The Case for Lung Cancer Screening ASRT presentation
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Transcript of The Case for Lung Cancer Screening ASRT presentation
The Case for Lung
Cancer ScreeningKimberly Ann Luse, Ed.D, RT(R)
My Background
Born and raised in Newport, Kentucky
Began smoking in high school
Stopped smoking when I became pregnant with my first of four
children in 1984
Became a Radiologic Technologist in 1985
Had a partial lung resection in 2000 after discovering a mass that was
thought to be malignant
Dense Material Ahead!
Background
Lung Cancer is the leading killer of all cancers combined
There has been evidence of the connection between smoking and lung
cancer than goes back four decades
Smoking cessation programs and efforts have increased
Lung Cancer screening needs to catch up to the evidence
Raising Awareness
February: Go Red For Women
October: Go Pink For Women
November: No Shave November
What month represents Lung Cancer Awareness?
November!
The High Fatality Rate is Staggering
The Center for Disease Control and Prevention lists the following on
their cancer statistics webpage, referencing 2010:
201,144 people in the United States were diagnosed with lung cancer,
including 107,164 men and 93,980 women
158,248 people in the United States died from lung cancer, including
87,698 men and 70,550 women
LOTS and LOTS of Acronyms Ahead!
More Context
The surgeon general first exposed the link between smoking and lung
cancer in a report that was released in 1964
Lung cancer is prevalent not only in the United States, but worldwide,
with particular elevations in third world countries
The International Agency for Research on Cancer estimated 1.6 million
new diagnoses in 2008 of lung cancer worldwide which translates into
12.7% of new manifestations of all cancers worldwide
Until a former smoker is past fifteen years smoke-free, they are
considered to be at approximately the same risk factor as patients
who are currently smoking
NCCN and USPSTF
The National Comprehensive Cancer Network (NCCN) is a
collaboration of twenty-five highly regarded cancer centers
They routinely issue consensus-based clinical practice guidelines on
how to most effectively diagnose and treat various forms of cancer
NCCN has recommended screening for high risk individuals but only
recently has any momentum begun
The United States Preventative Services Task Force (USPSTF) helped
move the fight forward in July 2013, endorsing low-dose CT screening
for those at the highest risk of developing lung cancer
ELCAP
The Early Lung Cancer Action Program (ELCAP) is an organization formed in
1992, consisting of a group of physicians from Cornell University Medical
Center and other specialists to establish research parameters to positively
impact lung cancer detection
This design utilized both chest radiography and low-dose chest CT
Baseline scanning was established followed by repeat annual screening
This research forged the way for others to build upon
ELCAP was scrutinized for not randomizing the trial
NCI and NLST
The National Cancer Institute (NCI) funded a randomized trial in 2002
The National Lung Screening Trial (NLST) enrolled 53,454 patients
identified to be high risk for lung cancer between 2002-2004
Clinical trial participants were randomly assigned to undergo three
annual screening with either low-dose chest CT (26,722) or single-
view PA chest radiography (26,732)
Data was collected through 2009
Researchers found a 20% reduction in deaths from lung cancer among
current or former heavy smokers who were screened with low-dose
helical CT vs. chest X-rays
Significance of the NLST
20% decrease in mortality from lung cancer was documented in the
low-dose chest CT group when compared with the group that received
only chest X-Rays
Official endorsement for low dose CT screening for lung cancer by:
The National Comprehensive Cancer Network, The International
Association for the Study of Lung Cancer, The American Cancer
Society, The American Lung Association, The American Thoracic
Society, The American College of Chest Physicians and The American
Society of Clinical Oncology occurred as a result
I Mustache You a Question
True or False?
True
As early as 2007, data
demonstrated less than 7% of lung
cancer was cured in patients
In Stage I, survival rates are
greater than 90% for patients,
especially if the tumors are equal
to or greater than 10%
The combined mortality rate for all
stages of lung disease is 90%
False Contact with radon is not an
indication for early screening
A history of other types of cancer does not influence a patient’s likelihood of developing lung cancer
Research groups have come to consensus on what constitutes risk factors for inclusion in low dose CT screening for detection of lung cancer
Recommended Risk Factors Include:
Tobacco smoking
Contact with radon
Contact with asbestos or other cancer-causing agents
History of other cancer(s)
Family history of lung cancer/other lung diseases
Contact with second hand smoke
Patients greater than 50 years old and greater than 20 pack years
Regular exposure to second hand smoke
Pack Years?
“Pack Years” is defined by the number of packs of
cigarettes smoked times the number of years the patient
has smoked, for example having smoked more than one
pack of cigarettes a day for thirty years, or two packs of
cigarettes a day for fifteen years would be translated as
“30 pack years”
Five Points for Consideration
Confounding Factors
Participants are still impacted by the stigma associated with lung
cancer due to smoking
Patients in the lower socio-economic ranks may not have access to the
education necessary to participate or the monetary ability to do so
Lack of consensus about what inclusion criteria to follow has fueled
the argument against the screening with low-dose CT
Participants who develop a secondary illness are disqualified
High rate of false positives leading to unnecessary follow up
procedures
Major Progress from the Centers for Medicare
and Medicaid Services February, 2015
Decision Memo for Screening for Lung Cancer with Low-Dose CT
CMS Criterion
Age 55-77 years
Asymptomatic
Tobacco smoking history of at least 30 pack years
Current smoker or someone who has quit within the last 15 years
Receives a written order for LDCT lung cancer screening
Indirect Benefits of Screening
Lung cancer screening programs serve as an entry point to other
services that generate revenue for the hospital system
Patients with a positive lung screening will require further evaluation
in the form of more imaging or surgical services for biopsy
Patients diagnosed with lung cancer will additionally require some
combination of surgical, oncology, and radiation oncology services
depending on the stage of the cancer
Screening programs can assist the health system in building strong
relationships within their neighborhoods
What is Your Why?
REFERENCES
1. Lung Cancer Alliance; www.lungcanceralliance.org.
2. Humphrey LL, Deffebach M, Pappas M, Baumann C, Atis K, Mitchell JP, Zaker
B, Rogwei F, Slator, CG. Screening for lung cancer with low-dose computed
tomography. Annals of Internal Medicine. July 2013; www.annals.org.
3. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen
IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-
dose computed tomographic screening. New England Journal of Medicine.
2011; 365: 395-409.
4. Moyer VA. Benefits and harms of computed tomography lung cancer
screening strategies. Annals of Internal Medicine. December 2013;
www.annals.org.
5. Henschke CI, Yankelevitz DF, Smith JP, Miettinen OS, ELCAP GROUP.
Screening for lung cancer: The early lung cancer action approach. Lung
Cancer. 2002; 35(2): 143-148.
6. Henschke CI, Yankelevitz DF. CT screening for lung cancer: Update 2007.
The Oncologist. 2008; 13: 65-78.
7. Tavernise S. Task force urges scans for smokers at high risk. The New York
Times. July 29, 2013.
8. Sox HC. Better evidence about screening for lung cancer. The New England
Journal of Medicine. 2011; 365: 455-457.
9. Henschke CI, Altorki N, Farooqi A, Hess J, Libby D, McCauley DI, Pasmantier
MW, Reeves AP, Smith JP, Vazquez M, Yankelevitz DF, Yip R, Zhang L, Agnello
K, Ostroff J, Miettinen OS. Computed tomographic screening for lung cancer:
Individualizing the benefit of the screening. European Respiratory Journal.
2007; 30: 843-847.