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D. Manners



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    MA 14 - Diagnostic Radiology, Staging and Screening for Lung Cancer I (ID 672)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      MA 14.09 - Impact of Lung Cancer Perceived Risk, Screening Eligibility and Worry on LDCT Screening Preference - Challenges for Engaging Patients at High Risk (ID 9669)

      15:45 - 17:30  |  Author(s): D. Manners

      • Abstract
      • Presentation
      • Slides

      Background:
      Lung cancer screening is only effective at reducing lung cancer deaths when the highest risk individuals are screened and followed. An individual’s risk of lung cancer, and therefore their screening eligibility, has not been shown to correlate with their perceived risk or intention to participate in screening. While previous studies have suggested many at-risk individuals are supportive of screening, no validated risk perception questionnaire has been used to compare perceived risk and worry with screening preference between eligible and ineligible individuals.

      Method:
      Participants were current or former smokers aged 55 to 80 years old who presented for medical outpatient specialist appointments at three Australian hospitals. The survey included 1) demographics and previous cancer screening participation 2) objective lung cancer risk measured by PLCOm2012 lung cancer risk prediction model 3) perceived lung cancer risk and worry about lung cancer measured by the questionnaire developed by Park et al and validated in sub-set of National Lung Screening Trial (NLST) participants and 4) preference for screening measured by a five point Likert scale. Eligibility for screening was PLCOm2012 risk >1.5%. Ordinal logistic regression identified factors associated with screening preference.

      Result:
      760 people 55-80 years old participated, of which 306 were ever-smokers. The participation rate was 26.9%. 23 did not complete either sufficient smoking details for PLCOm2012 risk or screening preference leaving 283 responses. Mean±SD age was 66.3±6.5, 60.4% (171/283) were male, median (IQR) PLCOm2012 risk was 1.28% (0.44-3.11) and 45.6% (129/283) were eligible for screening. Overall screening preference was high; 72.1% (204/283) either agreed or strongly agreed to having screening if offered. Objective lung cancer risk (PLCOm2012) was weakly correlated with both perceived lung cancer risk (r=0.28, p<0.0001) and worry (r=0.21, p<0.001). In univariate analysis, worry (OR 1.37, 95% CI [1.18-1.60], p<0.001), perceived risk (OR 1.10, 95% CI[1.04-1.16], p=0.002) and PLCOm2012 risk (OR 1.06, 95% CI[1.01-1.12], p=0.02) were associated with higher screening preference, but not associated with higher screening eligibility (OR 1.50, 95%CI[0.97-2.30], p=0.06). Age, gender, smoking status, family history of lung cancer and previous screening practice were not associated with screening preference. Only worry remained significantly associated with screening preference (adj-OR 1.33, [95%CI 1.10-1.60], p=0.003) with multivariate analysis.

      Conclusion:
      Worry about lung cancer appears to be a more important driver for screening preference than eligibility status. This presents a unique challenge when trying to engage with eligible individuals while minimizing screening demand from the ineligible majority.

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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: 2
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      P2.13-002 - The LungScreen WA Project: Feasibility of LDCT Screening with the PLCO<sub>m2012</sub> Risk Model and PanCan Nodule Risk Calculator (ID 8427)

      09:30 - 16:00  |  Author(s): D. Manners

      • Abstract
      • Slides

      Background:
      Low-dose CT (LDCT) screening for lung cancer is currently recommended in the USA but not in Australia, as there remain important knowledge gaps. We aimed to evaluate the feasibility of lung cancer screening in the Australian healthcare setting using the PLCO~m2012~ model to identify high-risk participants and the PanCan nodule malignancy risk-calculator to guide management of detected pulmonary nodules.

      Method:
      Current/former smokers, aged 55-74 years, were recruited from the community. Eligibility for LDCT-screening was defined as PLCO~m2012~ ≥1.51% over 6 years. Participants underwent interview, spirometry and LDCT. Detected nodules were managed with a risk-based algorithm using the PanCan nodule calculator (highest-risk nodule score used if multiple nodules present). If risk-score <1.5%: repeat LDCT at 24 months; 1.5-6%: LDCT at 12 and 24 months; 6-10%: LDCT at 3, 12 and 24 months; >10%: consider immediate investigation. If no nodules detected, no further LDCT arranged. We report results after 24-month follow-up.

      Result:
      We received 104 enquiries – 54 were eligible and 49 underwent screening LDCT. Results are summarised in Table 1. In participants with pulmonary nodules (n=26), the PanCan risk-score was <1.5% in 12 (46.2%), 1.5-6% in 5 (19.2%), 6-10% in 6 (23.1%) and >10% in 2 (7.7%). Of note, 65% of nodule-positive participants did not require further investigation within the first year of screening. Lung cancers were identified in 2 (4.1%) participants – 1 underwent surgical resection of a Stage 1b adenocarcinoma, the other had an enlarging nodule treated with stereotactic radiotherapy (no biopsy due to surrounding emphysema). A further participant is due surgery for a 53mm[3] slow-growing nodule with growth between 12 and 24 month scans. Table 1. Characteristics and LDCT findings of screened-individuals. Figure 1



      Conclusion:
      A targeted, algorithmic approach to lung cancer screening is feasible and identifies early-stage lung cancers. Use of the PanCan nodule risk calculator simplifies downstream investigation after baseline LDCT.

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      P2.13-023 - Lung Cancer Risk and Eligibility for Lung Cancer Screening in Patients Undergoing Computed Tomography Coronary Angiography (ID 10465)

      09:30 - 16:00  |  Author(s): D. Manners

      • Abstract

      Background:
      Computed Tomography Coronary Angiography (CTCA) is frequently performed for non-invasive coronary artery assessment. Extracardiac findings are frequent, with indeterminate pulmonary nodules the commonest incidental finding. Given the established efficacy of lung cancer screening with low dose CT (LDCT), CTCA has been suggested to be an opportunity for “opportunistic” lung cancer screening. This rationale has been used to justify full field of view imaging, despite limited field of view significantly reducing prevalence of nodules detected and therefore reduce downstream healthcare costs. Distribution of lung cancer risk of patients undergoing Cardiac CT has not previously been reported. We performed a cross-sectional survey to determine the proportion of patients undergoing CTCA who would be eligible for lung cancer screening, and to determine the lung cancer risk profile of eligible patients.

      Method:
      Patients attending two tertiary hospitals in Melbourne, Australia, for clinically indicated out-patient CT coronary angiography were screened for inclusion in the study. Patients eligible for Lung Cancer screening according to the US Preventive Services Task Force (USPSTF) recommendations were invited to complete a questionnaire including smoking history and demographic details, to determine 6-year lung cancer risk, according to the PLCO~m2012~ risk prediction model. A threshold PLCOm2012 risk at least 1.5% was used to identify a sub-group in whom LDCT screening is most likely to be cost-effective and reduce lung cancer mortality.

      Result:
      In a four month period, 216 patients (60% male) were screened prior to CTCA across both sites. Only 57 patients (26%) were potentially eligible for lung cancer screening according to USPSTF guidelines: 126 (58.3%) were never-smokers, with a further 33 patients (15.3%) outside the reccomended 55-80 years age range. Of 57 eligible patients, 48 (84%) consented to the questionnaire. Thirty-four were male (71%), with mean age 65.6+/-6.0 years. Median (IQR) PLCOm2012 risk was 1.30% (0.45–2.19%). Only 22 patients (45.8% of patients completing the questionnaire, estimated 12% of total cohort)had a PLCO~m2012~ risk score >1.5%, and just 18 of 48 (37.5% of patients completing the questionnaire) had a PLCOm2012 risk > 2.0%

      Conclusion:
      A majority of patients undergoing CTCA were never-smokers. Only 26% would be eligible for screening according to USPSTF criteria. Therefore routine use of Cardiac CT for “opportunistic” lung cancer screening is likely to result in net harm and is not appropriate A small proportion of patients undergoing CTCA have high risk for lung cancer and may benefit from full thoracic imaging at the time of CTCA