Study Suggests More Sensitive Lung Cancer Screening Criteria Needed

Study Suggests More Sensitive Lung Cancer Screening Criteria Needed

A new study analyzing lung cancer incidence and screening published in the February 24 issue of JAMA identified a declining proportion of lung cancer patients meeting the current qualification criteria for high-risk screening. The study suggests that increasing numbers of patients with lung cancer would not be acceptable as candidates for screening.

pingyangA research team led by Dr. Ping Yang M.D., Ph.D., of the Mayo Clinic at Rochester, Minnesota notes that low-dose computed tomography is recommended by professional associations, including the U.S. Preventive Services Task Force (USPSTF), for lung cancer screening of individuals deemed to be high-risk, conducted a study to examine the trends in the proportion of patients with lung cancer meeting the USPSTF screening criteria.

The study, supported by grants from the National Institutes of Health, a grant from the National Institute on Aging, and funding from the Mayo Clinic Foundation, entitled: Trends in the Proportion of Patients With Lung Cancer Meeting Screening Criteria (JAMA, 2015; 313 (8): 853 DOI: 10.1001/jama.2015.413), is coauthored by Yi Wang, MD, Ping Yang, MD, PhD, Shawn M. Stoddard, Shuo Zhang, MPH, and Bo Deng, MD, PhD, of the Mayo Clinic Division of Epidemiology at Rochester, Minnesota; David E. Midthun, MD, of the Mayo Clinic,Division of Pulmonary and Critical Care Medicine; and Jason A. Wampfler, BS, of the Mayo Clinic Division of Biomedical Statistics and Informatics. Dr. Wang is now with the Division of Preventive Medicine, Wenzhou Medical University, Wenzhou, China.

Lung cancer screening using low-dose computed tomography is recommended for high-risk individuals by professional associations, including the US Preventive Services Task Force (USPSTF). The implications of the USPSTF screening criteria were investigated in a well-defined population retrospectively over 28 years to demonstrate trends in the proportion of patients with lung cancer meeting the criteria.

Subjects of the study included all residents of Olmsted County, Minnesota older than 20 years from 1984 through 2011, a cohort comprising roughly 140,000 people, 83 percent of whom were non-Hispanic white in ethnicity and socioeconomically typical of the Midwestern U.S. general population.

In the study population there were 1,351 patients who had received a new primary lung cancer diagnosis between 1984 and 2011. The proportion of patients with lung cancer who had smoked more than 30 pack-years declined, while the proportion of former smokers, particularly ones who’d quit more than 15 years prior to diagnosis, increased. The researchers found a declining proportion of patients with lung cancer meeting the USPSTF criteria overall — down from 57 percent in 1984-1990 to 43 percent in 2005-2011.

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The scientists suggest that their current findings may reflect temporal changes in smoking patterns, with a diminished proportion of adults having a 30 pack-year smoking history and having quit within 15 years, and that the declining proportion of patients meeting USPSTF high-risk criteria points to increasing numbers of patients with lung cancer who would not be candidates for screening, contending that more sensitive screening criteria may need to be adopted, balanced against the risk of potential harm from computed tomography.

Dr. Ping Yang’s research is focused on the epidemiology of complex diseases, encompassing causes, risk factors, natural history, clinical course, treatment outcomes and quality of life. Her team’s research goals are to reduce cancer occurrence, diagnose cancer at a treatable stage, and design the best treatment plan for optimal quantity and quality of life.

Principal investigator and co-investigator for many lung cancer research studies funded by the National Institutes of Health (NIH) and other sources, Dr. Yang was a co-leader of three NIH-funded research studies in human glioma — one within the Mayo Clinic Specialized Program of Research Excellence (SPORE) and two within the Gliogene consortium (international brain tumor study and international glioma case-control study).

Dr. Yang’s primary efforts have been on the genetic and clinical epidemiology of cancer, particularly lung cancer and brain tumors, and her investigational team focuses on genetic and nongenetic components needing evaluation in order to better understand lung cancer etiology and clinical outcomes. She initiated and has led the Epidemiology and Genetics of Lung Cancer Research Program at Mayo Clinic, which is designed to identify genomic, environmental and other host factors (such as chronic lung diseases) that are involved in disease risk and development, progression, and prognosis, as well as health-related quality of life.

Dr. Yang’s team is now shifting to put greater emphasis on outcomes research, especially patient-reported outcomes, the objective being to bridge the transitional gap from patient to survivor status through better understanding of related deficits, definition of needs and development of care models in lung cancer patients after completion of cancer treatments, with the ultimate objective being acceleration of the recovery process from patient to survivor and from survivor to a healthy, productive member of society.

Within the framework of the Rochester Epidemiology Project, Dr. Yang’s research continues to monitor lung cancer morbidity and mortality trends in defined populations, providing new leads regarding causes, estimates of attributable risks associated with known causes, and evaluation of screening and early detection efforts’ effectiveness.

JAMA – Journal of the American Medical Association
Mayo Clinic

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Mayo Clinic

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