Lung cancer screening updated recommendations

1. Screening for Lung Cancer
Patients: Impact on
Reducing of Global Burden
Dr. Mohammad Zannatul Rayhan
MD (Pulmonology)
Pulmonologist
Chest Disease Hospital, Rajshahi

2. Lung cancer: Number 1 killer

3. Introduction
 Every year about 1.76 million death occurs due to
lung cancer all over the world
 The combined death count of prostate, colorectal
and breast cancer is less than lung cancer
 As of 2018, in Bangladesh out of all cancer patients,
8.2 % is newly diagnosed with lung cancer, the
number is about 12,374 people

4. Introduction…
 234,000 new cases and 154,000 lung cancer-
associated deaths yearly in the United States
 75 % of patients with lung cancer present with
symptoms due to advanced disease that is not
amenable to cure
 Despite advances in therapy, overall five-year
survival rates only 6-8 %

5.  Clinical outcome for non-small
cell lung cancer is directly
related to stage
 Five-year survival using clinical
staging ranges from 92 percent
(stage IA1) to no survival (stage
IVB)
Introduction…

6. Introduction…
 High morbidity and mortality
 Significant prevalence (0.5 to 2.2 percent)
 Identified risk factors allowing targeted screening
 A lengthy preclinical phase for some types of lung
cancer
 Evidence that therapy is more effective in early-
stage disease

7. EARLY DETECTION IS
THE KEY!!!!
Screening

8. Lung Cancer Screening Recommendations:
 US Preventive Services Task Force
(USPSTF)2021
 American Academy of Family Physicians
(AAFP)
 American College of Chest Physicians(ACCP)
 American Cancer Society (ACS)
 Centers for Disease Control and
Prevention(CDC)

9. Annual low-dose CT scan screening-
1. 50 to 80 years old and in fairly good health
and
2. Currently smoke or have quit in the past 15 years
and
3. Have at least a 20 pack-year smoking history. (This
is the number of packs of cigarettes per day
multiplied by the number of years smoked)

10. In addition
1. Receive counseling for smoking cessation
and
2. Have been told by their doctor about the possible
benefits, limits, and harms of screening
and
3. Can go to a center that has experience in lung
cancer screening and treatment

11. Canadian Task Force on the Periodic Health
Examination(2016):
Annual low-dose CT scan screening( 3 years) -
1. 55 to 74 years old asymptomatic
and
2. Currently smoke or have quit in the past 15 years
and
3. Have at least a 30 pack-year smoking history

12. Low-dose Chest CT(LDCT)
 A non contrast
multidetector CT
 High-resolution (1.0 to
2.5 mm interval) images
 Radiation dose is 1.4 mSv
(7 to 8 mSv for standard
dose chest CT)

13. Why Low-dose Chest CT?

14. Benefits of Lung Cancer Screening
 Detect early cancers
 Increase the overall cure rate
 Allow more limited surgical resection to achieve
cure
 More overall cancer detection rates
 Improves survival
 Decrease disease-specific mortality
 Decrease overall mortality

15. Harms of Lung Cancer Screening
 Consequences of evaluating abnormal findings:
False-positive results may lead to unnecessary tests
and invasive procedures
 Radiation exposure
 Patient distress
 Over diagnosis

16. Available Evidence
National Lung Screening Trial — The NLST was a randomized
trial comparing annual screening by LDCT scanning with chest
radiograph for three years in 53,454 high-risk persons at 33
United States medical centers. Participants were adults 55 to
74 years of age with a history of at least 30 pack-years of
smoking. Demonstrated a lung cancer mortality benefit of 20
percent, with all-cause mortality reduced by 6.7 percent.

17. NELSON Trial — The NELSON trial, a randomized LDCT-based
lung cancer trial including 15,789 (approximately 84 percent
male) current or former smokers aged 50 to 74 in the
Netherlands and Belgium, compared LDCT screening at
increasing intervals (baseline study and subsequent
screenings at years 1.0, 3.0, and 5.5) with no screening. The
study was powered to detect a 25 percent decrease in lung
cancer mortality after 10 years as well as the effects of
screening on quality of life, smoking cessation, and estimated
cost effectiveness.

18. The DANTE Trial- A randomized trial in Italy that enrolled 2472
male smokers age 60 to 74 years, was designed to assess
lung cancer-specific mortality over 10 years, comparing five
years of annual screening by single-slice spiral LDCT scan or
annual clinical follow-up; the control group received baseline
screening with chest radiograph and sputum
cytology. Follow-up at an average of 8.35 years from
enrollment and after completion of the baseline and annual
screens has been reported. Lung cancer was found in 8.2
percent of patients who received LDCT screening.

19. Meta-analysis — In a 2020 meta-analysis of seven trials
(including the NLST and NELSON) among over 84,000 patients
with a greater than 15 pack-year smoking history, patients
screened with LDCT had lower lung cancer mortality (risk ratio
[RR] 0.83, 95% CI 0.76-0.91), as well as a nonsignificant
relative reduction in overall mortality of 4 percent (RR 0.96,
95% CI 0.92-1.00) compared with other interventions.
However, this meta-analysis includes studies of differing
quality and different populations

20. Select
Individuals
01
Smoking
Cessation
02
Shared
Decision
Making
03 Annual LDCT
04
Approach
Treatment
and
Intervention
06
Follow Up
05

21. Future Modalities
Positron emission tomography(PET): At least two studies
evaluated annual low-dose computed tomography (LDCT)
followed by PET with fluorodeoxyglucose (FDG) for evaluating
patients with non calcified lesions ≥7 mm. FDG-PET correctly
diagnosed 19 of 25 indeterminate nodules.

22. Future Modalities…
Non radiographic technologies –Molecular and protein-
based tumor biomarkers, may also contribute to the early
detection of lung cancer. Include:
 Immunostaining or molecular analysis of sputum for tumor
markers eg, p53 mutation.
 Automated image cytometry of sputum
 Fluorescence Bronchoscopy
 Genomic and proteomic analysis of Bronchoscopic samples
 Serum protein microarrays for detecting molecular markers

23. Conclusion
 Prevention (smoking cessation) have far greater
impact on lung cancer mortality than is screening
 All smokers should be counseled about the
importance of smoking cessation and offered
supportive care
 Plain chest radiograph and sputum cytology
screening has been shown to be ineffective for lung
cancer screening

24. Conclusion…
 Lung cancer screening with low-dose computed
tomography (LDCT) has the potential to significantly
reduce the burden of lung cancer
 Major problem in Bangladesh is definitely the
overall high cost of screening along with poor
infrastructure in the periphery limiting the
accessibility

25. CREDITS: This presentation template was created by Slidesgo,
including icons by Flaticon, infographics & images by Freepik
THANKS!
Questions?
zannatulrayhan@gmail.com
+8801734138078
https://www.facebook.com/zannatul.rayhan