Tag: lung screening

More Support for CT Lung Cancer Screening

Posted on by Brian Casey

Yet another study supporting CT lung cancer screening has been published, adding to a growing body of evidence that population-based CT screening programs will be effective in reducing lung cancer deaths. 

The new study comes from European Radiology, where researchers from Hungary describe findings from HUNCHEST-II, a population-based program that screened 4.2k high-risk people at 18 institutions. 

  • Screening criteria were largely similar to other studies: people between the ages of 50 and 75 who were current or former smokers with at least 25 pack-year histories. Former smokers had quit within the last 15 years. 

Recruitment for HUNCHEST-II took place from September 2019 to January 2022. Participants received a baseline low-dose CT (LDCT) scan, with the study protocol calling for annual follow-up scans (more on this later). Researchers found: 

  • The prevalence of baseline screening exams positive for lung cancer was 4.1%, comparable to the NELSON trial (2.3%) but much lower than the NLST (27%)
  • 1.8% of participants were diagnosed with lung cancer throughout screening rounds
  • 1.5% of participants had their cancer found with the baseline exam
  • Positive predictive value was 58%, at the high end of population-based lung screening programs
  • 79% of screen-detected cancers were early stage, making them well-suited for treatment
  • False-positive rate was 42%, a figure the authors said was “concerning”

Taking a deeper dive into the data produces interesting revelations. Overdiagnosis is a major concern with any screening test; it was a particular problem with NLST but was lower with HUNCHEST-II. 

  • Researchers said they used a volume-based nodule evaluation protocol, which reduced the false-positive rate compared to the nodule diameter-based approach in NLST.

Also, a high attrition rate occurred between the baseline scan and annual screening rounds, with only 12% of individuals with negative baseline LDCT results going on to follow-up screening (although the COVID-19 pandemic may have affected these results). 

The Takeaway

The HUNCHEST-II results add to the growing momentum in favor of national population-based CT lung screening programs. Germany is planning to implement a program in early 2024, and Taiwan is moving in the same direction. The question is, does the US need to step up its game as screening compliance rates remain low?

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.

Value of Cancer Screening

Posted on by Brian Casey

A new study claims that medical screening for diseases like breast and cervical cancer has saved lives and generated value of at least $7.5T (yes, trillion) over the last 25 years. The findings, published in BMC Health Services Research, are a stunning rebuke to critics of screening exams.

While the vast majority of doctors and public health officials support evidence-based screening, a vocal minority of skeptics continues to raise questions about screening’s efficacy. These critics emphasize the “harms” of screening, such as overdiagnosis and patient anxiety – an accusation often levied against breast screening. 

Screening’s critics also target the downstream costs of medical tests intended to confirm suspicious findings. They argue that a single screen-detected finding can lead to a cascade of additional healthcare spending that drives up medical costs.

But the new study offers a counter-argument, putting a dollar figure on how much screening exams have saved by detecting disease earlier, when it can be treated more effectively. 

The research focused on the four main cancer screening tests – breast, cervical, colon, and lung cancer – analyzing the impact of preventive screening on life-years saved and its economic impact from 1996 to 2020, finding …

  • Americans enjoyed at least 12M more years of life thanks to cancer screening
  • The economic value of these life-years added up to at least $7.5T
  • If everyone who qualified for screening exams got them, it would save at least another 3.3M life-years and $1.7T in economic impact
  • Cervical cancer screening had by far the biggest economic impact ($5.2T-$5.7T), followed by breast ($0.8T-$1.9T), colorectal ($0.4T-$1T), and finally lung ($40B). 

Lung cancer’s paltry value was due to a small eligible population and low screening adherence rates. This finding is underscored by a new article in STAT that ponders why CT lung cancer screening rates are so low, with one observer calling it the “redheaded stepchild” of screening tests.  

The Takeaway
Screening skeptics have been taking it on the chin lately (witness the USPSTF’s U-turn on mammography for younger women) and the new findings will be another blow. We may continue to see a dribble of papers on the “harms” of overdiagnosis, but the momentum is definitely shifting in screening’s favor – to the benefit of patients.

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