Lung Cancer Screening: Reducing Lung Cancer Death

Introduction

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Comparing low-dose CT screening with CXR in high-risk group to reduce lung cancer mortality. (DR Aberle, ‎2011)

In this study, participants aged 55-74 years old, who had history of cigarette smoking >30 years or former smokers who had quit within 15 years were screened using low-dose CT (LDCT) or CXR, yearly for three consecutive years.

Results

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(A) Number of lung cancer cases diagnosed in low dose CT (LDCT) group > CXR group, while (B) number of lung cancer deaths is higher in CXR group > LDCT group.

Those who had yearly LDCT screening had higher number of lung cancer diagnosed when compared with screening using CXR only.

Conversely, the lung cancer specific mortality was lower in the LDCT screening group.

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Stages of the lung cancer when it was diagnosed in both arms of screenings. More lung cancers are diagnosed at earlier stage (I & II) in LDCT group.

The reasons are simply because those who had LDCT screenings had

  • more lung cancers diagnosed at earlier stage (stage 1: 50% vs 31%) and
  • lesser patients diagnosed at later stage (stage 3&4: 43% vs 61%).
Screen Shot 2018-08-19 at 10.18.24 PM.png
Summary of the above trial, with emphasis on the significant and large relative risk reduction (20%) when LDCT was compared with CXR for screening of lung cancer

Conclusion

In conclusion, although the absolute risk reduction was just 3 in 1000 or the number needed to screen to prevent one lung cancer specific death is 330 (1/0.003).

For the government, it’s not cost-effective to implement LDCT due to the large number of patients needed to be screened just to prevent one lung cancer specific death.

However, if you fall into the above risk group and can afford to pay for your own LDCT screening, you can reduce the risk of death by 20% for your own self.

Else, just can a CXR done. It can still play an important role to detect lung cancer at an earlier stage. #lungcancer #drbhnglatest

Future

There are active research being conducted using tumour auto-antibodies (TAA) and circulating tumor cells as complementary tools to improve early detection of lung cancer.

Tumour auto-antibodies had been found to be present even before the disease became symptomatic.

Currently, there are using a panel of seven tumour auto-antibody and the results from their study was very impressive, with positive predictive value of 95%!

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Early detection of lung cancer by using an autoantibody panel in Chinese population. (Ren, Oncoimmunology, 2018)

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