• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Real World Evidence: Has Low Dose CT Screening Improved Lung Cancer Detection in the US?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Previous randomized controlled trials have demonstrated the benefit of low dose computed tomography for detection of early-stage lung cancer vs chest radiography or no screening
  • Real world evidence is limited
  • Potter et al. (BMJ, 2022) examined the impact of low dose computed tomography screening on lung cancer outcomes

METHODS:

  • Quasi-experimental study
    • Data derived from the US National Cancer Database and SEER
  • Participants
    • 45 to 80 years
    • Diagnosed with non-small cell lung cancer (NSCLC) between January 2010 and December 2018
  • Exposures
    • 2010 to 2013: Pre-recommendation of USPSTF lung cancer screening guideline 
    • 2014 to 2018: Post-recommendation of USPSTF screening guideline
  • Study design
    • Multivariable ordinal logistic regression
    • Multivariable Cox proportional hazards modeling used to assess outcomes
  • Primary outcomes
    • Annual percent change in percentage of stage 1 NSCLC diagnosed among patients aged 45 to 54 (ineligible for screening) and 55 to 80 (potentially eligible for screening)
    • Median all cause survival
    • Incidence of NSCLC
    • Year-to-year changes in likelihood of having earlier stages of disease at diagnosis
    • Changes in hazard of death

RESULTS:

  • 763,474 patients
  • The percentage of stage I NSCLC diagnosed among patients 55 to 80 years did not significantly increase from 2010 to 2013 but did increase from 2014 to 2018
    • From 2010 to 2013: 27.8% to 29.4%
    • From 2014 to 2018: 30.2% to 35.5%
    • Annual increase: 3.9% per year (95% CI, 3.0 to 4.8)
  • The odds were higher of having one lung cancer stage lower at diagnosis during the post-recommendation period, compared with pre-recommendation
    • From 2014 to 2018: 6.2% increase in odds per year
    • Adjusted odds ratio (aOR) 1.062 (95% CI, 1.048 to 1.077); P<0.001
  • Median all-cause survival of patients 55 to 80 years did not significantly increase from 2010 to 2013, but did increase from 2014 to 2018
    • From 2010 to 2013: 15.8 to 18.1 months
    • From 2014 to 2018: 19.7 to 28.2 months
    • Annual increase 11.9% per year (95% CI, 8.9 to 15.0)
  • The hazard of death decreased significantly faster after 2014 vs before 2014 (P<0.001)
  • By 2018, stage 1 NSCLC was the predominant diagnosis among
    • Non-Hispanic White people
    • People living in the highest income or best educated regions
  • Stage IV disease at diagnosis were more commonly seen among
    • Non-White people
    • Lower income or less educated regions

CONCLUSION:

  • There has been a shift towards more stage 1 NSCLC diagnoses in the US following new USPSTF lung cancer screening recommendations introduced in 2013, suggestive of more early-stage diagnoses
  • Increases in the detection of early-stage lung cancer in the US from 2014 to 2018 averted an estimated 10,100 deaths
  • Non-white patients and those living in lower resource areas are less likely to experience the benefits of screening recommendations as they are the most likely to have stage IV disease at diagnosis
  • The authors state

Differences in the percentage of people at high risk meeting screening eligibility criteria among certain populations and the inability to support lung cancer screening programs in community settings may contribute to widening disparities in the early diagnosis and survival of patients with lung cancer in the near future if efforts to increase eligibility for screening and to increase adoption of screening are neglected

Learn More – Primary Sources:

Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study

Want to stay on top of key guidelines and research papers?

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

USPSTF Guidance on Screening for Lung Cancer
Lung Cancer Incidence Now Higher in Younger Women – Does Smoking Fully Account for This Change?
New Lung Cancer Diagnosis: Does Quitting Smoking Help Improve Outcomes?
Is Elevated Platelet Count Associated with Future Cancer Diagnosis?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site