Lung cancer screening with CT urged for head/neck cancer survivors

Reuters Health - 01/11/2021 - Patients with head and neck cancer (HNC) are at especially high risk of lung cancer and should be screened annually with low-dose computed tomography (CT), researchers suggest.

"I was struck by the magnitude of increased risk for lung cancer in HNC survivors," Dr. John Cramer of Wayne State University School of Medicine in Detroit told Reuters Health by email. "I thought (they) may be at a slightly higher risk of lung cancer but the data showed a dramatic difference."

Further, he said, "Smokers with prior HNC are at a markedly increased risk for lung cancer (and) the risk persists many years after treatment for HNC."

"Lung cancer screening with annual low-dose chest CT is significantly more effective at detecting cancer than chest x-ray (CXR)," he noted. Unlike x-rays, he added, low-dose CT has been shown to reduce mortality from lung cancer. "I would strongly recommend it as the preferred type of screening," Dr. Cramer said.

As reported in JAMA Otolaryngology-Head and Neck Surgery, Dr. Cramer and colleagues did an ad hoc secondary analysis of the National Lung Screening Trial (NLST), which enrolled more than 53,000 participants and compared screening with low-dose CT versus CXR in patients ages 55 to 74 at high risk for lung cancer.

The primary outcome was the incidence of a second primary lung cancer.

The team first compared HNC survivors with participants without prior HNC to examine the incidence of abnormal imaging findings and the incidence of lung cancer overall.

After adjustment for age, sex, race and pack-years of cigarette smoking, the incidence of lung cancer was higher among HNC versus non-HNC survivors: 2,080 per 100,000 person-years (2.1%) versus 609 per 100,000 person-years (0.6%); adjusted rate ratio, 2.54.

Then they compared the incidence of secondary primary lung cancer and overall survival. The incidence was 2,610 cases per 100,000 person-years in the low-dose CT group versus 1,594 cases per 100,000 person-years in the CXR group (rate ratio, 1.55).

In a subgroup of 171 HNC survivors (mean age 67;77% men; 90% white), overall survival was 7.07 years with low-dose CT versus 6.66 years with CXR. Notably, at least one screening exam was suspicious for lung cancer in 35 participants (42.7%) in the low-dose CT group versus 24 participants (27.0%) in the CXR group.

The authors state, "Based on the data presented here and in the other reports of the NLST, we would advocate that HNC survivors aged 50 years or older with a 20 pack-year or more smoking history who are fit enough to undergo curative lung cancer treatment should undergo annual low-dose CT screening for lung cancer."

Dr. Cramer said, "Currently only 14% of smokers who are eligible for lung cancer screening receive appropriate screening. These results should push all clinicians caring for patients with HNC to ensure these patients receive appropriate screening."

"I would like to emphasize that this was a secondary analysis of a randomized trial with inherent limitations," he added. "Foremost, the number of HNC survivors was modest."

Dr. Sean Massa of St. Louis University Hospital in Missouri, coauthor of a related editorial, commented in an email to Reuters Health, "Current guidelines recommend lung cancer screening for patients based primarily on the amount they have smoked, but do not account for other factors, like whether the patients have had other cancers."

The NLST and other studies "have demonstrated low-dose CT to be the preferred imaging modality for lung cancer screening," he said. "These screening exams are usually covered by insurance if patients meet the screening guidelines, but not all facilities have the required technology."

Like Dr. Cramer, he noted, "Most patients eligible for screening do not currently get screened. For HNC providers, it is important to be aware of these patients' elevated risk of lung cancer and that most will qualify for annual screening based on their smoking history."

"Lastly," he added, "it is important to note that these guidelines do not apply to all patients. For example, patients who are unable or unwilling to undergo lung cancer treatment do not benefit from screening."

SOURCE: https://bit.ly/3myUyFK and https://bit.ly/3mzRZ6D JAMA Otolaryngology-Head and Neck Surgery, online October 28, 2021

By Marilynn Larkin



Posted on 1 November 20214 November 2021