Targeting of Low-Dose CT Screening According to the Risk of Lung-Cancer Death
The 60% of patients at highest risk for lung cancer in the National Lung Screening Trial accounted for 88% of the lung-cancer deaths prevented by low-dose CT screening. The use of risk assessment can improve the yield from low-dose CT screening for lung cancer. Lung cancer is the most common cause o...
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| Veröffentlicht in: | The New England journal of medicine Jg. 369; H. 3; S. 245 - 254 |
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| Hauptverfasser: | , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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Waltham, MA
Massachusetts Medical Society
18.07.2013
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| ISSN: | 0028-4793, 1533-4406, 1533-4406 |
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| Abstract | The 60% of patients at highest risk for lung cancer in the National Lung Screening Trial accounted for 88% of the lung-cancer deaths prevented by low-dose CT screening. The use of risk assessment can improve the yield from low-dose CT screening for lung cancer.
Lung cancer is the most common cause of cancer-related death in the United States, accounting for 28% and 26% of all cancer deaths among men and women, respectively.
1
Recent results from the National Lung Screening Trial (NLST), which showed a 20% reduction in lung-cancer mortality with low-dose computed tomography (CT) screening, as compared with chest radiography, highlighted the opportunity to reduce the burden of death from lung cancer.
2
With 94 million current and former smokers in the United States,
3
deciding which smokers to target for low-dose CT screening remains an important public health challenge, given the potential costs and harms . . . |
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| AbstractList | The 60% of patients at highest risk for lung cancer in the National Lung Screening Trial accounted for 88% of the lung-cancer deaths prevented by low-dose CT screening. The use of risk assessment can improve the yield from low-dose CT screening for lung cancer.
Lung cancer is the most common cause of cancer-related death in the United States, accounting for 28% and 26% of all cancer deaths among men and women, respectively.
1
Recent results from the National Lung Screening Trial (NLST), which showed a 20% reduction in lung-cancer mortality with low-dose computed tomography (CT) screening, as compared with chest radiography, highlighted the opportunity to reduce the burden of death from lung cancer.
2
With 94 million current and former smokers in the United States,
3
deciding which smokers to target for low-dose CT screening remains an important public health challenge, given the potential costs and harms . . . In the National Lung Screening Trial (NLST), screening with low-dose computed tomography (CT) resulted in a 20% reduction in lung-cancer mortality among participants between the ages of 55 and 74 years with a minimum of 30 pack-years of smoking and no more than 15 years since quitting. It is not known whether the benefits and potential harms of such screening vary according to lung-cancer risk. We assessed the variation in efficacy, the number of false positive results, and the number of lung-cancer deaths prevented among 26,604 participants in the NLST who underwent low-dose CT screening, as compared with the 26,554 participants who underwent chest radiography, according to the quintile of 5-year risk of lung-cancer death (ranging from 0.15 to 0.55% in the lowest-risk group [quintile 1] to more than 2.00% in the highest-risk group [quintile 5]). The number of lung-cancer deaths per 10,000 person-years that were prevented in the CT-screening group, as compared with the radiography group, increased according to risk quintile (0.2 in quintile 1, 3.5 in quintile 2, 5.1 in quintile 3, 11.0 in quintile 4, and 12.0 in quintile 5; P=0.01 for trend). Across risk quintiles, there were significant decreasing trends in the number of participants with false positive results per screening-prevented lung-cancer death (1648 in quintile 1, 181 in quintile 2, 147 in quintile 3, 64 in quintile 4, and 65 in quintile 5). The 60% of participants at highest risk for lung-cancer death (quintiles 3 through 5) accounted for 88% of the screening-prevented lung-cancer deaths and for 64% of participants with false positive results. The 20% of participants at lowest risk (quintile 1) accounted for only 1% of prevented lung-cancer deaths. Screening with low-dose CT prevented the greatest number of deaths from lung cancer among participants who were at highest risk and prevented very few deaths among those at lowest risk. These findings provide empirical support for risk-based targeting of smokers for such screening. (Funded by the National Cancer Institute.). BackgroundIn the National Lung Screening Trial (NLST), screening with low-dose computed tomography (CT) resulted in a 20% reduction in lung-cancer mortality among participants between the ages of 55 and 74 years with a minimum of 30 pack-years of smoking and no more than 15 years since quitting. It is not known whether the benefits and potential harms of such screening vary according to lung-cancer risk.MethodsWe assessed the variation in efficacy, the number of false positive results, and the number of lung-cancer deaths prevented among 26,604 participants in the NLST who underwent low-dose CT screening, as compared with the 26,554 participants who underwent chest radiography, according to the quintile of 5-year risk of lung-cancer death (ranging from 0.15 to 0.55% in the lowest-risk group [quintile 1] to more than 2.00% in the highest-risk group [quintile 5]).ResultsThe number of lung-cancer deaths per 10,000 person-years that were prevented in the CT-screening group, as compared with the radiography group, increased according to risk quintile (0.2 in quintile 1, 3.5 in quintile 2, 5.1 in quintile 3, 11.0 in quintile 4, and 12.0 in quintile 5; P=0.01 for trend). Across risk quintiles, there were significant decreasing trends in the number of participants with false positive results per screening-prevented lung-cancer death (1648 in quintile 1, 181 in quintile 2, 147 in quintile 3, 64 in quintile 4, and 65 in quintile 5). The 60% of participants at highest risk for lung-cancer death (quintiles 3 through 5) accounted for 88% of the screening-prevented lung-cancer deaths and for 64% of participants with false positive results. The 20% of participants at lowest risk (quintile 1) accounted for only 1% of prevented lung-cancer deaths.ConclusionsScreening with low-dose CT prevented the greatest number of deaths from lung cancer among participants who were at highest risk and prevented very few deaths among those at lowest risk. These findings provide empirical support for risk-based targeting of smokers for such screening. (Funded by the National Cancer Institute.) In the National Lung Screening Trial (NLST), screening with low-dose computed tomography (CT) resulted in a 20% reduction in lung-cancer mortality among participants between the ages of 55 and 74 years with a minimum of 30 pack-years of smoking and no more than 15 years since quitting. It is not known whether the benefits and potential harms of such screening vary according to lung-cancer risk.BACKGROUNDIn the National Lung Screening Trial (NLST), screening with low-dose computed tomography (CT) resulted in a 20% reduction in lung-cancer mortality among participants between the ages of 55 and 74 years with a minimum of 30 pack-years of smoking and no more than 15 years since quitting. It is not known whether the benefits and potential harms of such screening vary according to lung-cancer risk.We assessed the variation in efficacy, the number of false positive results, and the number of lung-cancer deaths prevented among 26,604 participants in the NLST who underwent low-dose CT screening, as compared with the 26,554 participants who underwent chest radiography, according to the quintile of 5-year risk of lung-cancer death (ranging from 0.15 to 0.55% in the lowest-risk group [quintile 1] to more than 2.00% in the highest-risk group [quintile 5]).METHODSWe assessed the variation in efficacy, the number of false positive results, and the number of lung-cancer deaths prevented among 26,604 participants in the NLST who underwent low-dose CT screening, as compared with the 26,554 participants who underwent chest radiography, according to the quintile of 5-year risk of lung-cancer death (ranging from 0.15 to 0.55% in the lowest-risk group [quintile 1] to more than 2.00% in the highest-risk group [quintile 5]).The number of lung-cancer deaths per 10,000 person-years that were prevented in the CT-screening group, as compared with the radiography group, increased according to risk quintile (0.2 in quintile 1, 3.5 in quintile 2, 5.1 in quintile 3, 11.0 in quintile 4, and 12.0 in quintile 5; P=0.01 for trend). Across risk quintiles, there were significant decreasing trends in the number of participants with false positive results per screening-prevented lung-cancer death (1648 in quintile 1, 181 in quintile 2, 147 in quintile 3, 64 in quintile 4, and 65 in quintile 5). The 60% of participants at highest risk for lung-cancer death (quintiles 3 through 5) accounted for 88% of the screening-prevented lung-cancer deaths and for 64% of participants with false positive results. The 20% of participants at lowest risk (quintile 1) accounted for only 1% of prevented lung-cancer deaths.RESULTSThe number of lung-cancer deaths per 10,000 person-years that were prevented in the CT-screening group, as compared with the radiography group, increased according to risk quintile (0.2 in quintile 1, 3.5 in quintile 2, 5.1 in quintile 3, 11.0 in quintile 4, and 12.0 in quintile 5; P=0.01 for trend). Across risk quintiles, there were significant decreasing trends in the number of participants with false positive results per screening-prevented lung-cancer death (1648 in quintile 1, 181 in quintile 2, 147 in quintile 3, 64 in quintile 4, and 65 in quintile 5). The 60% of participants at highest risk for lung-cancer death (quintiles 3 through 5) accounted for 88% of the screening-prevented lung-cancer deaths and for 64% of participants with false positive results. The 20% of participants at lowest risk (quintile 1) accounted for only 1% of prevented lung-cancer deaths.Screening with low-dose CT prevented the greatest number of deaths from lung cancer among participants who were at highest risk and prevented very few deaths among those at lowest risk. These findings provide empirical support for risk-based targeting of smokers for such screening. (Funded by the National Cancer Institute.).CONCLUSIONSScreening with low-dose CT prevented the greatest number of deaths from lung cancer among participants who were at highest risk and prevented very few deaths among those at lowest risk. These findings provide empirical support for risk-based targeting of smokers for such screening. (Funded by the National Cancer Institute.). |
| Author | Caporaso, Neil E Katki, Hormuzd A Chaturvedi, Anil K Korch, Mary Tammemagi, Martin Berg, Christine D Kovalchik, Stephanie A Riley, Tom L Silvestri, Gerard A |
| Author_xml | – sequence: 1 givenname: Stephanie A surname: Kovalchik fullname: Kovalchik, Stephanie A organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) – sequence: 2 givenname: Martin surname: Tammemagi fullname: Tammemagi, Martin organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) – sequence: 3 givenname: Christine D surname: Berg fullname: Berg, Christine D organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) – sequence: 4 givenname: Neil E surname: Caporaso fullname: Caporaso, Neil E organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) – sequence: 5 givenname: Tom L surname: Riley fullname: Riley, Tom L organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) – sequence: 6 givenname: Mary surname: Korch fullname: Korch, Mary organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) – sequence: 7 givenname: Gerard A surname: Silvestri fullname: Silvestri, Gerard A organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) – sequence: 8 givenname: Anil K surname: Chaturvedi fullname: Chaturvedi, Anil K organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) – sequence: 9 givenname: Hormuzd A surname: Katki fullname: Katki, Hormuzd A organization: From the Divisions of Cancer Epidemiology and Genetics (S.A.K., N.E.C., A.K.C., H.A.K.) and Cancer Prevention (C.D.B.), National Cancer Institute, National Institutes of Health, and Information Management Services (T.L.R., M.K.) — all in Rockville, MD; the Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada (M.T.); and the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston (G.A.S.) |
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