266 Uspstf Lung Cancer Screening Update
266.1 Summary
- USPSTF Lung Cancer Screening Update
- Morning conference on the new US PSTF recommendations and residual unknowns in lung cancer screening
- Lung Ca Screening - via Emily Beck. Large amounts of data online.
- What to do with incidentalomas
- Current USPSTF
- NLST
- NELSON
- However, a meta-analysis of 7 randomized controlled trials using LDCT also showed no difference in all-cause mortality (RR 0.96; 95%CI 0.92-1.00; p0.67)(5)
- Breathe easy July 21 2020 – shared decision making in lung cancer screening.
- Nishi – retrospective analysis of Clinformatics Data Mart health insurance database - RWD
- Absolute benefits and harms
- https://pubmed.ncbi.nlm.nih.gov/35167780/
266.2 Slide outline
266.2.1 Slide 1
- USPSTF Lung Cancer Screening Update ### Slide 2
- TODO: No text extracted from this slide. ### Slide 3
- Morning conference on the new US PSTF recommendations and residual unknowns in lung cancer screening
- Plenary session Nelson review, JAMA March 2021 addition, conversation with Dr. Buacner podcast
- LUNGRADS introduction, rate of surgical resection
- “if candidate for surgical resection – no mention of radiation ### Slide 4
- Lung Ca Screening - via Emily Beck. Large amounts of data online.
- Do we have incidence and follow-up data on inceidentalomas and their management?
- “14. We suggest that low-dose CT screening programs develop strategies to guide the management of non-nodule findings. (Ungraded Consensus-Based Statement) ### Slide 5
- What to do with incidentalomas
- Remark: Examples include coronary artery calcification, thyroid nodules, adrenal nodules, kidney and liver lesions, thoracic aortic aneurysms, pleural effusions, and parenchymal lung disease.” ### Slide 6
- Current USPSTF
- 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 ### Slide 7
- NLST
- N53,454
- 3 annual rounds of LDCT
- 24.2% had abnormal results, 96% of which did not lead to ca diagnosis; 11% required invasive procedure. ### Slide 8
- NELSON
- RCT – LDCT at yr (0,1,3,5.5) vs no screening
- Inclusion (current/former wn 10 y smokers; 50-74) – 13,195 men
- Primary: lung ca mortality: 156 men (screened) 206 (control) dead at 10y from lung ca. RR 0.76.
- Secondary: all cause mortality (RR 1.01 - no difference), lung cancer dx
- Diff from NLST: volume-based nodule-management in NELSON vs diameter-based in NLST. ### Slide 9
- However, a meta-analysis of 7 randomized controlled trials using LDCT also showed no difference in all-cause mortality (RR 0.96; 95%CI 0.92-1.00; p0.67)(5)
- Sadate A, Occean BV, Beregi JP, Hamard A, Addala T, de Forges H, Fabbro-Peray P, Frandon J. Systematic review and meta-analysis on the impact of lung cancer screening by low-dose computed tomography. Eur J Cancer 2020; 134: 107-114. ### Slide 10
- Breathe easy July 21 2020 – shared decision making in lung cancer screening.
- 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 ### Slide 11
- Nishi – retrospective analysis of Clinformatics Data Mart health insurance database - RWD
- N11,520 who underwent LDCT screening in 2016 compared to matched controls who did not undergo screening.
- 20.7% (vs 6.8% in control) underwent CT w/n 1 yr. 0.3% PET-CT, 0.05% MRI.
- 0.9% (vs 0.3% in NLST) underwent thorascopy, 1.3% vs 0.6% w CT-guided biopsy, 2.0 vs 1.2% for bronchoscopy.
- Thus, the difference in CT between screened vs not (13.8%) was actually less than imaging rate in NLST (21.7%)
- Nishi SPE, Zhou J, Okereke I, Kuo YF, Goodwin J. Use of Imaging and Diagnostic Procedures After Low-Dose CT Screening for Lung Cancer. Chest 2020; 157: 427-434. ### Slide 12
- Absolute benefits and harms
266.2.2 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) ### Slide 13
- https://pubmed.ncbi.nlm.nih.gov/35167780/
- The Chain of Adherence for Incidentally-detected Pulmonary Nodules after an Initial Radiologic Imaging Study: A Multi-system Observational Study ### Slide 14
- Review: https://www.plenarysessionpodcast.com/episodes/jw9w58yrajfyr6r-7b8sr-6xwsz-6m9zm-y9bgz-wkczr-rkbad-5knrb-cr2ah-mrfaz-r3b96-fnstm-x4xlp
- Expansions in screening [52:00]
- Association of Computed Tomographic Screening Promotion With Lung Cancer Overdiagnosis Among Asian Women
266.3 Learning objectives
- USPSTF Lung Cancer Screening Update
- Morning conference on the new US PSTF recommendations and residual unknowns in lung cancer screening
- Lung Ca Screening - via Emily Beck. Large amounts of data online.
- What to do with incidentalomas
- Current USPSTF
266.4 Bottom line / summary
- USPSTF Lung Cancer Screening Update
- Morning conference on the new US PSTF recommendations and residual unknowns in lung cancer screening
- Lung Ca Screening - via Emily Beck. Large amounts of data online.
- What to do with incidentalomas
- Current USPSTF
266.5 Approach
- TODO: Outline the initial assessment or decision point.
- TODO: Outline the next diagnostic or management step.
- TODO: Outline follow-up or escalation criteria.
266.6 Red flags / when to escalate
- TODO: List red flags that require urgent escalation.
266.7 Common pitfalls
- TODO: Capture common errors or missed steps.
266.8 References
TODO: Add landmark references or guideline citations.