Annual screening for lung cancer low-dose CT

This is a major advance as American healthcare evolves from reactive to preventive.

But a key to success in this lung cancer screening program is keeping the radiation dose of each exam as low as possible – certainly well below one mSv. Ideally, a low dose approach would involve model based or some other form of iterative reconstruction. All the other techniques to minimize dose should be employed together. Fortunately, this is an application where very low kVp will work well (70-100).

Next – and possibly even more impactful: coverage for screening CT colonography.

Lung Cancer Screening in High Risk Patients

For the question of whether lung cancer screening in high risk patients causes more good than harm, check out this article.

I’m pretty convinced the data shows that in a research study high risk population where the scans are read by highly skilled experts closely following the rules, lives are saved by CT screening and the cost is reasonable for each QUALY.

Further, the interpretation of these chest CT screening exams is fairly straightforward for experienced and trained radiologists. That suggests that when CT screening is extended beyond research to broader community practice, results should also be good.

Risk Model Emerges for CT Lung Cancer Screening!

A new risk model for lung cancer was recently highlighted in the August 21 issue of Annals of Internal Medicine. According to the report, the Liverpool Lung Project (LLP) risk model was developed to determine, based on specific and sophisticated assessments, which individuals would benefit most from CT lung screening.

The LLP risk model has a strong ability to predict lung cancer, and, according to principal investigators, does so better than smoking duration or family history. In fact, this data has been confirmed by researchers from the University of Liverpool, as well as several U.K. centers, the U.S. National Cancer Institute, and the Harvard School of Public Health.

Unlike some other major diseases, like breast cancer and heart disease, lung cancer, thus far, has lacked adequate identification tools to determine which patients should be targeted to maximize screening benefits, and minimize its potential harms. Identification of those with the highest risk for lung cancer, a disease which now kills upwards of 1 million annually, will make the best use of the benefit-harm ratio.

Though other risk models have been created, none have been able to successfully apply to all of the world’s population. The LLP could overcome these challenges, though, as it accounts for important risk factors that others skip, including history of pneumonia, non-lung cancer, and asbestos exposure, among family history and smoking history.

The model certainly appears a good way to improve patient selection. As always, the key inscreening exams is to do no harm. Even for those patients deemed appropriate for screening by the LLP, the best approach is with ultra-low dose CT— such as done with model based iterative reconstruction.

To learn more about the LLP, please click here!

Further Validation: American Lung Association Supports CT Screening!

Another major organization has joined the U.S. National Cancer Institute to support CT lung cancer screening as a life saving procedure! Recently, the American Lung Association updated its recommendations to support low-dose CT lung screening for smokers and former smokers.

Lung cancer continues to be the leading cause of death in the U.S., with more than 150,000 deaths annually and a five year survival rate as low as 15 percent. However, research from the US National Cancer Institute’s Lung Cancer Screening Trial gives promising hope. The study found that low-dose CT can reduce mortality rates by at least 20 percent among smokers and former smokers. Other published reports have estimated even higher rates of mortality gains! According to the LCST, individuals between the ages of 55 and 74 years who are current or former smokers of at least 30 pack-years and have no history of lung cancer are ideal candidates for lung cancer screening with CT.

Currently, besides never smoking, low-dose CT screening is the only viable option for significantly reducing the risk of lung cancer. The ALA’s recommendation of this medical imaging exam is an important step toward the development of widespread population-based CT screening program through the U.S.

The ALA joins the National Comprehensive Cancer Network, the first major professional organization to recommend low-dose lung cancer screening last fall.

For more information on factors that may effect the widespread implementation of lung cancer screening, see this post on low-cost screening.

Is Low-cost a Benefit for Lung Cancer Screening?

Is low-cost an added benefit to widespread lung cancer screening? According to this article, from April’s Health Affairs—yes!  The study on this much debated about topic asserts that routine CT lung cancer screening of high-risk individuals would save thousands of lives annually for less than one dollar a month per patient, if implemented throughout the US. According to these figures, the cost of low-dose lung cancer screening could be less than that for both breast cancer screening and colorectal cancer screening.

As we’ve pointed out, lung cancer screening is effective and life saving.  For high- risk patients, those who are multiple pack year smokers for 25 years or more, screening provides significant benefits. For these individuals, low-dose CT screening reduces the number of lung cancer deaths by 20 percent!

Despite this, widespread lung cancer screening has yet to be implemented nationwide, largely due to cost. This study reports interesting and encouraging data about widespread implementation of the procedure, though. However, we must remember that there are also reputable articles which report much higher cost numbers when adjusted for quality-life-years saved. It is necessary to take these studies into account, too.

Looks like the jury may still be out on this one!