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Effectiveness of Lung Cancer Screening Improved with Different Criteria

Changing the criteria of who gets screened for lung cancer appears to significantly improve the effectiveness of detection of early lung cancer. These results were recently published in the New England Journal of Medicine.

Lung cancer remains the leading cause of cancer-related deaths in the United States and worldwide. Cure rates for lung cancer once it has spread from its site of origin remain suboptimal, particularly once the cancer has spread outside of the lungs. Unfortunately, there are typically no signs or symptoms of lung cancer in patients until the disease is in an advanced stage. Therefore, effective screening measures to detect this cancer early, prior to spread, remains a priority to advance survival rates.

Results from the National Lung Screening Trial (NLST), published in 2011, demonstrated a 20% reduction in deaths from lung cancer when patients who were at a high risk of developing the disease were screened with low-dose computed tomography (LDCT).2 These findings resulted in the adoption of LDCT into screening guidelines for high-risk individuals.

However, researchers continue to evaluate ways in which to refine screening methods so that the greatest number of patients with early lung cancer get detected while those without lung cancer do not require additional testing.

Researchers from Canada and the United States recently re-evaluated results from the NLST and used different criteria to categorize patients into being high-risk for the development of lung cancer. Under these different parameters, the researchers analyzed results.

With the new criteria, 43% fewer lung cancers were missed.
Specificity remained the same (correctly identifying individuals who did not have cancer).
The researchers stated that “Use of an accurate model that incorporates additional risk factors to select persons for screening may identify more persons who have lung cancer or in whom lung cancer will develop.”

Screening guidelines for lung cancer will continually be updated as new results such as these emerge. Therefore, it is imperative that individuals who are smokers, former smokers, have chronic obstructive pulmonary disease (COPD), have been exposed to asbestos or radon, have other cancers, or have a family history of lung cancer speak with their physician regarding their personal risks and potential benefits of screening.

References:

1. The National Lung Cancer Trial Screening Research Team. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine. 2011; 365:395-409.
2. Tammemagi M, Katki H, Hocking W, et al. Selection Criteria for Lung-Cancer Screening.New England Journal of Medicine. 2013; 368:728-736.