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Andrea Katalin Borondy Kitts



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    MA 04 - Advocacy: Listen to the Patients (ID 655)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Patient Advocacy
    • Presentations: 1
    • Now Available
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      MA 04.08 - Discussant - MA 04.05, MA 04.06, MA 04.07 (Now Available) (ID 10863)

      11:40 - 11:55  |  Presenting Author(s): Andrea Katalin Borondy Kitts

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P1.06 - Epidemiology/Primary Prevention/Tobacco Control and Cessation (ID 692)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
    • Presentations: 1
    • Now Available
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      P1.06-017 - Lung Cancer Detection Rates for National Comprehensive Cancer Network Group 2 High Risk Individuals (Now Available) (ID 9982)

      09:30 - 09:30  |  Presenting Author(s): Andrea Katalin Borondy Kitts

      • Abstract
      • Slides

      Background:
      Lung cancer screening with LDCT scan is covered by private insurance and Medicare for current and former smokers quit within the last 15 years, age 55 to 77 (55-80 for private insurance), with a 30 or greater pack year smoking history. However, it is not covered for National Comprehensive Cancer Network (NCCN) Group 2; a group of slightly younger, lighter smokers with no limit on quit duration but at least one additional risk factor. Our previous study on 1328 patients demonstrated NCCN Group 2 (Cohort A) to be at equivalent risk for lung cancer as the covered group (Cohort B). The objective of this study is to statistically evaluate the potential difference in lung cancer prevalence between Cohorts A and B. Towards that end we are compiling a large sample set (1563 Cohort A, 4000 Cohort B) with 80% power that can detect a minimum of 1% difference in lung cancer prevalence between the two groups.

      Method:
      A REDCap data registry was created to retrospectively collect LDCT scan data on high-risk individuals from two historical cohorts who underwent lung cancer screening at three institutions between January 1, 2012 and May 31, 2017.

      Result:
      To date, 804 Cohort A and 2712 Cohort B individuals have been entered into the data registry. Data entry is expected to be complete by the end of 2017 with follow-up through end of May 2019 to ensure a minimum follow up period of two years for each patient. A preliminary analysis is planned with 3 month minimum follow-up. A separate analysis of overall cancer detection rates (CDR) with a smaller sample at one of the study institutions shows CDR are not statistically different between the two cohorts (Pearson’s Chi-Square). The CDR for Cohort A, the NCCN Group 2 patients, was 3.98% (28 lung cancers in 704 patients) and in Cohort B, the covered group, was 3.92% (91 lung cancers in 2319 patients; p=0.95). Average time in the program was 2.5 years for Cohort A and 2.4 years for the Cohort B (p=0.18). Maximum time in the program was 5.4 years for both groups; minimum follow-up time was 3 months.

      Conclusion:
      Using an expanded data set, NCCN Group 2 CDR continue to be the same as the group covered by Medicare and insurance. At this point, there is no statistical difference in lung cancer risks between the two groups.

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    P2.13 - Radiology/Staging/Screening (ID 714)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P2.13-017 - Four Years of Data in an Established Low Dose CT (LDCT) Screening Program (ID 10297)

      09:30 - 09:30  |  Author(s): Andrea Katalin Borondy Kitts

      • Abstract

      Background:
      Lung screening with LDCT has demonstrated a significant improvement in lung cancer specific overall survival including the National Lung Screening Trial (NLST) comparison of LDCT vs chest x-ray. LDCT is recommended by the USPSTF and covered by Medicare, prompting the development of lung screening programs. In January, 2012, Lahey began a program for lung screening by low dose CT scan.

      Method:
      All individuals enrolled in the Lahey screening program fulfilled the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Lung Cancer Screening v1.2012 (NCCN Guidelines®) high risk criteria for lung cancer and had a physician order for CT lung screening. Patients qualifying by NCCN Group 2 criteria were included in our free program from 2012-2015.

      Result:
      More than 11,000 LDCT lung screening scans have been performed in the Rescue Lung Rescue Life program on about 4500 patients. As of June, 2017 the program has diagnosed 135 cancers, of which approximately 70% are early stage non-small cell lung cancers. The rate of positive scans in year 1 of patient enrollment is about 15% and decreases substantially in following years. About 84% of patients continued in the program with recommended follow up scans. A very small number of patients undergo an invasive intervention without ultimately having a cancer diagnosis. We will present updated numbers.

      Conclusion:
      The reported numbers from screening trials have impacted the discussion about lung cancer screening program development and expectations. Our single institution data set of more than 11,000 scans shows a lower rate of positive screening tests with a higher positive predictive value than that reported in NLST, in part due to evolution of the recommended nodule size categorization. The high rate of patient retention in the program suggests follow up scans and regular screening are feasible. Our data showing limited intervention in patients with benign nodules, and about 70% of patients diagnosed with early stage disease, further demonstrates the importance of lung screening and limited risk associated with lung screening in an established program. The largest lung screening study performed to date, NLST, evaluated low dose CT chest vs chest x-ray yearly for 3 years. We provide data from an established lung screening program over more than 4 years.

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    WS 01 - IASLC Supporting the Implementation of Quality Assured Global CT Screening Workshop (By Invitation Only) (ID 632)

    • Event: WCLC 2017
    • Type: Workshop
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      WS 01.03 - CT Screened Lung Cancer Survivor: A Patients Prospective on Lung Cancer Screening (ID 10641)

      08:40 - 08:55  |  Presenting Author(s): Andrea Katalin Borondy Kitts

      • Abstract
      • Slides

      Abstract:
      In 2011, my husband Dan was 69 years old. He had quit smoking 11 years prior but had an 80 pack year smoking history. Dan also had COPD. His sister, also a former smoker, had died of lung cancer at age 62, six months after being diagnosed. In January 2012, I read an article in Prevention magazine, a health and fitness magazine, about recommended screening tests. One of the tests was a spiral CT to screen for lung cancer. I knew Dan was at risk so I asked our primary care physician about getting Dan tested. Our physician did not know about the test. When I discussed the test with Dan, he did not want to do it because it was not covered by Medicare. Dan was diagnosed 9 months later with Stage 4 Adenocarcinoma. For the next 18 months taking care of Dan, I immersed myself in reading about and looking for all of the possible treatment options for him. However, it was too late for Dan. He died in April 2013, eighteen months after his diagnosis. During this eighteen months, I realized how little the general public, and in many cases medical professionals, knew about lung cancer risks, early detection, and the latest research. I decided to become an advocate for people with lung cancer. I started my advocacy in April 2013. Despite the lack of insurance and Medicare coverage, some institutions in the United States started lung cancer screening programs in 2012 and 2013. Many professional societies and advocacy groups had endorsed lung cancer screening based on the National Lung Screening Trail (NLST) results and published screening recommendations and guidelines. In the United States, lung cancer screening is now recommended by the US Preventive Services Task Force and by Medicare and covered for eligible patients without a co-pay. However, based on National Health Interview Survey results, in 2015 the year private insurance and Medicare coverage began, only 2.1% of those eligible for screening had an LDCT. This is actually less than the 2.7% of respondents in the high risk category that indicted they had a chest x-ray to screen for lung cancer. Obstacles to lung cancer screening mentioned by healthcare professionals include high false positive rates, potential for invasive procedures for benign disease, and need for follow-up for positive scans and incidental findings. Also mentioned were lack of time for the shared decision making discussion required by Medicare prior to screening, the lack of validated decision aids, and that patients don’t ask about screening. There is a lack of understanding among healthcare professionals about quality metrics achieved in screening programs with current screening quality processes that are updated from those used in the NLST. In particular, positive rates with LungRADS structured reporting guidelines are approximately 10% as compared to 26% in the NLST. Additionally, the return for follow-up testing in less than one year after an annual scan is much lower than after the baseline, prevalence scan (Figure 1). Figure 1 Figure 1. Lung Cancer Screening Quality Metrics in an Established Clinical Lung Cancer Screening Program There is a general lack of awareness among the high risk population about their risk of lung cancer and about the opportunity for lung cancer screening for current and, especially former smokers. Many former smokers think once they quit smoking, they are no longer at high risk. About 50% of lung cancers are diagnosed in former smokers so this is an important group to reach. The recently launched American Lung Association “Saved by the Scan” campaign is designed to target this group. One of the differences between lung cancer screening and other cancer screening tests is the stigma associated with lung cancer. Because of the close link between smoking and lung cancer, many people with lung cancer are blamed, or blame themselves, for their disease. People at high risk for lung cancer often express denial, self-blame, nihilism and fear of stigma and anger from loved ones and others and decline the opportunity for screening. “I smoked. If I get lung cancer it will be my fault. I don’t want to get screened. I don’t want to know” are comments I have heard too often during my community outreach activities. Similar to other screening tests, the main reason people decide to get tested is because of a recommendation by their healthcare provider. Educating and raising awareness among both medical professionals and the high risk population needs additional focus to reach the 9 million people at high risk for lung cancer in the US. In Europe, lung cancer screening is not yet recommended. Europeans are awaiting the results of the NELSON screening trial to evaluate the best approach to screening for their population. Although there have been numerous small lung cancer screening trails in European countries, in general they were underpowered and the results mixed and inconclusive. 51% of the world’s lung cancer cases and 21% of lung cancer deaths occur in Asia. China alone has 300 million current smokers. The opportunity to save lives with the implementation of lung cancer screening in this region is huge. From a patient advocate perspective, the results of the NLST and the US experience with screening should be used to accelerate implementation of lung cancer screening programs worldwide. The world loses 1.6 million people every year to lung cancer. The test for early lung cancer detection is available now. Every day of delay results in additional unnecessary deaths.



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    WS 02 - IASLC Symposium on the Advances in Lung Cancer CT Screening (Ticketed Session SOLD OUT) (ID 631)

    • Event: WCLC 2017
    • Type: Symposium
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      WS 02.17 - Session 4: Lung Cancer Screening’s Impact on COPD and Smoking Cessation (ID 10590)

      16:15 - 16:15  |  Presenting Author(s): Andrea Katalin Borondy Kitts

      • Abstract

      Abstract not provided