05:16am Thursday 21 September 2017

Early recall rates decline after second round of lung cancer screening

enlarged view Picture: Wikimedia Commons

In the United States the National Lung Cancer Screening Trial (NLST) showed that annual lung cancer screening of high-risk individuals with LDCT reduces lung cancer mortality by 20% and overall mortality by 7%. There are now multiple lung cancer screening trials ongoing throughout the world, but one concern is the high number of early repeat scans for suspicious findings that are in fact not lung cancer. This high number of false positives could make screening impractical due to cost, invasive follow-up procedures, and anxiety for the patients.

The LUSI is comparing no intervention (n=2023) to 5 annual screens of individuals’ aged 50-69 with a history of heavy tobacco smoking (n=2029). All the participants have been followed for at least 3 years but many have been followed for 5 years. The control arm is tracked with an annual questionnaire and query of cancer registries. The LUSI is ongoing but the current analyses compare the first screening round to subsequent rounds with regard to performance indicators, such as early recall rate, detection rate, and interval cancer rate.

The results published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer, show that there was a strong decline in the early recall rate from 20% in the first screening round to 3-4% in rounds 2-4. The detection of lung cancer was 1.1% in the first round but then declined to 0.5%, on average, for the subsequent rounds. The cumulative number of advanced lung cancers was almost identical between the control and intervention groups for the first two years but by year three the number of advanced cancers in the screening group began to decline. The same trend was observed for the overall mortality.

“Our data indicate that the most prominent side effect “false positive alarm” cannot be controlled if the choice of doctor is at the screenee’s discretion at every annual screening visit. The early recall rates of rounds 2-4 would have been around 30%, instead of 3-4%, if the prior scans were not available. Thus, a potential lung cancer screening program must be organized such that all previous images and results are available,” concludes Nikolaus Becker, head of the study.

Becker N., Motsch E., Gross M.-L., Eigentopf A., Heussel C.P., Dienemann H, Schnabel P.A., Eichinger M., Optazaite D.-E., Puderbach M.; Wielpütz M., Kauczor H.-U., Tremper J., Delorme S.: Randomised study on early detection of lung cancer with MSCT in Germany: results of the first 3 years of follow-up after randomization: Journal of Thoracic Oncology 2015, DOI: 10.1097/JTO.0000000000000530 

The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institute in Germany. At DKFZ, more than 1,000 scientists investigate how cancer develops, identify cancer risk factors and endeavor to find new strategies to prevent people from getting cancer. They develop novel approaches to make tumor diagnosis more precise and treatment of cancer patients more successful. The staff of the Cancer Information Service (KID) offers information about the widespread disease of cancer for patients, their families, and the general public. Jointly with Heidelberg University Hospital, DKFZ has established the National Center for Tumor Diseases (NCT) Heidelberg, where promising approaches from cancer research are translated into the clinic. In the German Consortium for Translational Cancer Research (DKTK), one of six German Centers for Health Research, DKFZ maintains translational centers at seven university partnering sites. Combining excellent university hospitals with high-profile research at a Helmholtz Center is an important contribution to improving the chances of cancer patients. DKFZ is a member of the Helmholtz Association of National Research Centers, with ninety percent of its funding coming from the German Federal Ministry of Education and Research and the remaining ten percent from the State of Baden-Württemberg.

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