Lung cancer screening: Most patients not eligible 1-2 years prior to diagnosis

An analysis of lung cancer patients in a district hospital showed that only a third of all patients would have been eligible for lung cancer screening. Additional tools are urgently needed to stratify risk and facilitate an earlier diagnosis in lung cancer patients [1].

In Europe, lung cancer ranks third among the most common cancers. “As you all know, we found a lot of evidence for using low-dose computed tomography (LDCT) to reduce lung cancer mortality in the last decade,” explained Dr Kiran Desai (Barking, Havering and Redbridge University Hospitals, UK). The National Lung Screening Trial (NLST), the Dutch NELSON, and the UK Lung Cancer Screening (UKLS) trials have all provided strong evidence for its use in reducing lung cancer mortality [2-4]. To understand the service implications for a district general hospital, Dr Desai and his team evaluated the proportion of his patients that would have been eligible for screening 1 and 2 years prior to diagnosis according to these trial protocols.

Data was extracted from registry or manual review of electronic health records. Patients with a smoking history and likely or confirmed lung carcinoma or mesothelioma were included. Data collection was over a year. Descriptive analyses were conducted and the proportion of study population eligible for LDCT screening under major trial inclusion criteria was calculated. “The majority of our patients were ex-smoker with a median pack/year among ever-smokers of 40,” Dr Desai elaborated. The median time between the diagnosis and the smoke stop was 13 years. Further, 73.4% of patients were already stage 3-4 at diagnosis, which emphasises the importance of screening measures.

“Only 35% of our patients would have been eligible for lung cancer screening. A significant proportion of lung cancers cases would not have been detected via this approach,” Dr Desai criticised. Thus, he thinks that additional biomarkers should be urgently investigated to raise the recognition rate.

 

1. 
   
   1. Desai K. Lung cancer screening - what does it mean for our practice? Abstract 4172, ERS International Virtual Congress 2020, 7-9 Sept.
   2. National Lung Screening Trial Research Team. N Engl J Med 2011;365:395-409.
   3. Zhao YR, et al. Cancer Imaging 2011;11:S79-84.
   4. Field JK, et al. Health Technol Assess 2016;20.

 



Posted on 29 October, 202029 October, 2020