Author of

• 12812

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  P3.20 - Poster Session 3 - Early Detection and Screening (ID 174)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Imaging, Staging & Screening
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12815

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    P3.20-003 - A Practice Guideline for Low Dose CT Screening for Lung Cancer: Evidence Based Recommendations Before Implementation. (ID 1197)

    09:30 - 09:30  |  Author(s): K. Sivjee
    • Abstract

    Background
    The National Lung Screening Trial (NLST) compared low dose CT (LDCT) with chest radiography (CXR) in high-risk populations and found a 20% reduction in lung cancer mortality at 6 years with LDCT after an initial scan and two annual rounds of screening. This is the first randomized controlled trial (RCT) to show a mortality benefit with lung cancer screening. LDCT screening is not yet part of the standard of care and no formal process currently exists in Ontario, Canada for lung cancer screening. Injudicious use of LDCT can potentially cause more harm than benefit, including exposure of healthy persons to ionizing radiation and subsequent invasive procedures for ultimately benign lesions. When used correctly, however, LDCT screening has the potential to save lives. A practice guideline was developed to guide clinicians and healthcare policy makers with evidence-based recommendations for screening high-risk populations for lung cancer.

    Methods
    The guideline was developed using the methods of Cancer Care Ontario’s Program in Evidence-Based Care (PEBC). The core methodology of the PEBC’s guideline development process is a systematic review. A systematic review had recently been completed by a collaboration of the American Cancer Society, the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. The evidence from that systematic review formed the basis of the current recommendations, which were reviewed, and amended where necessary, by clinical experts in the fields of medical, radiation, and thoracic oncology; diagnostic radiology; pulmonary disease; and population health. The recommendations were reviewed by the Provincial Lung Cancer Disease Site Group and underwent both internal review by an expert panel and external review by clinicians with expertise in the topic to achieve consensus.

    Results
    The systematic review included three RCTs comparing LDCT screening with CXR (including the NLST), 5 RCTs comparing LDCT screening with usual care (no screening), and 13 single-arm studies of LDCT in patients at risk for lung cancer. One large RCT reported a statistically significant reduction in lung cancer mortality with low-dose computed tomography at six years compared with CXR. The practice guideline recommendations generally align with the parameters of the NLST. Deviations were described and justified by the guideline working group. The recommendations support screening persons at high-risk for lung cancer with advice for defining a positive result on LDCT, appropriate follow-up, and optimal screening interval.

    Conclusion
    The benefits of screening high-risk populations for lung cancer with LDCT outweigh the harms if screening is implemented in a strictly controlled manner targeting the high risk population. This practice guideline forms the basis for the rationale for a screening program. An economic impact analysis will need to be done to design an appropriate cost effective lung cancer screening program prior to implementation.