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K.M. Reiger-Christ
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P1.06 - Epidemiology/Primary Prevention/Tobacco Control and Cessation (ID 692)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.06-017 - Lung Cancer Detection Rates for National Comprehensive Cancer Network Group 2 High Risk Individuals (ID 9982)
09:30 - 09:30 | Author(s): K.M. Reiger-Christ
- Abstract
Background:
Lung cancer screening with LDCT scan is covered by private insurance and Medicare for current and former smokers quit within the last 15 years, age 55 to 77 (55-80 for private insurance), with a 30 or greater pack year smoking history. However, it is not covered for National Comprehensive Cancer Network (NCCN) Group 2; a group of slightly younger, lighter smokers with no limit on quit duration but at least one additional risk factor. Our previous study on 1328 patients demonstrated NCCN Group 2 (Cohort A) to be at equivalent risk for lung cancer as the covered group (Cohort B). The objective of this study is to statistically evaluate the potential difference in lung cancer prevalence between Cohorts A and B. Towards that end we are compiling a large sample set (1563 Cohort A, 4000 Cohort B) with 80% power that can detect a minimum of 1% difference in lung cancer prevalence between the two groups.
Method:
A REDCap data registry was created to retrospectively collect LDCT scan data on high-risk individuals from two historical cohorts who underwent lung cancer screening at three institutions between January 1, 2012 and May 31, 2017.
Result:
To date, 804 Cohort A and 2712 Cohort B individuals have been entered into the data registry. Data entry is expected to be complete by the end of 2017 with follow-up through end of May 2019 to ensure a minimum follow up period of two years for each patient. A preliminary analysis is planned with 3 month minimum follow-up. A separate analysis of overall cancer detection rates (CDR) with a smaller sample at one of the study institutions shows CDR are not statistically different between the two cohorts (Pearson’s Chi-Square). The CDR for Cohort A, the NCCN Group 2 patients, was 3.98% (28 lung cancers in 704 patients) and in Cohort B, the covered group, was 3.92% (91 lung cancers in 2319 patients; p=0.95). Average time in the program was 2.5 years for Cohort A and 2.4 years for the Cohort B (p=0.18). Maximum time in the program was 5.4 years for both groups; minimum follow-up time was 3 months.
Conclusion:
Using an expanded data set, NCCN Group 2 CDR continue to be the same as the group covered by Medicare and insurance. At this point, there is no statistical difference in lung cancer risks between the two groups.
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P2.13 - Radiology/Staging/Screening (ID 714)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 2
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.13-017 - Four Years of Data in an Established Low Dose CT (LDCT) Screening Program (ID 10297)
09:30 - 09:30 | Author(s): K.M. Reiger-Christ
- Abstract
Background:
Lung screening with LDCT has demonstrated a significant improvement in lung cancer specific overall survival including the National Lung Screening Trial (NLST) comparison of LDCT vs chest x-ray. LDCT is recommended by the USPSTF and covered by Medicare, prompting the development of lung screening programs. In January, 2012, Lahey began a program for lung screening by low dose CT scan.
Method:
All individuals enrolled in the Lahey screening program fulfilled the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Lung Cancer Screening v1.2012 (NCCN Guidelines®) high risk criteria for lung cancer and had a physician order for CT lung screening. Patients qualifying by NCCN Group 2 criteria were included in our free program from 2012-2015.
Result:
More than 11,000 LDCT lung screening scans have been performed in the Rescue Lung Rescue Life program on about 4500 patients. As of June, 2017 the program has diagnosed 135 cancers, of which approximately 70% are early stage non-small cell lung cancers. The rate of positive scans in year 1 of patient enrollment is about 15% and decreases substantially in following years. About 84% of patients continued in the program with recommended follow up scans. A very small number of patients undergo an invasive intervention without ultimately having a cancer diagnosis. We will present updated numbers.
Conclusion:
The reported numbers from screening trials have impacted the discussion about lung cancer screening program development and expectations. Our single institution data set of more than 11,000 scans shows a lower rate of positive screening tests with a higher positive predictive value than that reported in NLST, in part due to evolution of the recommended nodule size categorization. The high rate of patient retention in the program suggests follow up scans and regular screening are feasible. Our data showing limited intervention in patients with benign nodules, and about 70% of patients diagnosed with early stage disease, further demonstrates the importance of lung screening and limited risk associated with lung screening in an established program. The largest lung screening study performed to date, NLST, evaluated low dose CT chest vs chest x-ray yearly for 3 years. We provide data from an established lung screening program over more than 4 years.
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P2.13-018 - Clinical Outcomes Stage I/0 Adenocarcinoma Lung Diagnosed by Low Dose CT (LDCT) Screening vs Incidentally Discovered (ID 10298)
09:30 - 09:30 | Author(s): K.M. Reiger-Christ
- Abstract
Background:
Although LDCT lung screening has demonstrated improvement in overall survival, some have worried that indolent BAC-like adenocarcinomas (ADCA) may be over-detected/treated. We previously reported comprehensive and detailed pathologic comparison of stage I/0 lung ADCAs detected by LDCT screening vs incidentally discovered ADCAs stratified by NCCN risk criteria, demonstrating the presence of high grade invasive disease and high risk features in the LDCT group similar to incidentally discovered cancers. We now report clinical outcomes from a single institution LDCT program with associated pathology details.
Method:
Comprehensive histologic subtyping was performed on 54 consecutive stage I/0 LDCT screen detected ADCAs in patients meeting NCCN group 1/2 high risk (HR) criteria and compared to 77 incidentally detected stage I/0 ADCAs meeting HR criteria. We evaluated clinical outcomes in relation to details from pathologic evaluation.
Result:
We provide clinical data including disease free interval and recurrence in patients treated with curative intent for stage I adenocarcinoma detected by lung cancer screening vs incidentally discovered in HR patients with associated detailed pathologic evaluation. Screen detected and incidentally detected ADCAs show an equally low-rate of indolent, non-invasive/minimally invasive ADCAs. A collection of lepidic predominant (BAC-like) ADCAs associated with aggressive non-predominant cribriform and/or solid patterns and high proportion of lymphatic invasion were more frequently observed in the screen-detected group. Subgroup analysis of screen detected NCCN group 1 vs. 2 shows group 2 tumors exhibit histologic features which are at least as aggressive as group 1 tumors. Updated numbers with a larger cohort than previously reported and associated clinical data will be presented.
Conclusion:
We have demonstrated that many BAC-like tumors in LDCT screen detected patients bear histologic features of aggressive ADCAs, including among those still in a lepidic predominant phase. We provide the clinical data associated with updated numbers of the first detailed pathologic comparison of LDCT screen and incidentally detected ADCA of NCCN HR tumors.
