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Lung Cancer Screening

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Lung Cancer

Part of the book series: Cancer Treatment and Research ((CTAR,volume 170))

Abstract

Lung cancer is the leading cause of cancer mortality in the United States and worldwide. Since lung cancer outcomes are dependent on stage at diagnosis with early disease resulting in longer survival, the goal of screening is to capture lung cancer in its early stages when it can be treated and cured. Multiple studies have evaluated the use of chest X-ray (CXR) with or without sputum cytologic examination for lung cancer screening, but none has demonstrated a mortality benefit. In contrast, the multicenter National Lung Screening Trial (NLST) from the United States found a 20 % reduction in lung cancer mortality following three consecutive screenings with low-dose computed tomography (LDCT) in high-risk current and former smokers. Data from European trials are not yet available. In addition to a mortality benefit, lung cancer screening with LDCT also offers a unique opportunity to promote smoking cessation and abstinence and may lead to the diagnoses of treatable chronic diseases, thus decreasing the overall disease burden. The risks of lung cancer screening include overdiagnosis, radiation exposure, and false-positive results leading to unnecessary testing and possible patient anxiety and distress. However, the reduction in lung cancer mortality is a benefit that outweighs the risks and major health organizations currently recommend lung cancer screening using age, smoking history, and quit time criteria derived from the NLST. Although more research is needed to clearly define and understand the application and utility of lung cancer screening in the general population, current data support that lung cancer screening is effective and should be offered to eligible beneficiaries.

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References

  1. Torre LA et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108

    Article  PubMed  Google Scholar 

  2. Howlader N et al (2014) SEER cancer statistics review, 1975–2012, National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015

  3. Flieder DB et al (2005) Tumor size is a determinant of stage distribution in T1 non-small cell lung cancer. Chest 128(4):2304–2308

    Article  PubMed  Google Scholar 

  4. Raz DJ et al (2007) Clinical characteristics and survival of patients with surgically resected, incidentally detected lung cancer. J Thorac Oncol 2(2):125–130

    Article  PubMed  Google Scholar 

  5. Quadrelli S et al (2015) Clinical characteristics and prognosis of incidentally detected lung cancers. Int J Surg Oncol 2015:287604

    CAS  PubMed  PubMed Central  Google Scholar 

  6. International Early Lung Cancer Action Program I et al (2006) Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 355(17):1763–1771

    Google Scholar 

  7. Humphrey LL et al (2004) Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: an update for the U.S. preventive services task force. Ann Intern Med 140(9):740–753

    Article  PubMed  Google Scholar 

  8. Brett GZ (1968) The value of lung cancer detection by six-monthly chest radiographs. Thorax 23(4):414–420

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Brett GZ (1969) Earlier diagnosis and survival in lung cancer. Br Med J 4(5678):260–262

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Dales LG, Friedman GD, Collen MF (1979) Evaluating periodic multiphasic health checkups: a controlled trial. J Chronic Dis 32(5):385–404

    Article  CAS  Google Scholar 

  11. Friedman GD, Collen MF, Fireman BH (1986) Multiphasic health checkup evaluation: a 16-year follow-up. J Chronic Dis 39(6):453–463

    Article  CAS  PubMed  Google Scholar 

  12. Fontana RS et al (1984) Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo clinic study. Am Rev Respir Dis 130(4):561–565

    CAS  PubMed  Google Scholar 

  13. Fontana RS et al (1986) Lung cancer screening: the Mayo program. J Occup Med 28(8):746–750

    Article  CAS  PubMed  Google Scholar 

  14. Marcus PM et al (2000) Lung cancer mortality in the Mayo Lung Project: impact of extended follow-up. J Natl Cancer Inst 92(16):1308–1316

    Article  CAS  PubMed  Google Scholar 

  15. Fontana RS et al (1991) Screening for lung cancer. A critique of the Mayo Lung Project. Cancer. 67(4 Supp):1155–1164

    Google Scholar 

  16. Marcus PM et al (2006) Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. J Natl Cancer Inst 98(11):748–756

    Article  PubMed  Google Scholar 

  17. Frost JK et al (1984) Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis 130(4):549–554

    CAS  PubMed  Google Scholar 

  18. Melamed MR et al (1984) Screening for early lung cancer. Results of the memorial Sloan-Kettering study in New York. Chest 86(1):44–53

    Article  CAS  PubMed  Google Scholar 

  19. Tockman MS (1986) Survival and mortality from lung cancer in a screened population: the Johns Hopkins study. Chest 89(4 Supp):324S–325S

    Google Scholar 

  20. Flehinger BJ et al (1984) Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study. Am Rev Respir Dis 130(4):555–560

    CAS  PubMed  Google Scholar 

  21. Martini N (1986) Results of the Memorial Sloan-Kettering study in screening for early lung cancer. Chest 89(4Supp):325S–325S

    Google Scholar 

  22. Melamed MR (2000) Lung cancer screening results in the National Cancer Institute New York study. Cancer 89(11 Suppl):2356–2362

    Article  CAS  PubMed  Google Scholar 

  23. Kubik A, Polak J (1986) Lung cancer detection. Results of a randomized prospective study in Czechoslovakia. Cancer 57(12):2427–2437

    Article  CAS  PubMed  Google Scholar 

  24. Kubik AK, Parkin DM, Zatloukal P (2000) Czech study on lung cancer screening: post-trial follow-up of lung cancer deaths up to year 15 since enrollment. Cancer 89(11 Suppl):2363–2368

    Article  CAS  PubMed  Google Scholar 

  25. Wilde J (1989) A 10 year follow-up of semi-annual screening for early detection of lung cancer in the Erfurt County, GDR. Eur Respir J 2(7):656–662

    CAS  PubMed  Google Scholar 

  26. Okamoto N et al (1999) Evaluation of a clinic-based screening program for lung cancer with a case-control design in Kanagawa, Japan. Lung Cancer 25(2):77–85

    Article  CAS  PubMed  Google Scholar 

  27. Nishii K et al (2001) A case-control study of lung cancer screening in Okayama Prefecture, Japan. Lung Cancer 34(3):325–332

    Article  CAS  PubMed  Google Scholar 

  28. Sagawa M et al (2001) A case-control study for evaluating the efficacy of mass screening program for lung cancer in Miyagi Prefecture, Japan. Cancer 92(3):588–594

    Article  CAS  PubMed  Google Scholar 

  29. Tsukada H et al (2001) An evaluation of screening for lung cancer in Niigata Prefecture, Japan: a population-based case-control study. Br J Cancer 85(9):1326–1331

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Oken MM et al (2005) Baseline chest radiograph for lung cancer detection in the randomized prostate, lung, colorectal and ovarian cancer screening trial. J Natl Cancer Inst 97(24):1832–1839

    Article  PubMed  Google Scholar 

  31. Oken MM et al (2011) Screening by chest radiograph and lung cancer mortality: the prostate, lung, colorectal, and ovarian (PLCO) randomized trial. JAMA 306(17):1865–1873

    Article  CAS  PubMed  Google Scholar 

  32. Black WC (2007) Computed tomography screening for lung cancer: review of screening principles and update on current status. Cancer 110(11):2370–2384

    Article  PubMed  Google Scholar 

  33. Henschke CI et al (1999) Early lung cancer action project: overall design and findings from baseline screening. Lancet 354(9173):99–105

    Article  CAS  PubMed  Google Scholar 

  34. National Lung Screening Trial Research T et al (2011) The national lung screening trial: overview and study design. Radiology 258(1):243–253

    Google Scholar 

  35. National Lung Screening Trial Research T et al (2013) Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 368(21):1980–1991

    Google Scholar 

  36. National Lung Screening Trial Research T et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365(5):395–409

    Google Scholar 

  37. Aberle DR et al (2013) Results of the two incidence screenings in the national lung screening trial. N Engl J Med 369(10):920–931

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Field JK et al (2013) European randomized lung cancer screening trials: post NLST. J Surg Oncol 108(5):280–286

    Article  PubMed  Google Scholar 

  39. Horeweg N et al (2014) Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers. Lancet Oncol 15(12):1342–1350

    Article  PubMed  Google Scholar 

  40. Pedersen JH et al (2009) The Danish randomized lung cancer CT screening trial–overall design and results of the prevalence round. J Thorac Oncol 4(5):608–614

    Article  PubMed  Google Scholar 

  41. Saghir Z et al (2012) CT screening for lung cancer brings forward early disease. The randomised danish lung cancer screening trial: status after five annual screening rounds with low-dose CT. Thorax 67(4):296–301

    Article  PubMed  Google Scholar 

  42. Infante M et al (2008) Lung cancer screening with spiral CT: baseline results of the randomized DANTE trial. Lung Cancer 59(3):355–363

    Article  PubMed  Google Scholar 

  43. Infante M et al (2009) A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. Am J Respir Crit Care Med 180(5):445–453

    Article  PubMed  Google Scholar 

  44. Pastorino U et al (2012) Annual or biennial CT screening versus observation in heavy smokers: 5-year results of the MILD trial. Eur J Cancer Prev 21(3):308–315

    Article  PubMed  Google Scholar 

  45. Humphrey LL et al (2013) Screening for lung cancer with low-dose computed tomography: a systematic review to update the US preventive services task force recommendation. Ann Intern Med 159(6):411–420

    Article  PubMed  Google Scholar 

  46. Grannis FW (2004) Can we avert the need for pneumonectomy by screening for lung cancer? Eur J Cardiothorac Surg 25(2):296

    Article  PubMed  Google Scholar 

  47. Flores RM et al (2009) Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg 138(1):11–18

    Article  PubMed  Google Scholar 

  48. Paul S et al (2010) Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 139(2):366–378

    Article  PubMed  Google Scholar 

  49. Paul S et al (2013) Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the nationwide inpatient sample database. Eur J Cardiothorac Surg 43(4):813–817

    Article  PubMed  Google Scholar 

  50. Higuchi M et al (2014) Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer. J Cardiothorac Surg 9:88

    Article  PubMed  PubMed Central  Google Scholar 

  51. Lee PC et al (2013) Long-term survival after lobectomy for non-small cell lung cancer by video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 96(3):951–60 (discussion 960-1)

    Google Scholar 

  52. Timmerman R et al (2010) Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 303(11):1070–1076

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Mets OM, de Jong PA, Prokop M (2012) Computed tomographic screening for lung cancer: an opportunity to evaluate other diseases. JAMA 308(14):1433–1434

    Article  CAS  PubMed  Google Scholar 

  54. Mets OM et al (2011) Identification of chronic obstructive pulmonary disease in lung cancer screening computed tomographic scans. JAMA 306(16):1775–1781

    Article  CAS  PubMed  Google Scholar 

  55. Jacobs PC et al (2011) Unrequested information from routine diagnostic chest CT predicts future cardiovascular events. Eur Radiol 21(8):1577–1585

    Article  PubMed  PubMed Central  Google Scholar 

  56. Taylor KL et al (2007) Lung cancer screening as a teachable moment for smoking cessation. Lung Cancer 56(1):125–134

    Article  PubMed  Google Scholar 

  57. Anderson CM et al (2009) Smoking cessation and relapse during a lung cancer screening program. Cancer Epidemiol Biomarkers Prev 18(12):3476–3483

    Article  PubMed  Google Scholar 

  58. Ashraf H et al (2009) Effect of CT screening on smoking habits at 1-year follow-up in the danish lung cancer screening trial (DLCST). Thorax 64(5):388–392

    Article  CAS  PubMed  Google Scholar 

  59. Townsend CO et al (2005) Relation between smoking cessation and receiving results from three annual spiral chest computed tomography scans for lung carcinoma screening. Cancer 103(10):2154–2162

    Article  PubMed  Google Scholar 

  60. Villanti AC et al (2013) A cost-utility analysis of lung cancer screening and the additional benefits of incorporating smoking cessation interventions. PLoS ONE 8(8):e71379

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Henschke CI et al (2013) Definition of a positive test result in computed tomography screening for lung cancer: a cohort study. Ann Intern Med 158(4):246–252

    Article  PubMed  Google Scholar 

  62. Pinsky PF et al (2015) Performance of Lung-RADS in the national lung screening trial: a retrospective assessment. Ann Intern Med 162(7):485–491

    Article  PubMed  PubMed Central  Google Scholar 

  63. Bach PB et al (2012) Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 307(22):2418–2429

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Berrington de Gonzalez A, Kim KP, Berg CD (2008) Low-dose lung computed tomography screening before age 55: estimates of the mortality reduction required to outweigh the radiation-induced cancer risk. J Med Screen 15(3):153–158

    Google Scholar 

  65. Reich JM (2008) A critical appraisal of overdiagnosis: estimates of its magnitude and implications for lung cancer screening. Thorax 63(4):377–383

    Article  CAS  PubMed  Google Scholar 

  66. Lindell RM et al (2007) Five-year lung cancer screening experience: CT appearance, growth rate, location, and histologic features of 61 lung cancers. Radiology 242(2):555–562

    Article  PubMed  Google Scholar 

  67. Sone S et al (2007) Long-term follow-up study of a population-based 1996–1998 mass screening programme for lung cancer using mobile low-dose spiral computed tomography. Lung Cancer 58(3):329–341

    Article  PubMed  Google Scholar 

  68. Raz DJ et al (2007) Natural history of stage I non-small cell lung cancer: implications for early detection. Chest 132(1):193–199

    Article  PubMed  Google Scholar 

  69. Slatore CG et al (2014) Patient-centered outcomes among lung cancer screening recipients with computed tomography: a systematic review. J Thorac Oncol 9(7):927–934

    Article  Google Scholar 

  70. Wu GX et al (2015) Psychological harm associated with lung cancer screening: a systematic review, in Submitted to Psychooncology

    Google Scholar 

  71. Moyer VA, U.S.P.S.T. Force (2014) Screening for lung cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 160(5):330–338

    Google Scholar 

  72. Wood DE et al (2012) Lung cancer screening. J Natl Compr Canc Netw 10(2):240–265

    CAS  PubMed  Google Scholar 

  73. Jaklitsch MT et al (2012) The American association for thoracic surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg 144(1):33–38

    Article  PubMed  Google Scholar 

  74. Jensen T et al (2015) Final national coverage determination on screening for lung cancer with low dose computed tomography (LDCT). The Centers for Medicare & Medicaid Services (CMS)

    Google Scholar 

  75. National Lung Screening Trial Research T et al (2010) Baseline characteristics of participants in the randomized national lung screening trial. J Natl Cancer Inst 102(23):1771–1779

    Google Scholar 

  76. Wang Y et al (2015) Trends in the proportion of patients with lung cancer meeting screening criteria. JAMA 313(8):853–855

    Article  PubMed  PubMed Central  Google Scholar 

  77. Wu GX et al (2015) The proportion of newly diagnosed non-small cell lung cancer patients that would have been eligible for lung cancer screening. Submitted to JTCVS

    Google Scholar 

  78. Gray SW et al (2012) Improved outcomes associated with higher surgery rates for older patients with early stage nonsmall cell lung cancer. Cancer 118(5):1404–1411

    Article  PubMed  Google Scholar 

  79. Mery CM et al (2005) Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. Chest 128(1):237–245

    Article  PubMed  Google Scholar 

  80. Rueth NM et al (2012) Surgical treatment of lung cancer: predicting postoperative morbidity in the elderly population. J Thorac Cardiovasc Surg 143(6):1314–1323

    Article  PubMed  Google Scholar 

  81. McMahon PM et al (2014) Comparing benefits from many possible computed tomography lung cancer screening programs: extrapolating from the national lung screening trial using comparative modeling. PLoS ONE 9(6):e99978

    Article  PubMed  PubMed Central  Google Scholar 

  82. Tammemagi MC et al (2013) Selection criteria for lung-cancer screening. N Engl J Med 368(8):728–736

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Black WC et al (2014) Cost-effectiveness of CT screening in the national lung screening trial. N Engl J Med 371(19):1793–1802

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Kubik A et al (1990) Lack of benefit from semi-annual screening for cancer of the lung: follow-up report of a randomized controlled trial on a population of high-risk males in Czechoslovakia. Int J Cancer 45(1):26–33

    Article  CAS  PubMed  Google Scholar 

  85. Becker N et al (2012) Randomized study on early detection of lung cancer with MSCT in Germany: study design and results of the first screening round. J Cancer Res Clin Oncol 138(9):1475–1486

    Article  CAS  PubMed  Google Scholar 

  86. Becker N et al (2015) Randomised study on early detection of lung cancer with MSCT in Germany: results of the first 3 years of follow-up after randomisation. J Thorac Oncol 10:890–896

    Google Scholar 

  87. Lopes Pegna A et al (2009) Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT. Lung Cancer 64(1):34–40

    Google Scholar 

  88. Smith RA et al (2014) Cancer screening in the United States, 2014: a review of current American cancer society guidelines and current issues in cancer screening. CA Cancer J Clin 64(1):30–51

    Article  PubMed  Google Scholar 

  89. Detterbeck FC et al (2013) Screening for lung cancer: diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e78S–e92S

    Article  PubMed  PubMed Central  Google Scholar 

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Wu, G.X., Raz, D.J. (2016). Lung Cancer Screening. In: Reckamp, K. (eds) Lung Cancer. Cancer Treatment and Research, vol 170. Springer, Cham. https://doi.org/10.1007/978-3-319-40389-2_1

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