Post on 22-Feb-2016
description
Goldstraw et al. J Thorac Oncol 2007
Why should we want to screen?
Survival (years)
Why should we want to screen?
Localised
Regional spread
Distant spread
When diagnosis is based on symptoms
When diagnosis is based on screening
Stage shift !
National lung screening trial (NLST)
Inclusion criteria- Age 55-74 years- Smoking history ≥30PY, active or stopped less than
15 years ago
Exclusion criteria- History of lung cancer- Other prior cancer in past 5 years- Chest CT less than 18 months ago- Unexplained weight loss (>15lb in past year)- Metallic implants or devices in chest or back- Home oxygen supplementation- Pneumonia treated with antibiotics in past 12 weeks
Aberle et al. N Engl J Med 2011
- 53’454 subjects randomised to one of two groups:- Low dose CT- Chest X-ray
- 3 screening rounds at annual intervals- Non-calcified nodules ≥4mm in CT or any
size in X-ray were referred for diagnostic work-up
- Primary outcome: lung cancer related mortality
National lung screening trial (NLST)
Aberle et al. N Engl J Med 2011
Aberle et al. N Engl J Med 2011
National lung screening trial (NLST)
Aberle et al. N Engl J Med 2011
National lung screening trial (NLST)
Kovalchik et al. N Engl J Med 2013
National lung screening trial (NLST)
Kovalchik et al. N Engl J Med 2013
National lung screening trial (NLST)
Lung cancer screening trials
Boiselle, JAMA 2013
Screening recommendations
Boiselle, JAMA 2013
Open issues
- Is one positive trial enough evidence?- Was there overdiagnosis in the NSLT?- Will other populations at risk of lung cancer benefit
from CT screening?- Screening of a large, at-risk population possible?- How many screening rounds?- Cost effectiveness?- «side effects» of screening (i.e.radiation exposure)
Conclusions
Lung cancer is a lethal disease associated with substantial medical and economic burden.
NLST: lung cancer screening may reduce mortality considerably.
Possible advantage of LDCT screening has to be balanced against the potential of inducing harm.
Many issues are not yet resolved: i.e. overdiagnosis, number of screening rounds, study population, cost-efficacy.
Further evidence and information is needed, before lung cancer screening can be recommended in Switzerland.