低剂量螺旋CT与CEA、PTN、NSE、角质蛋白在肺癌筛查中的应用价值

目的探讨低剂量螺旋CT与癌胚抗原(CEA)、多效蛋白(PTN)、神经元特异性烯醇化酶(NSE)、角质蛋白在肺癌筛查中的应用价值。方法选取2018年3月至2019年7月在本院行肺癌筛查的肺癌高危人群711例,随机分为观察组356例和对照组355例。观察组进行低剂量螺旋CT检查,对照组行胸部X线检查,比较两组筛查阳性率。根据低剂量螺旋CT检测结果将观察组分为3个亚组:确诊肺癌组、筛查呈阳性但排除肺癌组、阴性组;检测各亚组癌胚抗原(CEA)、多效蛋白(PTN)、神经元特异性烯醇化酶(NSE)、角质蛋白水平。结果观察组低剂量螺旋CT筛查肺癌阳性率23.32%(83/356)及确诊率3.93%(14/356)均明显高于对照组,差异有统计学意义(P<0.05)。确诊肺癌组CEA、PTN、NSE、角质蛋白水平明显高于低剂量螺旋CT肺癌筛查呈阳性但排除肺癌组和阴性组,差异均有统计学意义(均P<0.01)。不同年龄、吸烟支数、职业有害因素接触史的肺癌高危人群中低剂量螺旋CT筛查阳性率之间比较差异均有统计学意义(均P<0.01)。多因素Logistic回归分析显示,年龄、吸烟指数、职业有害因素接触史是肺癌高危人群中低剂量螺旋CT筛查阳性的独立影响因素(均P<0.05)。结论低剂量螺旋CT肺癌筛查阳性率明显高于胸部X线,与CEA、PTN、NSE、角质蛋白联合检测的肺癌确诊率更高。     

辽宁省肺癌高发农村地区1 381名肺癌高危人群筛查结果分析

目的 分析肺癌高危筛查人群特征及高危因素,为完善肺癌筛查方案提供依据。 方法 根据《癌症早诊早治肺癌筛查及早诊早治技术方案2015年试行版》,在辽宁省肺癌高发地区(丹东东港市和朝阳北票市)利用问卷对肺癌高危人群进行筛查,分析高危人群的分布情况及高危因素对肺癌的影响。 结果 52 600人纳入筛查覆盖范围,从中筛选出符合高危标准的1 381人。 在高危人群中,吸烟暴露率最高为95.51%,室内污染暴露率80.38%,职业史、既往疾病史和家族史暴露率分别为1.81%、19.19%和26.00%,多个危险因素暴露率为95.94%,其中吸烟与室内污染同时暴露率为76.76%。通过低剂量螺旋CT检查,检出肺癌患者15例,检出率为1.09%,15名肺癌检出者均暴露于吸烟或室内空气污染。 结论 吸烟和室内污染在高危人群中分布最广,包含了99.13%的高危人群和100%肺癌阳性人群,提示可以简化筛查条目,即仅通过吸烟和室内污染情况筛查人群,减少筛查时间,并可避免因隐私、记忆等问题不愿意暴露或者描述不清自己或者亲属的状况发生。     

社区低剂量螺旋CT筛查在早期肺癌发现中的作用

目的了解社区低剂量螺旋CT筛查早期肺癌的检出效果。方法对上海市虹桥社区历年管理的1,306例肺癌高危对象开展胸部低剂量螺旋CT筛查,筛查结果呈阳性者通过绿色通道转至上级医院进行CT复查。结果发现肺癌前期1例,早期肺癌10例,非早期肺癌20例,纵隔占位5例,结节169例,磨玻璃样影13例。癌症检出率为2.37%,其中,早期肺癌占35.48%。结论社区低剂量螺旋CT筛查能有效发现早期肺癌。     

低剂量CT联合肿瘤标志物对肺癌高危人群的筛查效果

目的探讨低剂量CT联合肿瘤标志物对肺癌高危人群的筛查效果。方法选取2018年6月至2019年9月在本院体检的肺癌高危人群694例;随机分为观察组316例,对照组378例。观察组采用低剂量螺旋CT检查,对照组采用胸部X线检查;记录肺癌筛查阳性率。全自动电化学发光免疫分析仪测定癌胚抗原、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、神经元特异性烯醇化酶(NSE)、细胞角质蛋白(CYFRA21-1)水平。根据低剂量CT联合肿瘤标志物筛查情况及病理检查结果将观察组患者分为:初筛阴性亚组,初筛阳性但排除肺癌亚组,肺癌亚组。结果观察组肺癌高危人群中初筛阳性率为13.29%(42/316)、肺癌确诊率为1.90%(6/316),明显高于对照组的初筛阳性率2.38%(9/378)、确诊率0.53%(2/378),差异均有统计学意义(均P<0.01)。血清癌胚抗原、NSE、CYFRA21-1水平在3亚组间比较差异均有统计学意义(均P<0.01);其中肺癌组患者血清癌胚抗原、NSE、CYFRA21-1水平明显高于初筛阴性组、初筛阳性但排除肺癌组。多因素Logistic回归分析显示,年龄、吸烟指数、肺癌家族史、职业有害因素接触史是肺癌高危人群中低剂量螺旋CT初筛阳性的独立影响因素(均P<0.05)。结论低剂量CT联合癌胚抗原、NSE、CYFRA21-1能够明显提升肺癌高危人群的筛查确诊率,对合并高危因素的人群应增加筛查频率。     

低剂量螺旋CT在早期肺癌筛查中的应用

目的：探究在早期肺癌筛查中应用低剂量螺旋CT扫描检查的临床效果。方法：纳入2021年3月～2022年12月到本院体检中心进行检查的肺癌高危人群群体200名，根据对其螺旋CT检查所使用剂量差异为准进行分组，其中常规剂量螺旋CT检查100名对象设为对照组，低剂量螺旋CT检查100名对象设为观察组。对两种不同剂量螺旋CT检查所得图像质量进行评估，同时从病灶筛查情况做评价。结果：对照组患者图像质量评分高于观察组（P<0.05），在满足诊断要求方面两组差异无统计学意义（P>0.05）。对照组患者评分与观察组患者评分差异无存在统计学意义（P>0.05）。观察组患者辐射剂量显著低于对照组（P<0.05）。结论：对肺癌高危人群群体应用低剂量螺旋CT方式扫描，虽然会影响图像整体质量，但对于病灶检出和判断与常规剂量CT扫描无明显差异。     

早期肺癌应用螺旋CT诊断及鉴别价值分析

目的探讨低剂量64排螺旋CT应用于早期肺癌中的诊断及鉴别价值。方法选取2011年1月—2016年1月76例符合肺癌高危人群标准者纳入本次研究对象,所有患者均采用DR正位胸片与CT扫描检查。统计两组检出肺癌结节例数及不同大小结节数检出情况,记录两组肺癌检出例数。结果 CT检出肺癌结节率21.05%,明显高于DR检出率7.89%,P0.05;CT在不同大小结节诊断方面明显优于对照组,P0.05。CT检出肺癌率9.21%,明显高于DR检出率1.32%,P0.05。结论应用低剂量64排螺旋CT诊断早期肺癌具有明显优势,尤其是对小结节的诊断及鉴别能力,因此对高危人群进行肺癌筛查应首选低剂量多层螺旋CT。     

6400例城市肺癌高危人群筛查结果分析

目的 通过实施肺癌早诊早治项目,达到在城市肺癌高危人群中进行肺癌早期诊断,提高早期肺癌的检出率,予以早期干预和治疗,从而降低肺癌的发病率和死亡率。方法 根据2012-2013年湖南省城市癌症早诊早治项目技术方案,选取长沙市城区五区（天心区、开福区、芙蓉区、雨花区、岳麓区）作为项目具体实施地区。通过问卷调查和高危人群评估模型选出筛查人群,使用低剂量螺旋CT照射的方法对纳入对象进行研究。结果 2012-2014两年依据高危人群评估模型以及低剂量螺旋CT照射的方法共完成肺癌筛查6400例,共筛查出肺癌40例,阳性检出率625.0/10万,明显高于2011年全国肺癌粗发病率48.32/10万^[1]。结论 开展肺癌早诊早治项目,能够提高肺癌早诊早治率, 对改善患者的生存质量具有重大意义.     

肺功能检测在吸烟人群中肺癌筛查的作用

目的:通过对比不同肺功能吸烟人群通过低剂量螺旋CT筛查肺癌的情况,分析肺功能检测在吸烟人群中肺癌筛查的作用。方法:选取2015年1月到2016年1月期间在我院体检的369例重度吸烟个体进行肺功能检测,根据肺功能损伤程度分为肺功能重度降低组、肺功能中轻度降低组以及肺功能轻度降低组,分别进行低剂量CT检测,比较不同肺功能损伤程度的吸烟个体经低剂量螺旋CT扫描肺癌的发现率,分析肺功能检测在吸烟人群中肺癌筛查的作用。结果:369例吸烟个体经过低剂量螺旋CT扫描共发现9例肺癌,肺癌发生率为2.4%,其中肺功能重度损伤组筛查出5例,肺功能轻中度损伤组筛查出3例,肺功能正常组筛查出1例,三组比较差异均具有统计学意义(P0.05)。结论:肺功能检测有助于鉴别出更适宜低剂量螺旋CT筛查的重度吸烟肺癌高风险人群。     

上海某镇60岁以上农民肿瘤高危人群的特征分析

[目的]筛查>60岁原农村居民中恶性肿瘤和具有高危险因素的人群,以探索郊区社区肿瘤发生发展的控制情况.[方法]参考"城市癌症早诊早治项目及高危人群评估"调查表中的部分内容进行调查.临床检查包括血清肿瘤标记物检测、肺癌CT筛查,大肠癌隐血(+)+肠镜筛查,乳腺钼靶检查等.高危人群界定为上述临床检测结果阳性的对象.[结果]...     

低剂量CT筛查肺癌,有必要推广吗

专家视角1:推广低剂量CT肺癌筛查,规范是关键 解读专家:首都医科大学附属朝阳医院呼吸与危重症医学科王峰张予辉施焕中 尽管对于低剂量CT肺癌筛查还存在着前文提及的各种问题,但是筛查可以大幅提高Ⅰ期肺癌的检出率和治愈率,显著增加肺癌的5年、10年生存率,降低高危人群的病死率,甚至促进戒烟,这些也是不争的事实.因此,我国应积极开展低剂量CT肺癌筛查工作.     

2014-2019年北京城市癌症早诊早治项目人群肺癌筛查结果分析

目的分析2014—2019年北京城市癌症早诊早治项目肺癌筛查结果。方法基于国家城市癌症早诊早治项目,以北京市东城、西城、朝阳、海淀、丰台和石景山区的80个筛查项目实施街道为研究现场,采用整群抽样的方法,将街道/居委会所辖的88044名40~69岁北京市户籍居民纳入研究。对问卷初筛肺癌阳性的人群,采用低剂量螺旋CT(LDCT)进行筛查,同时每年通过主动和被动随访相结合的方式对募集的全部人群进行随访,获取其健康结局信息(确诊肺癌/未确诊肺癌)。计算不同特征人群经问卷初筛的肺癌高危率、LDCT筛查参与率、肺部阳性结节检出率、肺癌发病密度(率)、累积发病率以及早诊率;采用Cox比例回归模型计算不同筛查模式下肺癌发生的风险。结果88044名研究对象年龄为(57.4±7.4)岁,其中男性占38.76%(34128例)。问卷初筛肺癌高危率为23.14%,临床筛查参与率为52.26%,肺部阳性结节检出率为10.99%。平均随访3年后,40~69岁男性肺癌发病密度为172.82/10万人年,女性肺癌发病密度为133.52/10万人年;肺癌发生风险随年龄升高而上升(P_趋势<0.001)。问卷初筛阳性人群发病密度为259.22/10万人年;与问卷初筛阴性人群相比,问卷初筛阳性人群肺癌发病风险HR(95%CI)值为2.27(1.83~2.81)。接受LDCT筛查且被判定为阳性结节人群的肺癌发病密度为1825.03/10万人年,3年内的累积发病率为4615.38/10万;与结节阴性人群相比,结节阳性人群肺癌发病风险HR(95%CI)值为13.80(8.91~21.36)。接受LDCT筛查者三年内确诊肺癌的早诊率为70.21%,高于未接受临床筛查者确诊肺癌时的早期比例(45.45%,P=0.016)。结论北京城市癌症早诊早治项目肺癌临床筛查依从性较好;在高危人群中应用LDCT筛查肺癌,能够提高肺癌患者检出率和早诊率。     

低剂量螺旋CT和痰液基薄层细胞学联合筛查社区肺癌高危人群的研究

目的 评价低剂量螺旋CT（low-dose computed tomography, LDCT）和痰液基薄层细胞学检测（thinprep cytologic test, TCT）对社区肺癌高危人群的联合筛查效果。方法 对2013年8月~2014年9月在社区招募符合本研究高危人群定义的3 708名东莞本地居民进行肺癌筛查。肺癌高危人群定义为符合下列任何一项的40岁以上者:20包年以上的吸烟史,肺癌家族史,肺部既往病史,职业接触史或被动吸烟史。发现至少一个直径≥4 mm 非钙化结节为LDCT筛查的阳性结果;细胞学重度不典型增生或镜检可见癌细胞为TCT检查的阳性结果。结果 LDCT肺部结节的检出率为12.59%（467/3 708）。经病理证实,LDCT筛查阳性人群中共确诊肺癌56例,检出率为1.51%（56/3 708）。TCT的阳性检出率为1.91%（71/3 708）。TCT阳性人群中共确诊肺癌36例,肺癌检出率为0.97%（36/3 708）。本次联合筛查共确诊肺癌58例,非小细胞肺癌41例,其中0～Ⅰ 期22例,早期诊断率为53.66%（22/41）。结论 LDCT和TCT联合筛查肺癌高危人群有助于提高肺癌的早期诊断率和检出率,降低筛查的假阳性比例。     

多基因遗传风险评分指导肺癌个体化筛查的前瞻性队列研究

目的探索如何利用遗传风险评分,制订个体化的肺癌筛查方案。方法利用中国慢性病前瞻性研究(CKB)队列10个地区100615例具有全基因组基因分型信息的样本,根据前期课题组发表的19个遗传变异构建肺癌多基因遗传风险评分PRS-19。以55岁且吸烟剂量30包/年人群的5年绝对发病风险为参考届值,在吸烟者和非吸烟者中分别计算不同遗传风险人群5年肺癌绝对发病风险随年龄和吸烟剂量的变化趋势,并绘制5年绝对发病风险分布图,从而判断不同遗传风险人群达到参考界值时的理论年龄或吸烟剂量。根据上述结果给出不同遗传风险人群参加肺癌筛查起始年龄的具体建议。结果CKB队列中55岁吸烟者,当吸烟量为30包/年时,5年内发生肺癌的绝对风险为0.67%。在吸烟者中,随着遗传风险增加,其5年绝对发病风险呈不断上升趋势,对于高遗传风险人群应降低筛查起始年龄,遗传风险最高的1%人群建议从50岁开始进行筛查;若保持筛查起始年龄55岁不变,则应在高遗传风险人群中降低吸烟剂量标准;不管累积吸烟剂量为多少,遗传风险最高的1%人群都应纳入肺癌筛查。在非吸烟者中,高遗传风险人群同样具备筛查价值,建议遗传风险最高的1%人群从62岁起进行肺癌筛查,而对于遗传风险最低的5%人群,当年龄达到74岁时才可达到参考届值。结论对于不同遗传风险的个体,可采用个体化的肺癌筛查方案,对于高遗传风险的吸烟者可减小肺癌筛查起始年龄或吸烟剂量,而我国高遗传风险的非吸烟者同样具备筛查价值。     

Lung cancer screening: a review of available data and current guidelines

Lung cancer is the leading cause of cancer mortality worldwide. A lack of clinical symptoms in early-stage disease frequently leads to diagnosis at a late stage, and a 15% 5-year survival rate in all patients so diagnosed. This has led to significant interest in effective screening methods to detect early-stage cancers, particularly for high-risk groups, such as current or former smokers. Early clinical trials focused on chest radiograph with or without sputum cytology and failed to show an improvement in mortality with screening. A meta-analysis also failed to show a difference in all-cause mortality. Subsequent protocols compared low-dose computed tomography (LDCT) scan with chest radiograph and documented increased detection of early-stage disease; however, they were not designed to prove a reduction in mortality. The most recent trials have focused on LDCT scans, including the National Lung Screening Trial. Data released from the National Lung Screening Trial demonstrated a statistically significant reduction in lung cancer deaths in patients screened with LDCT scans. When data from the study, including cost-effectiveness, are completely analyzed, they may lead to revision of current lung cancer screening recommendations to include LDCT scans in specific populations at high risk of developing lung cancer.     

广州地区肺癌高危人群筛查依从性及筛查结果分析

目的调查广州地区肺癌高危人群筛查依从性现状及影响因素,并分析肺癌筛查结果。方法选取2020年1月至2021年12月广州地区常住居民为研究对象,通过问卷收集其社会人口学资料及肺癌危险因素资料,筛查出肺癌高危人群,肺癌高危者由专业放射科医生进行低剂量螺旋CT(LDCT)扫描并根据诊断标准完成诊断。采用描述性分析方法对高危人群筛查依从性及筛查结果进行分析,并采用单、多因素分析方法对肺癌高危人群筛查依从性影响因素进行分析。结果17980名研究对象中肺癌高危评估率为19.96%(3589/17980),LDCT筛查依从率为34.99%(1256/3589)。3589例肺癌高危人员的肺癌确诊率为2.17%(78/3589),其中男性占61.54%(48/78),女性占38.46%(30/78),40~50岁占17.95%(14/78)、51~60岁占33.33%(26/78)、61~74岁占48.72%(38/78)。Logistic回归分析显示,女性(OR=2.130)、年龄越大(OR=1.408)、BMI≥24.0 kg/m2(OR=2.349、2.375)、中专及以上受教育程度(OR=2.008、3.251)、饮酒(OR=1.498)、吸烟(OR=2.239)、被动吸烟(OR=2.428)、有肺癌家族史(OR=2.081)、有慢性呼吸系统疾病史(OR=2.006)及不经常体育锻炼(OR=2.130)的肺癌高危者具有更高的筛查依从性。结论广州地区肺癌高危人群筛查依从性普遍较低,年龄、受教育程度、家族病史等均与筛查依从性有关,肺癌高危筛查有助于早期诊断肺癌及相关疾病,改善国民生活质量。     

Should we screen for occupational lung cancer with low-dose computed tomography?

OBJECTIVE: The objective of this study was to assess the potential value of screening for occupational lung cancer through the use of low-dose computed tomography (LDCT). METHODS: A literature review of Medline was conducted to assess: 1) screening studies of occupational lung cancer that used LDCT; 2) screening studies of nonoccupational lung cancer that used LDCT; and 3) position papers of medical professional societies and nongovernmental health organizations that have addressed the value of screening for lung cancer with LDCT. RESULTS: No screening studies of occupational lung cancer with LDCT were uncovered; however, numerous observational and population-based studies have addressed the value of screening for lung cancer among cigarette smokers. Results of these studies are difficult to interpret in light of numerous biases associated with these types of studies. No randomized, controlled studies on screening for lung cancer have been published at this time. No professional, governmental, or nonprofit health organization recommends screening asymptomatic people at risk of lung cancer with LDCT at this time. CONCLUSION: In the absence of randomized, controlled studies that can address biases commonly encountered in observational and population-based studies, it is unclear whether LDCT reduces mortality from lung cancer. The National Cancer Institute is sponsoring a randomized, controlled study of over 50,000 current and former smokers with the results expected in 2009.     

全球肺癌筛查卫生经济学研究的系统评价

目的 了解全球肺癌筛查的卫生经济学评价研究进展,为我国相关研究和筛查工作开展提供参考。方法 系统检索PubMed、EMbase、The Cochrane Library、中国知网及万方数据知识服务平台自建库至2018年6月30日间肺癌筛查卫生经济学研究相关文献,摘录其经济学评价方法及结果等信息,并进行质量评价。成本统一货币单位后计算增量成本效果比（ICER）后计算与当年当地人均GDP比值。结果 共纳入23项研究（1项基于人群随机对照试验,20项完全基于模型评价）,整体质量较好;22项来自发达国家,11项筛查起始年龄为55岁,18项目标人群考虑了吸烟史;评价的筛查技术全部涉及低剂量螺旋CT（LDCT）,筛查频率以每年1次（17项）和终生1次（7项）居多。22项研究可获得与未筛查相比的ICER,其中17项研究报道的ICER低于3倍当年当地人均GDP。各有15项和7项研究可获得每年1次和终生1次的ICER,其中各有12项和7项支持其经济有效,且终生1次略优于每年1次;不同筛查起始年龄和吸烟包年的经济有效性优劣差异不明显。结论 发达国家多开展基于模型LDCT肺癌筛查卫生经济学评价,并结合年龄和吸烟史进行高危人群选择,初步提示该方案经济有效;可为证据有限的欠发达地区提供参考,但实施需结合当地卫生资源现状;预算有限时低频次LDCT筛查更佳,而筛查起始年龄和吸烟史等细节确定需结合人群特征进行精准评价。     

Offering Lung Cancer Screening to High-Risk Medicare Beneficiaries Saves Lives and Is Cost-Effective: An Actuarial Analysis

Background

By a wide margin, lung cancer is the most significant cause of cancer death in the United States and worldwide. The incidence of lung cancer increases with age, and Medicare beneficiaries are often at increased risk. Because of its demonstrated effectiveness in reducing mortality, lung cancer screening with low-dose computed tomography (LDCT) imaging will be covered without cost-sharing starting January 1, 2015, by nongrandfathered commercial plans. Medicare is considering coverage for lung cancer screening.

Objective

To estimate the cost and cost-effectiveness (ie, cost per life-year saved) of LDCT lung cancer screening of the Medicare population at high risk for lung cancer.

Methods

Medicare costs, enrollment, and demographics were used for this study; they were derived from the 2012 Centers for Medicare & Medicaid Services (CMS) beneficiary files and were forecast to 2014 based on CMS and US Census Bureau projections. Standard life and health actuarial techniques were used to calculate the cost and cost-effectiveness of lung cancer screening. The cost, incidence rates, mortality rates, and other parameters chosen by the authors were taken from actual Medicare data, and the modeled screenings are consistent with Medicare processes and procedures.

Results

Approximately 4.9 million high-risk Medicare beneficiaries would meet criteria for lung cancer screening in 2014. Without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of approximately 3 years. Based on our analysis, the average annual cost of LDCT lung cancer screening in Medicare is estimated to be $241 per person screened. LDCT screening for lung cancer in Medicare beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years is low cost, at approximately $1 per member per month. This assumes that 50% of these patients were screened. Such screening is also highly cost-effective, at <$19,000 per life-year saved.

Conclusion

If all eligible Medicare beneficiaries had been screened and treated consistently from age 55 years, approximately 358,134 additional individuals with current or past lung cancer would be alive in 2014. LDCT screening is a low-cost and cost-effective strategy that fits well within the standard Medicare benefit, including its claims payment and quality monitoring.Lung cancer is a lethal disease that claims the lives of more people in the United States annually than the next 4 most lethal cancers combined, which are, in order, colon, breast, pancreas, and prostate cancers.1,2 In the United States, an estimated 224,210 people will be diagnosed with lung cancer, and an estimated 159,260 people will die of the disease in 2014.3 The incidence of lung cancer increases with age,4 and the risk increases with the cumulative effects of past smoking. Millions of Medicare beneficiaries are at significant risk.5On December 31, 2013, lung cancer screening using low-dose computed tomography (LDCT) was rated as a level “B” recommendation by the US Preventive Services Task Force (USPSTF),6 a panel of independent experts convened by the Agency for Healthcare Research and Quality to evaluate the strength of evidence and the balance of benefits and harms of preventive services.7 The USPSTF recommendation applies to people aged 55 to 80 years with a history of heavy smoking.6 LDCT is an imaging technology that enables 3-dimensional visualization of internal body structures, including the lungs, using low doses of radiation.Under the Affordable Care Act, the “B” recommendation means that LDCT lung cancer screening must be covered without cost-sharing by qualified health plans starting January 1, 2015.6,8 Qualified health plans include commercial insurance and self-insured benefit plans, with the exclusion of grandfathered plans. Several private insurers have initiated LDCT screening coverage in advance of the 2015 requirement.9 Furthermore, versions of the USPSTF recommendations have been adopted essentially by every major academic body with an interest in lung cancer, including the National Comprehensive Cancer Network, American Association for Thoracic Surgery, American College of Radiology, Society of Thoracic Surgeons, International Association for the Study of Lung Cancer, American College of Chest Physicians, and the American Cancer Society.Medicare has begun a national coverage analysis to determine whether LDCT lung cancer screening meets its criteria for coverage, which includes whether screening is reasonable and necessary for early detection, whether the service has an “A” or a “B” recommendation by the USPSTF, and whether screening is appropriate for Medicare beneficiaries.High doses of radiation can be harmful. LDCT can be performed at very low doses of <0.7 mSv per procedure10 by comparison, the annual natural background radiation in New York City (sea level) is 3 mSv. LDCT technology refinements and protocol optimization have translated into patient benefits, supporting the detection of ever-smaller lung cancers, reducing the rate of surgical procedures, and providing higher cure rates.11–14Advances in LDCT technology, promising results from nonrandomized trials,14 and unchanged survival statistics over the previous 30 years, led to the implementation of the National Lung Screening Trial (NLST), the most expensive and one of the largest randomized screening trials ever sponsored by the National Cancer Institute.13 The trial of 53,454 people aged 55 to 74 years at high risk for lung cancer was conducted to determine whether LDCT screening could reduce mortality from lung cancer. Participants in this 2-arm US study received 3 annual screenings with either an LDCT or a chest x-ray. Based on the study protocol, the trial was stopped when findings demonstrated a relative reduction of 20% in lung cancer mortality in the LDCT arm versus the chest x-ray arm.13Observational data and epidemiologic arguments for breast cancer also suggest that additional rounds of screening would reduce lung cancer mortality by much more than 20%.15–22 Other large studies have shown that computed tomography (CT) screening is associated with a high proportion (much higher than 70%) of the lung cancer diagnoses being early stage15–17,21 compared with 15% in the national data.23 Long-term survival rates of approximately 80% have been reported for patients with lung cancer who are diagnosed by CT screening12,15,16 compared with a 16.8% 5-year survival rate from the national data.23

KEY POINTS

• ▸ Lung cancer is the leading cause of cancer death in the United States and worldwide.
• ▸ Because the risk increases with age and with a history of smoking, some Medicare beneficiaries are at high risk for this type of cancer.
• ▸ Low-dose computed tomography (LDCT) has been shown to reduce mortality from lung cancer by more than 20%.
• ▸ Under healthcare reform, LDCT must be covered without cost-sharing by nongrandfathered commercial health plans beginning in 2015.
• ▸ Based on this new analysis, LDCT screening of high-risk Medicare beneficiaries is cost-effective and will cost approximately $1 per member per month.
• ▸ The average annual cost of such a screening policy is estimated to be $241 for a Medicare beneficiary screened.
• ▸ Given all causes of mortality, without screening, Medicare patients newly diagnosed with lung cancer have an average of 3 years life expectancy.
• ▸ With screening, these patients would have an additional 4 years of additional life expectancy incremental to the life expectancy without screening.
• ▸ If all eligible beneficiaries had been screened and treated consistently from age 55 years, approximately 358,134 additional individuals with current or past lung cancer would be alive in 2014.

One of the coauthors of this article was the lead author of an actuarial analysis of LDCT lung cancer screening for the commercially insured population.24 This report used similar methodology, types of structures, and data to examine lung cancer screening for the Medicare program. The Medicare program faces significant budget limitations, and any new coverage benefit will face scrutiny regarding its costs and benefits.The purpose of the present study was to estimate the hypothetical 2014 costs and benefits associated with the responsible implementation of widespread lung cancer screening in the high-risk US population covered by Medicare.     

Screening for lung cancer: A systematic review and meta-analysis

ObjectivesTo examine evidence on benefits and harms of screening average to high-risk adults for lung cancer using chest radiology (CXR), sputum cytology (SC) and low-dose computed tomography (LDCT).MethodsThis systematic review was conducted to provide up to date evidence for Canadian Task Force on Preventive Health Care (CTFPHC) lung cancer screening guidelines. Four databases were searched to March 31, 2015 along with utilizing a previous Cochrane review search. Randomized trials reporting benefits were included; any design was included for harms. Meta-analyses were performed if possible. PROSPERO #CRD42014009984.ResultsThirty-four studies were included. For lung cancer mortality there was no benefit of CXR screening, with or without SC. Pooled results from three small trials comparing LDCT to usual care found no significant benefits for lung cancer mortality. One large high quality trial showed statistically significant reductions of 20% in lung cancer mortality over a follow-up of 6.5 years, for LDCT compared with CXR. LDCT screening was associated with: overdiagnosis of 10.99–25.83%; 11.18 deaths and 52.03 patients with major complications per 1000 undergoing invasive follow-up procedures; median estimate for false positives of 25.53% for baseline/once-only screening and 23.28% for multiple rounds; and 9.74 and 5.28 individuals per 1000 screened, with benign conditions underwent minor and major invasive follow-up procedures.ConclusionThe evidence does not support CXR screening with or without sputum cytology for lung cancer. High quality evidence showed that in selected high-risk individuals, LDCT screening significantly reduced lung cancer mortality and all-cause mortality. However, for its implementation at a population level, the current evidence warrants the development of standardized practices for screening with LDCT and follow-up invasive testing to maximize accuracy and reduce potential associated harms.     

An Enhanced Shared Decision Making Model to Address Willingness and Ability to Undergo Lung Cancer Screening and Follow-Up Treatment in Minority Underserved Populations

Failure to address willingness and ability to undergo lung cancer treatment before lung cancer screening could cause patients unnecessary anxiety, cost and care. We employed an enhanced shared decision making (SDM) model to address willingness and ability to undergo lung cancer screening of low dose CT (LDCT) scanning. We hypothesized that enhanced SDM was feasible and did not discourage patients from undergoing lung cancer screening. We performed a prospective study of patients referred for lung cancer screening. We measured adherence to the LCS protocol, including consent to discuss lung cancer treatment if cancer is found and direct questions to patients about willingness and ability to undergo lung cancer treatment. We measured race, gender, adherence to the consent process and questions regarding willingness and ability to undergo lung cancer treatment and subsequent uptake of LDCT. All 190 patients have a documented SDM visit addressing the risks and benefits of lung cancer screening and consented to discuss lung cancer treatment if lung cancer is diagnosed. One hundred and seventy-nine (179) of 190 (94%) answered yes to being willing and able to undergo lung cancer treatment. One hundred and eighty-seven (187) patients underwent LDCT (98.4%). Discussion about willingness and ability to undergo lung cancer treatment should be an essential component of a SDM discussion prior to LDCT. This study demonstrated that an enhanced SDM experience is feasible in a clinical setting. Furthermore, patients proceeded with LDCT following the enhanced SDM process.