goldstraw et al. j thorac oncol 2007
DESCRIPTION
Why should we want to screen ?. Survival ( years ). Goldstraw et al. J Thorac Oncol 2007. Why should we want to screen ?. Localised. Stage shift !. Regional spread. Distant spread. When diagnosis is based on symptoms. When diagnosis is based on screening. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/1.jpg)
Goldstraw et al. J Thorac Oncol 2007
Why should we want to screen?
Survival (years)
![Page 2: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/2.jpg)
Why should we want to screen?
Localised
Regional spread
Distant spread
When diagnosis is based on symptoms
When diagnosis is based on screening
Stage shift !
![Page 3: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/3.jpg)
National lung screening trial (NLST)
Inclusion criteria- Age 55-74 years- Smoking history ≥30PY, active or stopped less than
15 years ago
Exclusion criteria- History of lung cancer- Other prior cancer in past 5 years- Chest CT less than 18 months ago- Unexplained weight loss (>15lb in past year)- Metallic implants or devices in chest or back- Home oxygen supplementation- Pneumonia treated with antibiotics in past 12 weeks
Aberle et al. N Engl J Med 2011
![Page 4: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/4.jpg)
- 53’454 subjects randomised to one of two groups:- Low dose CT- Chest X-ray
- 3 screening rounds at annual intervals- Non-calcified nodules ≥4mm in CT or any
size in X-ray were referred for diagnostic work-up
- Primary outcome: lung cancer related mortality
National lung screening trial (NLST)
Aberle et al. N Engl J Med 2011
![Page 5: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/5.jpg)
Aberle et al. N Engl J Med 2011
National lung screening trial (NLST)
![Page 6: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/6.jpg)
Aberle et al. N Engl J Med 2011
National lung screening trial (NLST)
![Page 7: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/7.jpg)
Kovalchik et al. N Engl J Med 2013
National lung screening trial (NLST)
![Page 8: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/8.jpg)
Kovalchik et al. N Engl J Med 2013
National lung screening trial (NLST)
![Page 9: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/9.jpg)
Lung cancer screening trials
Boiselle, JAMA 2013
![Page 10: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/10.jpg)
Screening recommendations
Boiselle, JAMA 2013
![Page 11: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/11.jpg)
Open issues
- Is one positive trial enough evidence?- Was there overdiagnosis in the NSLT?- Will other populations at risk of lung cancer benefit
from CT screening?- Screening of a large, at-risk population possible?- How many screening rounds?- Cost effectiveness?- «side effects» of screening (i.e.radiation exposure)
![Page 12: Goldstraw et al. J Thorac Oncol 2007](https://reader036.vdocuments.us/reader036/viewer/2022062305/56816046550346895dcf69a5/html5/thumbnails/12.jpg)
Conclusions
Lung cancer is a lethal disease associated with substantial medical and economic burden.
NLST: lung cancer screening may reduce mortality considerably.
Possible advantage of LDCT screening has to be balanced against the potential of inducing harm.
Many issues are not yet resolved: i.e. overdiagnosis, number of screening rounds, study population, cost-efficacy.
Further evidence and information is needed, before lung cancer screening can be recommended in Switzerland.