Implementing lung cancer screening in the real world: opportunity, challenges and solutions

We review the history of lung cancer screening, the current evidence for low-dose computed tomography screening, and the key elements needed for a successful screening program

Caroline Chiles; Robert J. Optican

2012

Scholarcy highlights

  • After 13 years of follow-up, it was reported that screening with CXR did not reduce lung-cancer specific mortality
  • In 2011, the largest randomized controlled trial of CT screening for lung cancer to date, the National Lung Screening Trial, changed the face of early detection of lung cancer when it reported a 20% reduction in lung-cancer specific mortality in a high- risk cohort of patients screened in the United States with CT in comparison with the control arm of high-risk individuals screened with annual chest radiographs for 3 years
  • In 2011, the NLST reported a 20% reduction in lung cancer mortality in heavy smokers screened with three annual low-dose computed tomography scans relative to those screened with three annual single view CXR
  • McMahon et al implemented a patient-level microsimulation model to estimate the cost-effectiveness of lung cancer screening in six US cohorts, using survey data to attribute smoking histories to the cohorts. They determined that annual CT screening in individuals with ≥20 pack-years smoking history reduced lung cancer-specific mortality by approximately 18% to 25% at 10 years, at a cost of $126,000 to $169,000 per quality-adjusted life-year gained
  • The age and smoking history criteria that currently determine screening eligibility yield a population with widely varying risks of lung cancer
  • We must collect the data from clinical screening programs to ensure that CT screening for lung cancer continues to provide a cost-effective mortality benefit in specific populations, regions, or age groups

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