Lung Cancer Screening Feed

Of course many questions remain about optimal subgroups to be screened, intervals, optimal management protocols and cost-effectiveness. But as further knowledge and experience is gained in these areas, outcomes should only improve from what is now a new benchmark.

Focus moving forward is to implement #lungcancerscreening internationally and improve screening rates where programs have already been initiated (USA).

#MILD with both longer screening window and annual screening seems to have best results (HR 0.61 at 10 years).

Longer screening window of 5.5 years may have lead to the greater lung cancer mortality reduction despite a lower risk cohort than NLST, but the relatively low rate of early stage cancers leaves me concerned regarding the longer screen intervals.

Study adds to the evidence that #LDCT #lungcancerscreening reduces lung cancer mortality, a fact that should now be considered as confirmed. Meta-analysis of all trials to date to shed more light on all-cause mortality benefit seen in the #NLST &10 year follow-up of #MILD trial.

Some criticism exists about overall study management and implementation. (see: https://www.ntvg.nl/artikelen/machiavelli-de-wetenschap/volledig …), but not unexpected in trial designed, implemented and analyzed over a 20 yr period. Results not interpreted in isolation, but in addition to other trials published to date.

Overdiagnosis: 40 excess cases of lung cancer at 10 years of 18.5% (344 vs. 304), but with ongoing reduction in this excess over time (down to 18 cases / 8.9% by year 11). Unclear how newer management algorithms for managing growing GGOs would affect these rates.

Overall 1.2% of participants had a false positive test (defined as requiring a clinical evaluation) over the length of the study.

Positive scans requiring clinical evaluation in only 2.1%, 43.5% of which led to a lung cancer diagnosis (positive predictive value) suggesting that few individuals need anything more than early follow-up LDCTs for indeterminate lung nodules under the NELSON volumetric protocol.

Downsides of screening: 9.2% of scans lead to a repeat CT / early recall. This was significantly higher after baseline (19.7%) vs follow-up exams (range 1.9-6.7%). Seems acceptable, but could reduce further with additional refinements to interpretation and management protocols?

48.8% of lung cancers in screening group were stage I/II vs. 23.4% in controls. This is significantly lower than in NLST which found 70.2% stage I/II in LDCT arm. Could this be a result of the longer screening intervals?

Mortality reduction in women (2ry analysis) shows lower point estimate for death from lung cancer of 0.67 but small sample size / wider confidence intervals does not lead to statistical significance (95% CI, 0.38 to 1.14). Trend consistent across studies including #NLST and #LUSI

1:1 randomization #LDCT vs. no screening (unlike CXR in #NLST) 4 rounds of LDCT: baseline, yrs 1, 3 & 5.5 (over 2x screening window @ 66 months vs. NLST’s 3 rounds at yr 0, 1, 2 / 24 month period). Volumetric nodule measurement protocols 10 year f/y (vs. 6.5y in NLST

Randomized trial 15,792 individuals (13,195 males for 1ry analysis). Lower risk cohort vs. NLST -Younger lower age limit 50 vs. 55 in NLST (median 58 years vs. 61.4) -lower pack-years 15-19 py (38py vs. 48 py in NLST) But shorter quit interval <10 years (vs. 15 in NLST)