SA 5 - Lung cancer screening: past, present, future
1. To learn about the results of European and international lung cancer screening and to appreciate opportunities for future screening research.
This state-of-the-art symposium (SA) aims to inform the audience about the real state of the art of the lung cancer screening. The session includes three lecturers each of whom will focus in some specific aspects of the lung cancer screening. The design, conduct, results and limitations of the largest randomised trial, the NLST, will be discussed by the first lecturer. The results and the latest insights from European trials will be presented by the second lecturer. The opportunities for future screening research will be discussed by the third lecturer. The panel discussion will focus on how to implement lung cancer screening in Europe.
1. To understand the design, conduct, results and limitations of the randomised NLST trial.
2. To learn about the results of previous trials in terms of mortality reduction.
3. To understand the results of feasibility studies in terms of prevalence and incidence of screening detected lung cancer.
Radiologic examinations have been used since the 1960s to identify asymptomatic lung cancers in at-risk populations. Chest radiography alone or in combination with sputum cytology was used in several randomized trials and was able to detect more cases of lung and more early cancer stages in the study groups compared to the control groups with no chest radiography. However, no study was able to demonstrate mortality reduction from chest radiography screening. In the 1990s, unenhanced low radiation dose computed tomography was used in feasibility studies to screen for asymptomatic lung cancer in risk populations, mainly active or ex-smokers. Several non-randomized trials were able to demonstrate that low-dose CT had a much improved sensitivity for asymptomatic lung cancers compared to chest radiography with an acceptable rate of invasive procedures for false-positive findings, although the rate of false-positive findings was high.The first randomized controlled trial of low-dose CT versus chest radiography screening in active or (maximum 15 years) ex-smoker aged 55 -74 years with a minimum of 30 pack years of cigarette smoking in the US (National Lung Screening Trial: NLST) to publish results on mortality reduction showed a 20% reduction of mortality from lung cancer.
What do we know: latest insights from European trials, modelling studies and current screening programmes
1. To learn how to select participants for maximum yield of screening.
2. To understand how to optimise reading and nodule management.
3. To learn how to improve patient outcome by quality control of screening and treatment.
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1. To understand the limitations of existing screening protocols.
2. To learn about opportunities for optimisation of future screening protocols.
3. To appreciate questions, not answered by current trials, for future screening research.
Opportunities for future research for lung cancer screening with CT will be guided by the need to answer specific questions related to implementation. Many of these questions are relevant to radiology. How frequently should participants be screened? How can nodule follow-up or biopsy be minimised without impacting on cancer diagnosis and patient outcomes? How can the reading process be optimized? Since many lung cancer screening trials are already completed or nearing completion, the methods by which these areas could be addressed and their challenges will be discussed.