Can Low-Dose CT Screening Detect Early-Stage Lung Cancer?

TOPLINE:

Low-dose CT screening in a high-risk population detected lung cancer in 2.0% of participants, with nearly 80% of cases diagnosed at stage I or II. The screening protocol demonstrated 97.0% sensitivity at 12 months, with a 4.8% false-positive rate.

METHODOLOGY:

• Annual low-dose CT screening has been recommended in the United States since 2013, but uptake remains low at only 4.5% of eligible individuals in 2022.
• Regional targeted lung health check pilot programs are ongoing in the United Kingdom and are expected to be rolled into a national program. This study was conducted to assess the implementation of these types of programs.
• Researchers conducted a prospective, longitudinal cohort study involving 12,773 participants aged 55-77 years, with current or former smoking habit within the past 20 years, identified from 329 primary care practices in London.
• Participants meeting US Preventive Services Taskforce criteria or having a Prostate, Lung, Colorectal, and Ovarian 2012 model 6-year risk ≥ 1.3% underwent noncontrast, thin collimation low-dose CT screening.
• Analysis included episode sensitivity of the screening protocol, with outcomes measured on a per-participant level using descriptive frequencies.

TAKEAWAY:

• Among 12,773 participants, 261 (2.0%) were diagnosed with lung cancer, including 163 (1.3%) with screen-detected cancer and 98 (0.8%) with delayed screen-detected cancer after nodule follow-up CT.
• The screening protocol demonstrated 97.0% sensitivity (95% CI, 95.0-99.1); 95.2% specificity (95% CI, 94.8-95.6), and a positive predictive value of 30.3% (95% CI, 27.3-33.4).
• Surgical resection was the primary treatment modality in 201 (77.0%) of cases, with 207 (79.3%) of lung cancers being diagnosed at stage I or II.
• Benign surgical resection rate was 11.6% (28 of 241 resections), with one death (0.4%) occurring within 90 days of surgery.

IN PRACTICE:

“Large-scale lung cancer screening is effective and can be delivered efficiently to an ethnically and socioeconomically diverse population…. The findings of our study will help lung cancer services understand the implications of this programme on resource use and help to develop quality assurance standards for lung cancer screening, both in the UK and elsewhere,” wrote the authors of the study.

SOURCE:

The study was led by Amyn Bhamani, PhD, and Andrew Creamer, PhD, Lungs for Living Research Centre, University College London in London, the United Kingdom. It was published online on March 25 in The Lancet Oncology.

LIMITATIONS:

According to the authors, the study was impacted by the COVID-19 pandemic, which caused procedures to be paused and led to delays in follow-up imaging. Some participants were unable to return for scans due to travel restrictions or pandemic-related concerns, resulting in higher attrition rates of 4.4% and 6.3% at 3-month and 6-month interval scans, respectively. Additionally, participation was limited to high-risk individuals based primarily on smoking history, excluding never smokers from the study population.

DISCLOSURES:

The study was funded by GRAIL. Sam M. Janes, PhD, received fees for advisory board membership from Bard1 Lifesciences, grant income from GRAIL, and lecture fees from Cheisi and AstraZeneca. His wife works for AstraZeneca. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.