# Lung Cancer Screening and Diagnosis

## Trials

NELSON

## Guidelines

Mar 2021 USPSTF update -> age now 55->50 to 80; minimum pack years 30->20 and quit within the last 15 years. https://jamanetwork.com/journals/jama/fullarticle/2777244

## Shared decision-making

Prediction model - https://www.atsjournals.org/doi/pdf/10.1164/rccm.202104-1009ED

- notably, they state that ~10% of eligible patients currently get screened. Authors state 50% might be reasonable (not clear what this is based on)

PLCOm2012 is another prediction score

The eligibility criteria are another inherent prediction model

### Absolute benefits and harms

Editorial of chance of benefits and risk of harm: JAMA. 2020;324(10):937-938. doi:10.1001/jama.2020.0354

Lung cancer specific mortality RRR of 20-33% in high-risk populations

Number needed to screen: ???

Misleading comparison between other screening tests (such as breast cancer, colon cancer) due to differing baseline risk of death from the cancer being screened for. (Ie. NNS is not a surrogate for strength of the test)

### Sensitivity to imaging follow-up algorithms? 

Discussion on the follow-up used in the trials



## Diagnosis and Staging

EBUS-TNA guidelines - Wahidi MM, Herth F, Yasufuku K, et al. Technical aspects of endobronchial
ultrasound-guided transbronchial needle aspiration: CHEST guideline and expert panel report. Chest. 2016;149(3):816-835.

### Tumor Markers: 

CHEST 2021; 160(6):2293-2303

EGFR mutations - allows erlotinib (EGFR TKI). EBUS-FNA is 94.5% sensitivity to identify.

ALK re-arrangement

BRAF 600E

ROSA1

PD-L1 expression over 50% = candidate for first-line immunotherapy.