancer Screening: Maximizing Gain and Dealing with Pandora s Box Mark M. Fuster, MD Division of Pulmonary & Critical Care UCSD Department of Medicine & VA San Diego Healthcare Service San Diego, CA
More informationRole of CT in Lung Cancer Screening: 2010 Stuart S. Sagel, M.D.
Role of CT in Lung Cancer Screening: 2010 Stuart S. Sagel, M.D. Lung Cancer 219,440 new cases/year in U.S. (2009) 169,390 deaths/year in U.S. mortality greater than from breast, colon, prostate CA combined
More informationLearning Objectives. 1. Identify which patients meet criteria for annual lung cancer screening
Disclosure I, Taylor Rowlett, DO NOT have a financial interest /arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context
More informationScreening for Lung Cancer: Are We There Yet?
Screening for Lung Cancer: Are We There Yet? Kavita Garg, MD Professor of Radiology University of CO, Denver Mountain States Cancer Conference Nov 6 th 2010 The Epidemiology of Lung Cancer Tobacco is the
More informationOutcomes in the NLST. Health system infrastructure needs to implement screening
Outcomes in the NLST Health system infrastructure needs to implement screening Denise R. Aberle, MD Professor of Radiology and Bioengineering David Geffen School of Medicine at UCLA 1 Disclosures I have
More informationLung Cancer Screening: A review of the recommendations Friday, November 11th, 2016 from 11:45 to 12:15. Dr. Tunji Fatoye Dr.
Lung Cancer Screening: A review of the recommendations Friday, November 11th, 2016 from 11:45 to 12:15 Dr. Tunji Fatoye Dr. Alan Kaplan Conflict of Interest Disclosure: Speaker Name: Alan Kaplan FINANCIAL
More informationScreening for Lung Cancer: New Guidelines, Old Problems
Screening for Lung Cancer: New Guidelines, Old Problems Robert Schilz DO, PhD Associate Professor of Medicine Interim Chief of the Division of Pulmonary, Critical Care and Sleep Medicine University Hospitals
More informationPulmonary Nodules & Masses
Pulmonary Nodules & Masses A Diagnostic Approach Heber MacMahon The University of Chicago Department of Radiology Disclosure Information Consultant for Riverain Technology Minor equity in Hologic Royalties
More informationLDCT Screening. Steven Kirtland, MD. Virginia Mason Medical Center February 27, 2015
LDCT Screening Steven Kirtland, MD Virginia Mason Medical Center February 27, 2015 2 Disclosures 4 5 Cancer Screening Mrs H 64yo 50 pk year smoker Lung Cancer Epidemiology Leading Cause of Cancer Death
More informationRobert J. McKenna M.D. Chief, Thoracic Surgery Cedars Sinai Medical Center
You Smoke, You Get Lung Cancer, You Die: Can Screening Change this Paradigm? Robert J. McKenna M.D. Chief, Thoracic Surgery Cedars Sinai Medical Center AATS Saturday 4/28/2012 Cancer Screening Cancer
More informationPulmonary Nodules. Michael Morris, MD
Pulmonary Nodules Michael Morris, MD Case 45 year old healthy male Smokes socially Normal physical exam Pre-employment screening remote +PPD screening CXR nodular opacity Case 45 year old healthy male
More informationScreening Programs background and clinical implementation. Denise R. Aberle, MD Professor of Radiology and Engineering
Screening Programs background and clinical implementation Denise R. Aberle, MD Professor of Radiology and Engineering disclosures I have no disclosures. I have no conflicts of interest relevant to this
More informationScreening for Lung Cancer. Michael S. Nolledo, MD Deborah Heart and Lung Center
Screening for Lung Cancer Michael S. Nolledo, MD Deborah Heart and Lung Center 1 1 Outline Ø Introduction Ø Lung Cancer Screening pre-2010 Ø Lung Cancer Screening today 2 2 Lung Cancer 2011 (Siegel et
More informationVHA Demonstration Project for Lung Cancer Screening Using Low-Dose Chest CT Screening
VHA Demonstration Project for Lung Cancer Screening Using Low-Dose Chest CT Screening ATS San Francisco 2016 James K. Brown MD 1, Kathryn L. Rice, MD 2 (1) San Francisco VA (2) Minneapolis VAMC Disclosures
More informationOBJECTIVES. Solitary Solid Spiculated Nodule. What would you do next? Case Based Discussion: State of the Art Management of Lung Nodules.
Organ Imaging : September 25 2015 OBJECTIVES Case Based Discussion: State of the Art Management of Lung Nodules Dr. Elsie T. Nguyen Dr. Kazuhiro Yasufuku 1. To review guidelines for follow up and management
More informationLung cancer screening in Switzerland
SAMO Interdisciplinary Workshop on Chest Tumors 27 th and 28 th January 2017 Hotel Hermitage, Lucerne Lung cancer screening in Switzerland Walter Weder, MD, Professor of Surgery University Hospital Zurich,
More informationI appreciate the courtesy of Kusumoto at NCC for this presentation. What is Early Lung Cancers. Early Lung Cancers. Early Lung Cancers 18/10/55
I appreciate the courtesy of Kusumoto at NCC for this presentation. Dr. What is Early Lung Cancers DEATH Early period in its lifetime Curative period in its lifetime Early Lung Cancers Early Lung Cancers
More informationLung Cancer Screening. Eric S. Papierniak, DO NF/SG VHA UF Health
Lung Cancer Screening Eric S. Papierniak, DO NF/SG VHA UF Health Overview Background Supporting evidence Guidelines Practical considerations Patient selection What to do with abnormal results Billing/coding
More informationCigna Medical Coverage Policy
Cigna Medical Coverage Policy Subject Low-Dose Computed Tomography for Lung Cancer Screening Effective Date... 2/15/2014 Next Review Date... 2/15/2015 Coverage Policy Number... 0007 Table of Contents Coverage
More informationObjectives. Why? Why? Background 11/5/ % incurable disease at presentation Locally advanced disease Metastasis. 14% 5 year survival
Objectives Appraise lung cancer screening trials results Review screening guidelines Lung Cancer Screening: Past, Present and Future Chi Wan Koo, MD Koo.chiwan@mayo.edu Discuss recommendations essential
More informationLung Cancer Screening
Scan for mobile link. Lung Cancer Screening What is lung cancer screening? Screening examinations are tests performed to find disease before symptoms begin. The goal of screening is to detect disease at
More informationIEHP UM Subcommittee Approved Authorization Guidelines CT Screening (Low Dose) for Lung Cancer
CT Screening (Low Dose) for Lung Cancer Policy: There is currently adequate evidence that using low dose computed tomography (LDCT) to screen asymptomatic individuals who are at risk for lung cancer improves
More informationLUNG CANCER SCREENING: LUNG CANCER SCREENING: THE TIME HAS COME LUNG CANCER: A NATIONAL EPIDEMIC
: THE TIME HAS COME Physician Leader, Lung Cancer Multi-Disciplinary Program Fletcher Allen Health Care Annual Meeting Montpelier, VT - April 25, 2014 Gerald S. Davis, MD Professor of Medicine University
More informationDiagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD. November 18, 2017
Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD November 18, 2017 Disclosures I do not have a financial interest/arrangement or affiliation with one or more organizations
More informationAnn Intern Med. 2012;156(5):
Lung Cancer Screening Update Doug Arenberg, M.D. University of Michigan Outline Screening; Some simple but necessary truths Do people benefit from screening? What are the harms (and are they outweighed
More informationEmerging Challenges in Primary Care: Lung Cancer Screening: Who, When, Why Or Why Not? Objectives. Faculty
Emerging Challenges in Primary Care: 2017 Lung Cancer Screening: Who, When, Why Or Why Not? Louis Kuritzky, MD Clinical Assistant Professor Emeritus Department of Community Health and Family Medicine University
More informationSubject: Low-Dose Helical (Spiral) Computed Tomography for Lung Cancer Screening Guidance Number: MCG-137 Revision Date(s): 5/13/2015
Subject: Low-Dose Helical (Spiral) Computed Tomography for Lung Cancer Screening Guidance Number: MCG-137 Revision Date(s): 5/13/2015 Original Effective Date: 6/26/2013 DESCRIPTION OF PROCEDURE/SERVICE/PHARMACEUTICAL
More informationLung Cancer Screening Who, When, Why
Lung Cancer Screening Who, When, Why Louis Kuritzky, MD Clinical Assistant Professor Emeritus Department of Community Health and Family Medicine University of Florida, Gainesville (352) 377 3193 Phone/FAX
More informationNone
2014 None rosemary clooney Cancer is one of the most common diseases in the developed world: 1 in 4 deaths are due to cancer 1 in 17 deaths are due to lung cancer Lung cancer is the most common
More informationLUNG CANCER SCREENING: ON WHOM DID YOU DO IT AND ON WHOM DO YOU RESPOND TO THE RESULTS?
LUNG CANCER SCREENING: ON WHOM DID YOU DO IT AND ON WHOM DO YOU RESPOND TO THE RESULTS? DAVID O. WILSON, MD, MHP DIRECTOR GEORGIA COOPER MEMORIAL LUNG CANCER RESEARCH REGISTRY UNIVERSITY OF PITTSBURGH
More informationSCBT-MR 2016 Lung Cancer Screening in Practice: State of the Art
SCBT-MR 2016 Lung Cancer Screening in Practice: State of the Art Reginald F. Munden MD, DMD, MBA I have no conflicts of interest to report National Lung Cancer Screening Trial 20% lung cancer mortality
More informationLung Cancer Screening Trials. Edward Harris Respiratory Research Fellow Sir Charles Gairdner Hospital
Lung Cancer Screening Trials Edward Harris Respiratory Research Fellow Sir Charles Gairdner Hospital Lung Cancer Screening in Australia Not Funded except as part of a clinical trial Rationale PLCO, ELCAP
More informationLUNG CANCER IS THE LEADING CAUSE
REVIEW CLINICIAN S CORNER ONLINE FIRST Benefits and Harms of CT Screening for Lung Cancer A Systematic Review Peter B. Bach, MD, MAPP Joshua N. Mirkin, BA Thomas K. Oliver, BA Christopher G. Azzoli, MD
More information10/17/16. Lung Cancer Screening. Question 1: Does lung cancer screening make sense? 3rd lung cancer third most prevalent tumor type
Lung Cancer Screening Greg Rogalski Mercy Radiology Group greg@grogo.org Question 1: Does lung cancer screening make sense? 2 Requirements for successful screening process Sufficiently high prevalence
More informationGuidelines for the Management of Pulmonary Nodules Detected by Low-dose CT Lung Cancer Screening
Guidelines for the Management of Pulmonary Nodules Detected by Low-dose CT Lung Cancer Screening 1. Introduction In January 2005, the Committee for Preparation of Clinical Practice Guidelines for the Management
More informationCT Lung Screening Implementation Challenges: State Based Initiatives
CT Lung Screening Implementation Challenges: State Based Initiatives Andrea McKee, MD Chair Radiation Oncology Lahey Hospital and Medical Center Co-Director Rescue Lung, Rescue Life Program Co-Chair Massachusetts
More informationLung Cancer Screening
Scan for mobile link. Lung Cancer Screening What is lung cancer screening? Screening examinations are tests performed to find disease before symptoms begin. The goal of screening is to detect disease at
More informationUltralow Dose Chest CT with MBIR
Ultralow Dose Chest CT with MBIR Ella A. Kazerooni, M.D. Professor & Director Cardiothoracic Radiology Associate Chair for Clinical Affairs University of Michigan Disclosures Consultant: GE Healthcare
More informationLung Cancer Risk Associated With New Solid Nodules in the National Lung Screening Trial
Cardiopulmonary Imaging Original Research Pinsky et al. Lung Cancer Risk Associated With New Nodules Cardiopulmonary Imaging Original Research Paul F. Pinsky 1 David S. Gierada 2 P. Hrudaya Nath 3 Reginald
More informationThoracic and head/neck oncology new developments
Thoracic and head/neck oncology new developments Goh Boon Cher Department of Hematology-Oncology National University Cancer Institute of Singapore Research Clinical Care Education Scope Lung cancer Screening
More informationCT Lung Screening Implementation Challenges: ALA/ATS Implementation Microsite
CT Lung Screening Implementation Challenges: ALA/ATS Implementation Microsite Andrea McKee, MD Chair Radiation Oncology Lahey Hospital and Medical Center November 2018 2016 data, 3 years after ACS recommendation
More informationLung Cancer Screening
Lung Cancer Screening Steven Leh, MD, FCCP Diplomat of the American Association for Bronchology and Interventional Pulmonology Aurora Medical Group Pulmonary and Sleep Medicine February 10, 2018 Disclosures
More informationRodney C Richie MD FACP FCCP DBIM Texas Life and EMSI
Rodney C Richie MD FACP FCCP DBIM Texas Life and EMSI Pulmonary Nodules Well-circumscribed, radiographic opacities measuring 3 cm in diameter Surrounded by aerated lung Not associated with atelectesis
More informationSelected Controversies. Cancer Screening. Breast Cancer Screening. Selected Controversies. Page 1. Using Best Evidence to Guide Practice
Cancer Screening Using Best Evidence to Guide Practice Judith M.E. Walsh, MD, MH Division of General Internal Medicine Women s Health Center of Excellence University of California, San Francisco Selected
More informationDeppen S, et al. Annals of Thoracic Surgery 2011;92:
Deppen S, et al. Annals of Thoracic Surgery 2011;92:428-33. http://www.nationmaster.com/graph/ mor_his-mortality-histoplasmosis http://www.humirarems.com/brochure.aspx Baddley, John W., et al. Emerging
More informationPage 1. Cancer Screening for Women I have no conflicts of interest. Overview. Breast, Colon, and Lung Cancer. Jeffrey A.
Cancer Screening for Women 2017 Breast, Colon, and Lung Cancer Jeffrey A. Tice, MD Professor of Medicine Division of General Internal Medicine University of California, San Francisco I have no conflicts
More informationLung cancer screening: are we ready now?
Mini-review Lung cancer screening: are we ready now? Gianluca Milanese Giovanni Capretti Nicola Sverzellati Mario Silva Section of Radiology, Department of Surgical Sciences, University Hospital of Parma,
More informationA Summary from the 2013World Conference on Lung Cancer Sydney, Australia
A Summary from the 2013World Conference on Lung Cancer Sydney, Australia In 2011, the U.S. National Lung Screening Trial (NLST) has demonstrated that low-dose computed tomography (LDCT) screening of high
More informationLarry Tan, MD Thoracic Surgery, HSC. Community Cancer Care Educational Conference October 27, 2017
Larry Tan, MD Thoracic Surgery, HSC Community Cancer Care Educational Conference October 27, 2017 To describe patient referral & triage for the patient with suspected lung cancer To describe the initial
More informationApproach to Pulmonary Nodules
Approach to Pulmonary Nodules Edwin Jackson, Jr., DO Assistant Professor-Clinical Director, James Early Detection Clinic Department of Internal Medicine Division of Pulmonary, Allergy, Critical Care and
More informationTHE BENEFITS OF BIG DATA
THE BENEFITS OF BIG DATA Disclosures I am a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on CT scans of the chest which are owned by Cornell
More informationScreening High-Risk Populations for Lung Cancer
Evidence-Based Series #15-10 A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Screening High-Risk Populations for Lung Cancer H. Roberts, C. Walker-Dilks, K.
More informationEarly detection of lung cancer may improve patient mortality. Computed tomography (CT) as a screening tool has been evaluated in several large screeni
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. Rebecca M. Lindell,
More informationProjected Outcomes Using Different Nodule Sizes to Define a Positive CT Lung Cancer Screening Examination
DOI:10.1093/jnci/dju284 First published online October 20, 2014 The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
More informationScreening for Lung Cancer
Screening for Lung Cancer 15 ΜΑΡΤΙΟΥ 2014 Ioannis Gkiozos Pulmonologist Oncology Unit G P General & Chest Diseases Hospital Sotiria Despite advances in therapy, 5-year survival rates of Lung Cancer Remains
More informationThe Maine Lung Cancer Coalition. Working Together to Reduce Lung Cancer in Maine
The Maine Lung Cancer Coalition Working Together to Reduce Lung Cancer in Maine funding Maine Lung Cancer Coalition (MLCC) Webinar Lung Cancer Screening: Following Up On Abnormal Low Dose CT Scans with
More informationCT Low Dose Lung Cancer Screening. Part I. Journey to LDCT LCS Program
CT Low Dose Lung Cancer Screening Part I Journey to LDCT LCS Program Paul Johnson, M.S., DABHP, DABR Cleveland Clinic September 26, 2015 Lung Caner is No. 1 In Cancer Related Death In The United States
More informationMaster Class: Fundamentals of Lung Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationLung Cancer Diagnosis for Primary Care
Lung Cancer Diagnosis for Primary Care Daniel Nader, DO, FCCP Cancer Treatment Center of America Case 1 In which of the following situations would the U.S. Preventive Services Task Force (USPSTF) recommend
More informationCLINICAL GUIDELINES. Lung-Cancer Screening Program Guidelines Robert Y. Kanterman, M.D. and Thomas J. Gilbert, M.D., M.P.P.
CLINICAL GUIDELINES Lung-Cancer Screening Program Guidelines Robert Y. Kanterman, M.D. and Thomas J. Gilbert, M.D., M.P.P. 3/14/2015 Introduction: The purpose of a lung-cancer screening program is to detect
More informationSlide 1. Slide 2. Slide 3. Investigation and management of lung cancer Robert Rintoul. Epidemiology. Risk factors/aetiology
Slide 1 Investigation and management of lung cancer Robert Rintoul Department of Thoracic Oncology Papworth Hospital Slide 2 Epidemiology Second most common cancer in the UK (after breast). 38 000 new
More informationThe National Lung Screening Trial (NLST)
The National Lung Screening Trial (NLST) Pamela Marcus US National Cancer Institute May 21, 2012 Today s talk NLST: an overview Typical challenges in cancer screening RCTs Starting ti a trial in the presence
More informationLow-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2
Low-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2 The Committee for Management of CT-screening-detected Pulmonary Nodules 2009-2011 The Japanese Society of CT Screening
More informationPublished Pulmonary Nodule Guidelines A Synthesis
Published Pulmonary Nodule Guidelines A Synthesis Dr A Devaraj Royal Brompton Hospital London 4/28/2015 1 And very soon to be published Published ^ Pulmonary Nodule Guidelines A Synthesis Dr A Devaraj
More informationPANEL DISCUSSION: SCREENING FOR LUNG CANCER. Anthony D Weaver MD
PANEL DISCUSSION: SCREENING FOR LUNG CANCER Anthony D Weaver MD Disclosures Anthony Weaver has no relationships to disclose. Thank God! A panel of experts! An Equal Opportunity University Objectives 1.
More informationPULMONARY NODULES DETECTED INCIDENTALLY OR BY SCREENING: LOTS OF GUIDELINES BUT WHERE IS THE EVIDENCE?
PULMONARY NODULES DETECTED INCIDENTALLY OR BY SCREENING: LOTS OF GUIDELINES BUT WHERE IS THE EVIDENCE? MICHAEL K. GOULD, MD SENIOR RESEARCH SCIENTIST DIRECTOR FOR HEALTH SCIENCES & IMPLEMENTATION SCIENCE
More information