Tag: LDCT

CT Lung Screening Saves Women

Posted on by Brian Casey

October may be Breast Cancer Awareness Month, but a new study has great news for women when it comes to another life-threatening disease: lung cancer. 

Italian researchers in Lung Cancer found that CT lung cancer screening delivered survival benefits that were particularly dramatic for women – and could address cardiovascular disease as well. 

  • They found that in addition to much higher survival rates, women who got CT lung screening after 12 years of follow-up had lower all-cause mortality than men. 

Of all the cancer screening tests, lung screening is the new kid on the block.

  • Although randomized clinical trials have shown it to deliver lung cancer mortality benefits of 20% and higher, uptake of lung screening has been relatively slow compared to other tests.

In the current study, researchers from the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan analyzed data from 6.5k heavy smokers in the MILD and BioMILD trials who got low-dose CT screening from 2005 to 2016. 

In addition to cancer incidence and mortality, they also used Coreline Soft’s AVIEW software to calculate coronary artery calcium (CAC) scores acquired with the screening exams to see if they predicted lung cancer mortality. Researchers found that after 12 years of follow-up …

  • There was no statistically significant difference in lung cancer incidence between women and men (4.4% vs. 4.7%)
  • But women had lower lung cancer mortality than men (1% vs. 1.9%) as well as lower all-cause mortality (4.1% vs. 7.7%), both statistically significant
  • Women had higher lung cancer survival than men (72% vs. 52%)
  • 15% of participants had CAC scores between 101-400, and all-cause mortality increased with higher scores
  • Women had lower CAC scores, which could play a role in lower all-cause mortality due to less cardiovascular disease

The Takeaway

This is a fascinating study on several levels. First, it shows that lung cancer screening produces a statistically significant decline in all-cause mortality for women compared to men.

Second, it shows that CT lung cancer screening can also serve as a screening test for cardiovascular disease, helping direct those with high CAC scores to treatment such as statin therapy. This type of opportunistic screening could change the cost-benefit dynamic when it comes to analyzing lung screening’s value – especially for women.

CT Detects Early Lung Cancer

Posted on by Brian Casey

A massive CT lung cancer screening program launched in Taiwan has been effective in detecting early lung cancer. Research presented at this week’s World Conference on Lung Cancer (WCLC) in Singapore offers more support for lung screening, which has seen the lowest uptake of the major population-based screening programs. 

Previous randomized clinical trials like the National Lung Screening Trial and the NELSON study have shown that LDCT lung cancer screening can reduce lung cancer mortality by at least 20%. But screening adherence rates remain low, ranging from the upper single digits to as high as 21% in a recent US study. 

Meanwhile, lung cancer remains the leading cause of cancer death worldwide. To reduce this burden, Taiwan in July 2022 launched the Lung Cancer Early Detection Program, which offers biennial screening nationwide to people at high risk of lung cancer.

The Taiwan program differs from screening programs in the US and South Korea by including family history of lung cancer in the eligibility criteria, rather than just focusing on people who smoke. 

Researchers at WCLC 2023 presented the first preliminary results from the program, covering almost 50k individuals screened from July 2022 to June 2023; 29k had a family history of lung cancer and 19k were people who smoked heavily. Researchers found …

  • 4.4k individuals receive a positive screening result for a positive rate of 9.2%
  • 531 people were diagnosed with lung cancer for a detection rate of 1.1%
  • 85% of cancers were diagnosed at an early stage, either stage 0 or stage 1

This last finding is perhaps the most significant, as part of the reason for lung cancer’s high mortality rate is that it’s often discovered at a late stage, when it’s far more difficult to treat. As such, lung cancer’s five-year survival rate is about 25% – far lower than breast cancer at 91%.

The Takeaway

Taiwan is setting an example to other countries for how to conduct a nationwide LDCT lung cancer screening program, even as some critics take aim at population-based screening. Taiwan’s approach is broader and more proactive than that of the US, for example, which has erected screening barriers like shared decision-making.

Although it’s still early days for the Taiwan program, future results will be examined closely to determine screening’s impact on lung cancer mortality – and respond to screening’s critics.

AI-Assisted Radiographers

Posted on by Jake Fishman

A new European Radiology study provided what might be the first insights into whether AI can allow radiographers to independently read lung cancer screening exams, while alleviating the resource challenges that have slowed LDCT screening program rollouts.

This is the type of study that makes some radiologists uncomfortable, but its results suggest that rads’ role in lung cancer screening remains very secure.

The researchers had two trained UK-based radiographers read 716 LDCT exams using a computer-assisted detection AI solution (158 w/ significant pulmonary nodules), and compared them with interpretations from radiologists who didn’t have CADe assistance.

The radiographers had significantly lower sensitivity than the radiologists (68% & 73.7%; p < 0.001), leading to 61 false negative exams. However, the two CADe-assisted radiographers did achieve:

  • Good sensitivity with cancers confirmed from baseline scans – 83.3% & 100%
  • Relatively high specificity – 92.1% & 92.7%
  • Low false-positive rates – 7.9% and 7.3%

The CADe AI solution might have both helped and hurt the radiographers’ performance, as CADe missed 20 of the radiographers’ 40 false negative nodules, and four of their seven false negative malignant nodules. 

Even as LDCT CADe tools become far more accurate, they might not be able to fill in radiographers’ incidental findings knowledge gap. The radiographers achieved either “good” or “fair” interobserver agreement rates with radiologists for emphysema and CAC findings, but the variety of other incidental pathologies was “too broad to reasonably expect radiographers to detect and interpret.”

The Takeaway
Although CADe-assisted radiographer studies might concern some radiologists, this seems like an important aspect of AI to understand given the workload demands that come with lung cancer screening programs, and the need to better understand how clinicians and AI can work together. 

Good thing for any concerned radiologists, this study shows that LDCT reporting is too complex and current CADe solutions are too limited for CADe-equipped radiographers to independently read LDCTs… “at least for the foreseeable future.”

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