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Low-dose CT screening predicts decreased risk of lung cancer
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Participants in the National Lung Screening Trial who received a negative result from a low-dose CT screening showed a lower overall incidence of developing lung cancer, according to recent research published in The Lancet Oncology.
“Annual low-dose CT screening detects some lung cancers at an earlier, more treatable stage than no screening at all or annual chest radiograph screening, and will improve outcomes for select patients,” Edward F Patz Jr., MD, from the department of radiology and department of pharmacology and cancer biology at Duke University Medical Center in Durham, N.C., and colleagues wrote in their study. “However, the magnitude of such an endeavour must be weighed against the risks and costs; resources are not unlimited and society should decide how to implement a responsible screening programme based on evidence-based data.”
Patz and colleagues evaluated 26,231 participants in a National Lung Screening Trial who were randomized to a low-dose CT screening group after undergoing a low-dose CT prevalence (T0) screen, according to the abstract. Participants were 55 years to 74 years old with a 30 pack-year minimum smoking history or a 15-year quit history if a former smoker. The researchers determined through screening whether or not lung cancer was detected, as well as the mortality rate for patients at the T1 screening if a T0 screening had not been performed.
They found that 19,066 participants with a negative T0 screening had a lower incidence of lung cancer (371.88 per 100,000 person-years; 95% CI, 337.97-408.26) compared with the rest of the 26,231 participants (661.23 per 100,000 person-years; 95% CI, 622.07-702.21), according to the abstract. The patients with a negative T0 screening also had a lower rate of mortality related to lung cancer (185.82 per 100,000 person-years; 95% CI, 162.17-211.93) compared with the general low-dose screening group (277.20 per 100,000 person-years; 95% CI, 252.28-303.90).
There was a 0.34% rate of lung cancer detected from T1 screenings among patients in the low-dose screening group with negative T0 screenings (62 of 18,121 participants) compared with a 1% rate of detection among patients in the T0 group (267 of 26,231 participants). Patz and colleagues estimated 28 additional patients in the T0 negative group would have died during the trial if not for the T1 screening, which was an increase from 185.82 (95% CI, 162.17-211.93) to 212.14 (95% CI, 186.80-239.96), according to the abstract.
In a related editorial, John K Field, from the Roy Castle Lung Cancer Research Programme at the University of Liverpool and Stephen W Duff, from the Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry at the Queen Mary University of London, wrote that because lung cancer screening is still in its infancy, there is still an opportunity to identify and focus efforts toward patients who need more frequent screenings.
“The frequency of screening is going to be an international question, and thus we should consider the potential for organising an international demonstration screening project, which could use an agreed protocol to tease out the complexities of deciding screening frequency and the requirements for annual or less frequent screening,” Field and Duff wrote. “An international protocol would need to include volumetric imaging analysis in the assessment of CT scans to minimise the human costs of false positives while maintaining sensitivity (and must also agree on the definition of false positives).” – by Jeff Craven
Disclosure: Patz receives grants from LabCorp and is a founder of Cue Biologics. The other researchers report various relevant financial disclosures. Please see the full study for a complete list of disclosures.
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