Download PDF
Semin Respir Crit Care Med 2020; 41(03): 447-452
DOI: 10.1055/s-0039-3400480
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Update on Lung Cancer Screening

Andrew R. Brownlee
1   Section of Thoracic Surgery, University of Chicago, Chicago, Illinois
,
Jessica S. Donington
1   Section of Thoracic Surgery, University of Chicago, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

Publication Date:
25 May 2020 (online)

    Permissions and Reprints

Abstract

Over the past 10 years, there has been substantial progress in the study and implementation of lung cancer screening using low-dose computed tomography (LDCT). The National Lung Screening Trial, the recently reported NELSON (NEderlands-Leuvens Longkanker Screenings ONderzoek) trial, and other European trials provide strong evidence for the efficacy of LDCT to reduce lung cancer mortality. This has resulted in the United State's Preventative Task Force and numerous professional medical societies adopting lung cancer screening recommendations. Despite the general acceptance of the positive effect of screening, low adoption and implementation rates remain nationally. In this article, the authors discuss the evolution and current state of the evidence for LDCT screening for lung cancer. The authors will also review the associated risks, cost, and challenges of implementation of an LDCT screening program.

Keywords

lung cancer screening - low-dose computed tomography - lung cancer mortality - national lung screening trial - nonsmall cell lung cancer
 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017; 67 (01) 7-30
    CrossrefPubMedGoogle Scholar
  • 2 Goldstraw P, Chansky K, Crowley J. , et al; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee Advisory Boards and Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 2016; 11 (01) 39-51
    CrossrefPubMedGoogle Scholar
  • 3 Molina JR, Adjei AA, Jett JR. Advances in chemotherapy of non-small cell lung cancer. Chest 2006; 130 (04) 1211-1219
    CrossrefPubMedGoogle Scholar
  • 4 Cole P, Morrison AS. Basic issues in population screening for cancer. J Natl Cancer Inst 1980; 64 (05) 1263-1272
    PubMedGoogle Scholar
  • 5 National Lung Screening Trial Research Team. Lung cancer incidence and mortality with extended follow-up in the national lung screening trial. J Thorac Oncol 2019; 14 (10) 1732-1742
    CrossrefPubMedGoogle Scholar
  • 6 Swensen SJ, Jett JR, Hartman TE. , et al. CT screening for lung cancer: five-year prospective experience. Radiology 2005; 235 (01) 259-265
    CrossrefPubMedGoogle Scholar
  • 7 Henschke CI, Yankelevitz DF, Libby DM. , et al. Early lung cancer action project: annual screening using single-slice helical CT. Ann N Y Acad Sci 2001; 952 (01) 124-134
    CrossrefPubMedGoogle Scholar
  • 8 Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS. ; International Early Lung Cancer Action Program Investigators. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006; 355 (17) 1763-1771
    CrossrefPubMedGoogle Scholar
  • 9 Aberle DR, Adams AM, Berg CD. , et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365 (05) 395-409
    CrossrefPubMedGoogle Scholar
  • 10 Infante M, Cavuto S, Lutman FR. , et al; DANTE Study Group. Long-term follow-up results of the DANTE trial, a randomized study of lung cancer screening with spiral computed tomography. Am J Respir Crit Care Med 2015; 191 (10) 1166-1175
    CrossrefPubMedGoogle Scholar
  • 11 Wille MM, Dirksen A, Ashraf H. , et al. Results of the randomized Danish lung cancer screening trial with focus on high-risk profiling. Am J Respir Crit Care Med 2016; 193 (05) 542-551
    CrossrefPubMedGoogle Scholar
  • 12 De Koning H, Van Der Aalst C, Ten Haaf K, Oudkerk M. Effects of volume CT lung cancer screening: mortality results of the NELSON randomised-controlled population based trial. J Thor Onc 2018; 13 (10) S185
    PubMedGoogle Scholar
  • 13 Pastorino U, Silva M, Sestini S. , et al. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial. Ann Oncol 2019; 30 (07) 1162-1169
    CrossrefPubMedGoogle Scholar
  • 14 Becker N, Motsch E, Gross ML. , et al. Randomized study on early detection of lung cancer with MSCT in Germany: results of the first 3 years of follow-up after randomization. J Thorac Oncol 2015; 10 (06) 890-896
    CrossrefPubMedGoogle Scholar
  • 15 Marshall D, Simpson KN, Earle CC, Chu C. Potential cost-effectiveness of one-time screening for lung cancer (LC) in a high risk cohort. Lung Cancer 2001; 32 (03) 227-236
    CrossrefPubMedGoogle Scholar
  • 16 Wisnivesky JP, Mushlin AI, Sicherman N, Henschke C. The cost-effectiveness of low-dose CT screening for lung cancer: preliminary results of baseline screening. Chest 2003; 124 (02) 614-621
    CrossrefPubMedGoogle Scholar
  • 17 Mahadevia PJ, Fleisher LA, Frick KD, Eng J, Goodman SN, Powe NR. Lung cancer screening with helical computed tomography in older adult smokers: a decision and cost-effectiveness analysis. JAMA 2003; 289 (03) 313-322
    CrossrefPubMedGoogle Scholar
  • 18 Manser R, Dalton A, Carter R, Byrnes G, Elwood M, Campbell DA. Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting. Lung Cancer 2005; 48 (02) 171-185
    CrossrefPubMedGoogle Scholar
  • 19 Black WC, Gareen IF, Soneji SS. , et al; National Lung Screening Trial Research Team. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med 2014; 371 (19) 1793-1802
    CrossrefPubMedGoogle Scholar
  • 20 Pataky R, Philips N, Peacock S, Coldman AJ. Cost-effectiveness of population-based mammography screening strategies by age range and frequency. J Cancer Policy 2014; 2 (04) 97-102
    PubMedGoogle Scholar
  • 21 Hoffman RM, Sussman AL, Getrich CM. , et al. Attitudes and beliefs of primary care providers in New Mexico about lung cancer screening using low-dose computed tomography. Prev Chronic Dis 2015; 12 (12) E108
    PubMedGoogle Scholar
  • 22 Larke FJ, Kruger RL, Cagnon CH. , et al. Estimated radiation dose associated with low-dose chest CT of average-size participants in the National Lung Screening Trial. AJR Am J Roentgenol 2011; 197 (05) 1165-1169
    CrossrefPubMedGoogle Scholar
  • 23 Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology 2004; 231 (02) 440-445
    CrossrefPubMedGoogle Scholar
  • 24 Slatore CG, Sullivan DR, Pappas M, Humphrey LL. Patient-centered outcomes among lung cancer screening recipients with computed tomography: a systematic review. J Thorac Oncol 2014; 9 (07) 927-934
    CrossrefPubMedGoogle Scholar
  • 25 Wu GX, Raz DJ, Brown L, Sun V. Psychological burden associated with lung cancer screening: a systematic review. Clin Lung Cancer 2016; 17 (05) 315-324
    CrossrefPubMedGoogle Scholar
  • 26 Reiter MJ, Nemesure A, Madu E, Reagan L, Plank A. Frequency and distribution of incidental findings deemed appropriate for S modifier designation on low-dose CT in a lung cancer screening program. Lung Cancer 2018; 120: 1-6
    CrossrefPubMedGoogle Scholar
  • 27 National Comprehensive Cancer Network. NCCN clincial practice guidelines in oncology: non-small cell. Lung Cancer 2019; 7: MS5-MS6 nccn.org/professionals/physician-gls/pdf/nsclc.pdf
    PubMedGoogle Scholar
  • 28 U.S. Preventative Services. Lung cancer: screening. Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening . Accessed August 1, 2019
    PubMed
  • 29 Medicare coverage of screening for lung cancer with low dose computed tomography (LDCT). Available from: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9246.pdf . Accessed August 1, 2019
    PubMed
  • 30 American Academy of Family Physicians. Lung cancer. Available from: https://www.aafp.org/patient-care/clinical-recommendations/all/lung-cancer.html . Accessed May 25, 2019
    PubMedGoogle Scholar
  • 31 McKee BJ, Regis S, Borondy-Kitts AK. , et al. NCCN guidelines as a model of extended criteria for lung cancer screening. J Natl Compr Canc Netw 2018; 16 (04) 444-449
    CrossrefPubMedGoogle Scholar
  • 32 Haiman CA, Stram DO, Wilkens LR. , et al. Ethnic and racial differences in the smoking-related risk of lung cancer. N Engl J Med 2006; 354 (04) 333-342
    CrossrefPubMedGoogle Scholar
  • 33 Pinsky PF. Racial and ethnic differences in lung cancer incidence: how much is explained by differences in smoking patterns? (United States). Cancer Causes Control 2006; 17 (08) 1017-1024
    CrossrefPubMedGoogle Scholar
  • 34 Aldrich MC, Mercaldo SF, Sandler KL, Blot WJ, Grogan EL, Blume JD. Evaluation of USPSTF lung cancer screening guidelines among African American adult smokers. JAMA Oncol 2019; 5 (09) 1318-1324
    CrossrefPubMedGoogle Scholar
  • 35 Pinsky PF. Does the evidence support the implementation of lung cancer screening with low-dose computed tomography?. Expert Rev Respir Med 2018; 12 (04) 257-260
    CrossrefPubMedGoogle Scholar
  • 36 Aberle DR. Implementing lung cancer screening: the US experience. Clin Radiol 2017; 72 (05) 401-406
    CrossrefPubMedGoogle Scholar
  • 37 Zeliadt SB, Hoffman RM, Birkby G. , et al. challenges implementing lung cancer screening in federally qualified health centers. Am J Prev Med 2018; 54 (04) 568-575
    CrossrefPubMedGoogle Scholar
  • 38 Rai A, Doria-Rose VP, Silvestri GA, Yabroff KR. Evaluating lung cancer screening uptake, outcomes, and costs in the united states: challenges with existing data and recommendations for improvement. J Natl Cancer Inst 2019; 111 (04) 342-349
    CrossrefPubMedGoogle Scholar
  • 39 National Lung Cancer Roundtable. Available from: https://nlcrt.org/ . Accessed August 1, 2019
    PubMedGoogle Scholar
  • 40 American College of Radiology. Lung cancer screening resources. Available from: https://www.acr.org/clinical-resources/lung-cancer-screening-resources . Accessed August 1, 2019
    PubMedGoogle Scholar
  • 41 Tammemägi MC. Selecting lung cancer screenees using risk prediction models-where do we go from here. Transl Lung Cancer Res 2018; 7 (03) 243-253
    CrossrefPubMedGoogle Scholar
  • 42 Horeweg N, van Rosmalen J, Heuvelmans MA. , et al. Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol 2014; 15 (12) 1332-1341
    CrossrefPubMedGoogle Scholar
  • 43 Seijo LM, Peled N, Ajona D. , et al. Biomarkers in lung cancer screening: achievements, promises, and challenges. J Thorac Oncol 2019; 14 (03) 343-357
    CrossrefPubMedGoogle Scholar