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Αξονική χαμηλής δόσης ή ακτινογραφία στο screening για καρκίνο του πνεύμονα;
paracelsus:
The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in persons at high risk for lung cancer based on age and smoking history. This is a Grade B recommendation. (This draft Recommendation Statement is not the final recommendation of the U.S. Preventive Services Task Force).
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Εγγραφή ή Είσοδος
Argirios Argiriou:
June 9, 2015, Journal Watch.
Allan S. Brett, MD Reviewing Infante M et al., Am J Respir Crit Care Med 2015 May 15; 191:1166
In a small study from Italy, screening conferred no benefit.
The U.S. National Lung Screening Trial (NLST) was the first randomized trial to show an effect of computed tomography (CT) screening on lung cancer mortality: At 6.5 years, 1 fewer lung cancer–specific death occurred per 320 smokers screened (NEJM JW Gen Med Aug 1 2011 and N Engl J Med 2011; 365:395). Now, results of another screening study — the DANTE trial, from Italy — have been published. DANTE included about 2500 men (age range, 60–74) with smoking histories of ≥20 pack-years; all were current smokers or had quit within 10 years. Participants were randomized to five rounds of annual low-dose CT screening or to no screening.
During median follow-up of 8.4 years, 104 screened patients and 72 controls were diagnosed with lung cancer. Lung cancer–specific mortality was identical in the two groups — 5.4 deaths per 1000 person-years. During the screening phase, 37% of participants in the screening group had at least one abnormal CT scan. Additional CT scans, invasive diagnostic procedures, and surgeries were all significantly more common in the screening group than in the control group.
Comment
Although the failure of screening to yield even a trend toward lower mortality is notable in this study, its obvious limitation is its small size and low statistical power; by contrast, 53,000 people were enrolled in the NLST. However, six other European trials with similar methodologies and a total of about 37,000 participants are in progress, and researchers are planning to pool those results (J Surg Oncol 2013; 108:280).
Argirios Argiriou:
August 4, 2015
Lung Cancer Screening Could Falsely Reassure Smokers.
Thomas L. Schwenk, MD reviewing Zeliadt SB et al. JAMA Intern Med 2015 Jul 27.
Qualitative findings reveal several misperceptions about the value of screening.
Computed tomography (CT) screening for lung cancer in heavy cigarette smokers is becoming part of routine practice. Researchers explored the effect of such screening on smokers' motivation to stop smoking in this qualitative study of 37 smokers (mean age, 62; mostly white men; mean smoking history, 49 pack-years) in the Veterans Affairs health system who were about to undergo CT screening. Eight participants were interviewed (in a semistructured and validated format) both before and after screening, 22 were interviewed after they had received their screening results, and 7 were interviewed after screening but before receiving results. Eighteen of the 30 participants received some type of abnormal result.
Several themes and misperceptions were identified:
Screening became an external focus for the participants' attention, displacing attention on control of their own behavior.
Screening de-emphasized the effect of smoking on diseases other than lung cancer.
Screening often was viewed as conferring protection from developing lung cancer.
Many participants believed that negative CT scans meant that they had not suffered (and would not suffer) any damage from smoking.
Many participants believed that detection of small nodules was not worrisome and merely required follow-up.
Many participants believed that screening lowered the likelihood that cancer treatment would be required.
COMMENT
Prior studies have reported lower quit rates in smokers who were screened than in those who were not, perhaps because of some of the false reassurances and misperceptions identified in these qualitative results. Future studies should explore new approaches to counseling smokers who undergo screening, with a focus on correcting misperceptions about the value and accuracy of screening.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Thomas L. Schwenk, MD at time of publication
Editorial boardsUpToDate
CITATION(S):
Zeliadt SB et al. Attitudes and perceptions about smoking cessation in the context of lung cancer screening. JAMA Intern Med 2015 Jul 27; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Argirios Argiriou:
March 10, 2016
A Negative Trial of Computed Tomography Screening for Lung Cancer
Allan S. Brett, MD reviewing Wille MMW et al. Am J Respir Crit Care Med 2016 Mar 1.
In a relatively small Danish study, screening did not lower lung cancer mortality.
Several European trials are being conducted to examine lung cancer screening with computed tomography (CT). In a recently published trial from Italy, CT screening did not lower lung cancer–associated mortality (NEJM JW Gen Med Jul 15 2015 and Am J Respir Crit Care Med 2015; 191:1166). Now, Danish investigators report outcomes of a study in which 4104 adults (age range, 50–70; smoking history, ≥20 pack-years) were randomized to undergo five annual rounds of low-dose CT screening or no screening.
During average follow-up of 9.5 years, twice as many lung cancers were diagnosed in screened patients as in controls (100 vs. 53). Death rates were virtually identical in the screening and control groups: 8.04% and 7.94% for overall mortality, and 1.90% and 1.85% for lung cancer–specific mortality.
( και αυτά στην Δανία, δηλαδή μια χώρα όπου οι δυνατότητες των Ογκολόγων είναι σαφώς καλύτερες από αυτές μιας χρεοκοπημένης χώρας όπως η Ελλάδα).
COMMENT
Proponents of lung cancer screening will point to limited statistical power as one shortcoming of this negative trial. Indeed, all of the European trials are smaller than the 53,000-person U.S. National Lung Screening Trial, which did show a modest but statistically significant reduction in lung cancer deaths among screened participants compared with controls (1.33% vs. 1.66% after median follow-up of 6.5 years; NEJM JW Gen Med Aug 1 2011 and N Engl J Med 2011; 365:455). Although the U.S. Preventive Services Task Force has endorsed CT lung cancer screening in older adults with long smoking histories (NEJM JW Gen Med Feb 15 2014 and Ann Intern Med 2014; 160:330), debate continues about the relative balance of benefits and harms; the latter include high false-positive rates and overdiagnosis of indolent tumors.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Allan S. Brett, MD at time of publication
Nothing to disclose
CITATION(S):
Wille MMW et al. Results of the randomized Danish Lung Cancer Screening Trial with focus on high-risk profiling. Am J Respir Crit Care Med 2016 Mar 1; 193:542. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Argirios Argiriou:
Journal Watch.
USPSTF Expands Its Recommendation for Lung Cancer Screening with Low-Dose Computed Tomography
Thomas L. Schwenk, MD, reviewing US Preventive Services Task Force. JAMA 2021 Mar 9 Colson YL et al. JAMA Surg 2021 Mar 9 Fukunaga MI et al. JAMA Oncol 2021 Mar 9
The U.S. Preventive Services Task Force's new recommendation expands the number of patients eligible for LDCT screening by about 80%.
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