Lung cancer screening programs are catching more disease while still curable

Story: https://www.healio.com/news/hematology-oncology/20221212/lung-cancer-screening-leads-to-more-stage-i-less-stage-iv-disease-incidence

Implementation of lung cancer screening across five diverse health care systems led to higher rates of stage I diagnoses and lower rates of stage IV disease, study results showed.

Overall incidence of lung cancer did not increase during the study period, indicating a limited impact of overdiagnosis, according to the findings published in Journal of Thoracic Oncology.

Data derived from Vachani A, et al. J Thorac Oncol. 2022;doi:10.1016/j.jtho.2022.08.011.

Methods

Although results of clinical trials have indicated favorable shifts in disease stage and improvements in lung cancer-specific mortality, “the effectiveness of lung cancer screening in clinical practice has not been clearly demonstrated,” Anil Vachani, MD, MS, associate professor of medicine at Hospital of the University of Pennsylvania and Pittsburgh Veterans Administration Medical Center, and colleagues wrote.

The multicenter cohort analysis included 3,678 patients (median age, 69 years [interquartile range, 64-74]; 52% women) diagnosed with a primary lung cancer between Jan. 1, 2014, and Sept. 30, 2019, across five IU.S. health care systems — Henry Ford Health System, Kaiser Permanente Colorado, Kaiser Permanente Hawaii, Marshfield Clinic Health System and University of Pennsylvania Health System.

Primary outcomes included cancer stage distribution and annual age-adjusted lung cancer incidence. Receipt of at least one low-dose CT scan before lung cancer diagnosis served as the primary exposure variable.

Findings

Overall, 11% (n = 404) of all patients were diagnosed with incident lung cancer after the health care systems initiated low-dose CT screening.

Researchers found that as the volume of lung cancer screening increased, the percentage of patients diagnosed with lung cancer after initiation of screening also increased, from none in 2014 to 20% in 2019. However, lung cancer screening did not correlate with a significant change in the overall incidence of lung cancer between 2014 and 2018 (average annual percentage change [AAPC], 0.8; 95% CI, -4.7 to 3.2).

Researchers additionally observed an average 8.4% increase in the annual rate of stage I cancer (AAPC, 8; 95% CI, 0.8-15.7) and a 6.6% decrease in stage IV disease (AAPC, 6; 95% CI, 11.2 to 0.5).

Implications

“This is the first study to determine the impact of lung cancer screening on cancer stage migration using a population-based multicenter cohort,” Vachani and colleagues wrote. “The distribution of [disease] stage was similar to rates observed in prior clinical trials despite limitations, such as lower adherence to annual screening that have been observed outside of trial settings.”

“As screening implementation progresses,” they added, “future population-based studies are needed to assess the impact of screening on other effectiveness outcomes, including rates of harms related to screening and the impact on lung cancer mortality.”

Dr. Robert Tarzwell, MD, FRCPC

In this study of lung cancer screening at 5 sites, in 3678 individuals, physicians detected 8% more stage 1 lung cancer, which is curable with surgery, and 6% less stage 4 (incurable) cancer. Overall, therefore, the program was catching lung cancer earlier in a screening population, offering a greater prospect of cure. If you’ve ever been a smoker, ask your physician or nurse practitioner about a lung cancer screening low dose CT scan of the chest, which we would  be happy to provide for you at INITIO.

Forms

Upon receiving your requisition INITIO staff will contact you via phone to gather your detailed medical history. They will fill out the appropriate intake package on your behalf. Upon your arrival at the clinic, you will be given the opportunity to review and make any necessary edits to your intake package before signing.

Alternatively, you may print the intake package at home, fill out the forms with your medical history and send it to us either through fax: (604) 678–9279 or via e-mail: info@initiomedical.ca. If you are sending us an intake package please ensure that your doctor has sent us a requisition.

As per the INITIO Medical Group Inc. cancellation policy, at the time of booking, we ask each patient to provide us with their credit card details. This information is used in the event that the patient cancels their appointment, or fails to attend their scheduled appointment.

Please note that no charges are made to the credit card on file, except in the event of an appointment cancellation or a failure to attend a scheduled appointment. All charges for the scan are made in person upon completion of the appointment, at which point the credit card authorization form will be shredded.

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