The outcome differences of CT screening for lung cancer pre and post following an algorithm in Zhuhai, China

ArticleinLung cancer (Amsterdam, Netherlands) 73(2):230-6 · December 2010with7 Reads
DOI: 10.1016/j.lungcan.2010.11.012 · Source: PubMed
To evaluate the change in outcomes from CT screening for lung cancer before and after collaboration with the International Early Lung Cancer Action Program (I-ELCAP) as well as changing from a single-row detector to a multi-row detector CT scanner (MDCT). All participants in the screening program were 40 years of age and older. From 1994 to 2002, a single slice spiral CT was used, the screening protocol was established empirically at our institution. From 2003 to 2009 a 16 slice MDCT was used and our institute became the first I-ELCAP site in China. Collaboration included use of the I-ELCAP protocol, image reading training, teaching files training and attendance at international conferences. The clinical and CT characteristics of participants and diagnosed lung cancers pre and post-collaboration were summarized. The outcomes before and after collaboration were compared, including nodule positive rate, lung cancer frequency, stage distribution, pathology, intervals between last routine screening and surgery, the rate of surgery for benign disease and survival rate. 3348 participants were enrolled during 1994-2002 and 3582 participants during 2003-2009. Their age, gender, smoking and family cancer histories were comparable. The screening detection rate of lung cancer was 1.1% (36/3348) vs. 1.0% (34/3582) (P=0.6), mean size was 18.6 mm vs. 15.6 mm (P=0.04), stage I lung cancer was 67% vs. 91% (P=0.38), median intervals between last routine screening and surgery was 213 days vs. 96 days (P<0.001), 5-year survival rate due to lung cancer was 75% vs. 95% (P=0.032) in pre- and post collaboration group respectively. The nodule positive rate was 6.2% (208/3348) vs. 9.8% (351/3582) (P<0.001), the rate of surgery for benign disease was 18% (8/44) vs. 8% (3/37) (P=0.4) in pre- and post collaboration group respectively. Smaller lung cancer were detected, interval between last routine screening and surgery was shorter, surgery for benign disease decreased, and survival rate increased in CT screening for lung cancer in Zhuhai after the collaboration with I-ELCAP and with MDCT. Technology improvements along with a well defined protocol improved outcomes of CT screening for lung cancer in Zhuhai, China.
  • [Show abstract] [Hide abstract] ABSTRACT: Lung cancer screening with LDCT is a complex and controversial topic, with inherent risks and benefits. Results from the large, prospective, randomized NLST show that lung cancer screening with LDCT can decrease lung cancer-specific mortality by 20% and even decrease all-cause mortality by 7%,8 The NLST results indicate that to prevent one death from lung cancer, 320 high-risk individuals must be screened with LDCT. However, the NLST findings have not been replicated yet in a separate cohort. Further analysis of the NLST is underway, including comparative effectiveness modeling. The cost- effectiveness and true benefit-to-risk ratio for lung cancer screening still must be determined. At some point, an acceptable level of risk will have to be deemed appropriate for the benefits of screening. The NCCN Lung Cancer Screening Panel recommends helical LDCT screening for select patients at high risk for lung cancer based on the NLST results, nonrandomized studies, and observational data. These guidelines discuss in detail the criteria for determining which patients are at high risk, and the algorithm provides recommendations for evaluating and following-up nodules detected on LDCT screening (e.g., solid and part-solid nodules). Smokers should always be encouraged to quit smoking tobacco (http ://www.smokefree .gov/). Programs using behavioral counseling combined with medications that promote smoking cessation (approved by the FDA) can be very useftil (see Treating Tobacco Use and Dependence: Quick Reference Guide for Clinicians; http://www.surgeongeneral .gov/tobacco/tobaqrg.htm). When considering lung cancer screening, it is important to have a full understanding of all risks and benefits related to screening with LDCT. As policies for implementing lung screening programs are designed, a focus on multidisciplinary programs (incorporating primary care doctors, pulmonologists, radiologists, thoracic surgeons, medical oncologists, and pathologists) will be helpful to optimize decision- making and minimize interventions for patients with benign lung disease.
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