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James L Mulshine

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    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 853)

    • Event: WCLC 2018
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 7
    • Now Available
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      S01.04 - Lung Cancer Screening: 1999 to Date – What Have We Learnt? (Now Available) (ID 11885)

      07:35 - 07:50  |  Presenting Author(s): David F Yankelevitz

      • Abstract
      • Presentation
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      Abstract

      In 1999, ELCAP published their initial results from baseline screening. It found that in a cohort of 1000 participants approximately 85% of the cancers could be diagnosed as clinical Stage I, and that compared with chest radiography found many more of the cancers. In a subsequent study the expanded I-ELCAP found that the long term survival as a measure of cure rate approached 80%. The publicity associated with this initial study was quite large and led to the initiation of several other trials including the NLST. The NLST published their results in 2011 and based this, screening was endorsed by insurers in the US and now other countries are similarly following suit. However, despite the positive result of the NLST, and reimbursement from insurers, screening has had extremely limited uptake in the US, with only approximately 2% of those eligible (among a restricted population) are being screened. Thus, we face a situation where the most common cancer killer has been studied in the most expensive screening trial ever performed which had a positive result, insurers are reimbursing for it, and few people are having it done.

      With lung cancer screening being touted as a major breakthrough in the war on cancer the question naturally arises as to why it is not being performed more frequently. There have been many reasons to explain the poor uptake, ranging from merely a slow start but expected steady increase, lack of awareness by the clinician or potential screenee, obstacles such as the shard decision making requirement, too many potential harms, and lack of significant benefits.

      This lack of perceived significant benefit is perhaps the most important aspect, since without a substantial benefit, even if the harms were minimized, why would anyone get screened and why would a clinician recommend it. It seems that this is clearly influencing the decision not to be screened as many experts and even guideline organizations consider the benefits to not be sufficient enough so as to recommend the screening. Even CMS considered the balance of the risks and benefits so tenuous that they took the unique step of requiring a shared decision making process to be included as necessary for reimbursement so that a person could balance the risks and benefits.

      It is this aspect of benefit that needs to be considered more carefully when explaining it to a potential screenee. Current decision aids, which are required as part of a shared decision making process, in the US and Canada rely almost exclusively on the NLST result and attempt to convert its findings into more visual aids. However, in translating those NLST results, it needs to be understood that they were highly dependent on the design parameters of the study itself, namely 3 rounds of screening and 6.5 years of follow-up. When these parameters change so do the benefits. In the US, current recommendations for screening include annual screening over the period of eligibility for the participant (although for Canada it is restricted to 3 years). Under the circumstance of continued annual screening, the reduction in mortality begins to approach the estimated cure rate for the cancer. It is this feature of cure rate that is really what is most important to any person interested in being screened, and it is substantially higher than the mortality reduction seen in a randomized trial where by necessity the mortality reduction is diluted by the time interval after screening has stopped and cancers are still being followed, and also by not including those cancers that are relatively slow growing and cured as a result of early treatment but not counted towards the mortality reduction because the trial has concluded before their counterpart in the control arm has died. Based on these considerations, it is possible to have a cancer that is 100% curable when screen detected, yet the trial may only show a 20% (or even lower) mortality reduction. Thus, there is inherently no incompatibility between the 80% cure rate seen in the I-ELCAP compared with the 20% mortality reduction seen in the NLST. The simple conversion of the 20% mortality reduction found in NLST into a cure rate as is so commonly done when explaining the benefit to a person interested in screening is highly misleading. The cure rate, which is the clinically relevant feature, is higher. This coupled with the way in which harms are currently expressed, based again almost solely on those NLST results has the effect of amplifying harms at the same time the benefits are being underestimated and surely affect the perception of overall value of CT screening both for physicians as well as people who might be interested.

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      S01.07 - The U19 Plans for Integration of Biomarkers into Future Lung Cancer Screening (Now Available) (ID 11888)

      08:00 - 08:50  |  Presenting Author(s): Rayjean J. Hung, Paul Brennan, Christopher Ian Amos

      • Abstract
      • Presentation
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      Abstract

      We are performing a series of three integrated research projects with the unifying goal of reducing mortality from LC by applying targeted approaches to its prevention or early detection. These projects study (1) genetic susceptibility to nicotine dependence and lung cancer, (2) biomarkers for early detection, and (3) application of the results for LC screening. This proposal leverages an extensive collaborative framework and wealth of data from the International Lung Cancer Consortium (ILCCO), the Transdisciplinary Research in Cancer of the Lung (TRICL) Consortium and the Lung Cancer Cohort Consortium (LC3). Epidemiological data from 60 LC studies have been harmonized within ILCCO including 71,000 cases and more than 1 million cohort individuals.

      Aims and Results

      Project 1: Genomic Predictors of Smoking and Lung Cancer Risk. This project extends and augments genomic analyses that have been completed on 16,000 LC cases and 50,000 controls and extensively characterizes the contribution that genetic variation makes to LC susceptibility. The four aims are. Aim 1: To precisely characterize the contribution of common genetic variation to LC etiology. We will analyze a GWAS of LC of 47,506 genotyped LC cases and 63,687 controls. Aim 2: To investigate uncommon genetic variants using imputation approaches. Aim 3: To identify genetic effects on smoking behavior. Aim 4: To characterize joint effects of environmental and genetic interactions on LC risk. For this aim we will take advantage of novel statistical approaches (Mendelian Randomization, Mediation analysis, gene by environment interactions and pathway based analyses) developed by our team to provide a comprehensive approach to evaluating the impact of environmental factors according to genetic background. Recent findings from project 1 include identification of 10 new loci influencing lung cancer risk, the identification of 3 novel gene-smoking interactions contributing to lung cancer risk, identification and validation of two rare variants that convey an over four fold higher risk for lung cancer among carriers, and Mendelian randomization studies that show excess BMI and shorter telomere lengths increase lung cancer risk in a histology-dependent fashion.

      Project 2: Biomarkers of Lung Cancer Risk. Multiple preliminary studies have implicated a wide range of circulating biomarkers in risk prediction for lung cancer. In Project 2, we hypothesize that a comprehensive and extensively validated risk prediction model that incorporates such risk biomarkers has the potential to substantially improve the selection of subjects at a high risk of developing LC and that these individuals are most likely to benefit from CT screening. This project involves three aims. Aim 1: To organize the LC3, including identifying the study population of 2,300 former and current smoking LC cases that were diagnosed within 5 years of donating their blood sample along with one smoking-matched control per case; and organize sample shipments and database preparation. Aim 2: To replicate a comprehensive panel of promising risk biomarkers and identify those that may be useful for risk prediction. This will involve assaying pre-diagnostic plasma samples for immune biomarkers, protein biomarkers such as pro-surfactant protein B, micro RNAs, methylation markers, and 34 additional promising biomarkers implicated in lung cancer. We will base this initial analysis on 800 case-control pairs from three LC3 cohorts, and define a panel of replicated risk biomarkers that provide non-redundant information on disease risk. Aim 3: To extensively evaluate all replicated risk biomarkers from Aim 2, identifying a minimum set of validated risk biomarkers, and ultimately evaluate the extent to which they improve risk prediction models. This will involve performing additional assays for 1,500 additional case-control pairs selected from 16 separate LC3 cohorts. The final outcome of this work will be risk prediction models incorporating a distinct set of biomarkers that provide meaningful information on disease risk, and these biomarkers will finally be evaluated in CT screening studies in collaboration with Project 3. This project recently completed analysis of a set of 4 biomarkers that improve the classification accuracy in prediction of lung cancer risk by 14% compared with a model that only included demographic and smoking information.

      Project 3: Translating Molecular and Clinical Data to Population Lung Cancer Risk Assessment will evaluate radiographic models using data from the National Lung Screening Trial (NLST), lung cancer CT screening programs in British Columbia Cancer Agency (BCCA), Early Detection of Lung Cancer – a Pan-Canadian Study (PanCan), and the International Early Lung Cancer Action Program- Toronto (IELCAP-Toronto) along with the UK Lung Screen Trial (UKLS), and the Dutch Belgian randomized Lung Cancer Screening trial (NELSON) trial. Data from Projects 1-2 will be used to improve the risk prediction model and the nodule probability models. There are 2 specific aims. Aim 1 will establish an integrated risk prediction model to identify individuals at high risk of lung cancer, initially analyzing epidemiological and smoking related phenotypes and then integrating targeted biomarker, genomic profile, and lung function data applied to LC CT screening populations. We will study 950 CT-detected LC patients with biosamples from 46,057 screening individuals. Specific Aim 2 will establish a comprehensive LC probability models for individuals with LDCT-detected non-calcified pulmonary nodules. In this aim we will (a) first establish the 2D diameter-based probability model in N. American CT programs based on 36,481 participants, and then validate it based on 9,576 participants in the European LDCT programs; (b) establish the volume 3D and radiomics-based probability model in European CT programs based on 9,576 participants in European CT programs, and then validate it in the North American CT screening populations; and (c) assess the added predictive value and clinical usefulness of targeted genomic and molecular profiles in both the 2D diameter- and 3D and radiomics volume-based LC probability models based on risk stratification table analysis and decision curve analysis. Finally we will (d) compare the model performance with the existing classification system such as Lung-RADS. This project has developed and evaluated a polygenic risk score using data from project 1 which highly significantly improves risk prediction for lung cancer risk, but has a limited impact on prediction accuracy.

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      S01.10 - EU Position Statement on Lung Cancer Screening (Now Available) (ID 11891)

      09:00 - 09:20  |  Presenting Author(s): Matthijs Oudkerk

      • Abstract
      • Presentation
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      Abstract not provided

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      S01.14 - Coordination of the Lung Cancer CT Screening Experience (Now Available) (ID 11895)

      09:50 - 10:05  |  Presenting Author(s): Joelle Thirsk Fathi

      • Abstract
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      Abstract

      Coordination of the Lung Cancer CT Screening Experience

      Tobacco use, including cigarette smoking is the most preventable cause of cancer in the entire world, contributing to one third of all cancers. While 80-90% of all lung cancers are directly correlated with cigarette smoking, tobacco is also identified as playing a direct role in a multitude of other malignancies and chronic diseases, and resides in the top ten contributors to human suffering, disability and death (U.S. Department of Health & Human Services, 2014). Tobacco will shorten the lives of 50% of its users, resulting in approximately 17,000 people dying every day in the world (Cahn, 2018)

      Since the National Lung Screening Trial data demonstrated that lung cancer screening provides a reduction in mortality in high-risk patients, (National Lung Screening Trial Research Team et al., 2011) interest and momentum in the adoption of lung cancer screening in the U.S. and abroad has been on a slow but upward trajectory. Yet only 2-4% of eligible people are getting screened (Jemal & Fedewa, 2017).

      Lung cancer screening patients, by having met high-risk criteria, are a defined and select population of people who could greatly benefit from a sophisticated and well-orchestrated lung cancer screening experience. Coordination of successful, high quality, and comprehensive care of patients in the screening environment is challenging, but screening represents an enormous opportunity to reduce disability and death from tobacco use. It is critical that transformation and refinement of screening practices occurs, to adapt a comprehensive model which encompasses a broader scope of diagnoses, treatments, and patient education.

      Uptake of lung cancer screening has been slow in the U.S., and education around screening needs to be continually promoted. Additionally, we need to continue to develop and refine the roles and responsibilities of all involved in the screening process, including the patient. Current diagnostic and health information technology allows for more precise, easier, faster, and safer care. In the setting of lung cancer screening, low dose computed tomography of the lung can often provide a snapshot into a patient’s overall health and has the potential to alert the healthcare team and the patient to additional potential disease states, to which we are obligated to address.

      Additionally, lung cancer screening is a unique and ideal opportunity to address tobacco cessation with patients. Technology is critical, but can’t replace coordination of care, patient engagement, and education with this invaluable opportunity for detection of tobacco related diseases and tobacco cessation efforts. Screening requirements and the high incidence of abnormal findings on screening scans represents the need for interprofessional collaboration, and a concert of sequential events and highly coordinated care potentially involving many members of different healthcare teams.

      In the setting of healthcare today, with an emphasis on collaboration and coordination of care, screening should be viewed and treated as a long-term commitment by all parties, and engagement and partnership with patients and fellow referring providers is critical in redefining the patient experience and delivery of care. It is not just about the chest CT; in fact, this is minor compared to the potential to intervene, and even halt disease progression and reduce risk with health behavior modification, while realizing earlier diagnosis and intervention, and saving money and lives.

      Cahn, Z., Drope, J., Hamill, S., Gomeshtapeh, F., Liber, Al, Nargis, N., Stoklosa, M.,. (2018). Health Effects. In J. Drope, Schluger, N., (Ed.), The tobacco atlas (pp. 24-25). Atlanta, Georgia: American Cancer Society.

      Jemal, A., & Fedewa, S. A. (2017). Lung Cancer Screening With Low-Dose Computed Tomography in the United States-2010 to 2015. JAMA Oncol, 3(9), 1278-1281. doi:10.1001/jamaoncol.2016.6416

      National Lung Screening Trial Research Team, Aberle, D. R., Adams, A. M., Berg, C. D., Black, W. C., Clapp, J. D., . . . Sicks, J. D. (2011). Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 365(5), 395-409. doi:10.1056/NEJMoa1102873

      U.S. Department of Health & Human Services. (2014). The health consequences of smoking—50 years of progress: A report of the Surgeon General 2014, executive summary. Retrieved from http://www.surgeongeneral.gov/library/reports/50-years-of-progress/

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      S01.15 - Integration of Smoking Cessation into Lung Cancer Screening (Now Available) (ID 11896)

      10:05 - 10:20  |  Presenting Author(s): Kate Brain

      • Abstract
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      Abstract

      Cigarette smoking is the largest preventable risk factor for lung cancer, disproportionately affecting people from socioeconomically disadvantaged communities. Low dose computed tomography (CT) screening for high risk smokers is now the standard of care in the United States, with implementation pending in Europe. The potential health gains from combined CT lung screening and smoking cessation are considerable. Recent evidence disputes the notion that CT screening offers a “license to smoke” and reveals that engaging with lung screening can give smokers an opportunity to access smoking cessation support at a time when they are likely to be receptive to offers of help. However, considerable challenges remain in identifying methods of engaging high risk smokers in lung screening, and little evidence exists on the optimal design and delivery of effective smoking cessation interventions in this setting. Findings from studies including the United Kingdom Lung Screening trial (UKLS1) will be presented to highlight patient barriers and facilitators to successful integration of smoking cessation within the lung screening pathway, including beliefs and attitudes towards lung screening among high risk smokers, and the impact of abnormal lung scan results. Using the UK-wide Lung Symptom Awareness and Health (LUSH) study example, reflections will also be made on contextual barriers to engaging smokers with comorbid lung conditions living in areas of socioeconomic deprivation. Emerging issues and trends will be presented in methods of recruiting high risk smokers using community-based strategies, and developing personalised materials to support smoking cessation. Novel methods of designing, delivering and testing smoking cessation interventions embedded in the lung screening context will be considered. This presentation will be relevant to clinicians and scientists who are interested in the contribution of behavioural science to optimising lung cancer screening protocols as a teachable moment for smoking cessation, designing evidence-based clinical services to deliver the maximum health benefits for current and future generations.

      1 Brain K, Carter B, Lifford KJ, Burkes O, Devaraj A, Baldwin D, Duffy S, Field JK. Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening trial. Thorax 2017 72:912–918. http://dx.doi.org/10.1136/thoraxjnl-2016-209690.

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      S01.17 - Session V: Panel Discussion: Next Steps for Lung Screening? (Now Available) (ID 11898)

      10:30 - 11:30  |  Presenting Author(s): Claudia I Henschke, Kwun M Fong, Motoyasu Sagawa, Matthew Eric Callister, Nasser Altorki, Bruce Pyenson, Andrea Katalin Borondy Kitts

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      S01.18 - IASLC Leads the International Collaboration on Data Sharing (IASLC- ELIC-CCTRR) (Now Available) (ID 11899)

      11:30 - 11:50  |  Presenting Author(s): John Kirkpatrick Field, James L Mulshine

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      Abstract

      The IASLC ELIC-CCTR vision is to create a globally-accessible, privacy-secured environment to enable the analysis and study of extremely large collections of quality-controlled internationally assembled CT lung cancer images and associated biomedical data for research and healthcare delivery. This initiative will rapidly accelerate improvements to the multi-disciplinary management of early curable, lung cancer and other major thoracic diseases. This new research environment will be deployed and used to conduct global studies within the first two years of this project and is designed to one day scale to enabling coherent analysis across millions of cases.

      The current problem is that the implementation and advancement of lung cancer low dose CT screening (LDCT) screening requires large and high-quality collections of data obtained from global populations with currently deployed scanning equipment 1-5. Furthermore, there are new opportunities to develop deep learning methods for lung cancer imaging, which requires large quality-controlled datasets. As a community we have to very aware of the privacy challenges around data sharing. Lack of high quality data has been a barrier to LDCT screening progress.

      The way forward has been developed at the recent IASLC Confederation of CT Screened Patients Registry & Resource (CCTRR) Roundtable Workshop, as outlined in figure 1.

      figure 1.jpg

      IASLC will develop and run a new international collaborative (the ELIC framework) building on the processes established in the successful TNM Staging project. An internationally-federated Hub and Spoke system will be deployed to permit analysis of CT images and associated data in a secure environment, without any requirement to reveal data itself (i.e. privacy-protecting). No identifiable data ever leaves sources under local governance (PI) control. Existing imaging collections remain in the geographic regions where they were collected, so the resulting environment remains consistent with local regulations without privacy or data disclosure risk. In addition to connecting the world’s largest lung cancer screening registries, which is necessary for exploiting advanced computing capabilities with trustworthy security, enabling the rapid ramp up and participation of new global screening groups.

      The structure will provide the ability to interrogate large, high-quality, and internationally sourced image data sets will allow the lung cancer screening community to identify key insights, publish studies, and make lung cancer recommendations based on potentially millions of screening participants. By validating and distributing common data standards for CT imaging as well as for additional clinical follow-up information, the framework can be applied to the collaborative study of related intrathoracic disease processes.

      1. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354(9173): 99-105.

      2. National Lung Screening Trial Research T, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365(5): 395-409.

      3. van Klaveren RJ, Oudkerk M, Prokop M, et al. Management of lung nodules detected by volume CT scanning. N Engl J Med 2009; 361(23): 2221-9.

      4. Tammemagi MC, Schmidt H, Martel S, et al. Participant selection for lung cancer screening by risk modelling (the Pan-Canadian Early Detection of Lung Cancer [PanCan] study): a single-arm, prospective study. Lancet Oncol 2017; 18(11): 1523-31.

      5. Field JK, Duffy SW, Baldwin DR, et al. The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer. Health Technol Assess 2016; 20(40): 1-146.

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    MTE04 - Comparison of Various Risk Models (Ticketed Session) (ID 814)

    • Event: WCLC 2018
    • Type: Meet the Expert Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/24/2018, 07:00 - 08:00, Room 205 AC
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      MTE04.02 - Where Should Health Programs Set Threshold for Tailored Screening? (Now Available) (ID 11553)

      07:30 - 08:00  |  Presenting Author(s): James L Mulshine

      • Abstract
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      Abstract

      Since the publication of the U.S. Preventive Services Task Force recommendation statement on lung cancer screening much discussion has focused on what is the critical information required to make an informed decision regarding the benefit of undergoing thoracic CT screening (1). Ever more sophisticated modeling approaches are being developed to better characterize the risk: benefit consequences of screening. This session will explore the current state of this complex issue. Yet as screening implementation builds momentum, more information is emerging about the information gleaned from thoracic CT obtained in a population of heavily tobacco-exposed individuals that may profoundly effect the screening health benefit discussion.

      A comprehensive analysis of diseases, injuries and risk factors across the United States from 1990 to 2016 was recently reported by a jointly sponsored consortium from the National Institutes of Health and The Bill and Melinda Gates Foundation, as a guide to investment for research, care and public health policy in the United States (2). According to that report, lung cancer including both the trachea and the bronchi was and remains the second leading cause of years of life lost across the 26 year time interval of that study due to an increase by 26.8% in the number of lung cancer deaths. In that analysis, the most lethal disease process was ischemic heart disease (IHD) which accounted for over 544,000 deaths in 2016. Even though, there was a 15% reduction in IHD mortality since 1990, ischemic heart disease still results in over 2.84 times more deaths than lung cancer. However, for both of these diseases, the age-standardized death rate is fortunately declining.

      In contrast for the third leading cause of death, chronic obstructive pulmonary disease (COPD), over that same 26 year interval, the total number of deaths has increased by 86.9%. Collectively, these three diseases, IHD, lung cancer and COPD account for over 44% of the mortality from the top 25 causes of years of life lost in 2016.

      As we consider risk developing risk models for lung cancer screening, it is useful to step back and consider the information being shared with the individual considering their screening benefit. Currently, in the United States that person being screened is most likely an over 55 years old, current or former smoker with over 30 pack year exposure to tobacco combustion products. As we have just reviewed, the most likely determinants of that individual’s life expectancy are the three most lethal diseases, IHD, lung cancer and COPD.

      Even as we are beginning to screening tobacco-exposed populations, we know that there large numbers of individuals found in the course of their lung cancer screening CT, who will also be found that have asymptomatic but objective evidence of COPD or coronary calcification (3-7). For both IHD and COPD, NIH is encouraging measures to improve the early detection of these two major diseases so that pre-emptive strategies can be employed, before the development of symptoms and avoid the disabling burden of largely incurable advanced disease. Guidelines have already been published for managing the extent of coronary calcium found on thoracic CT scans as promulgated by cardiac professional societies (8). In parallel developments, the pulmonary community is also finding compelling evidence for cardiovascular disease when evaluating for COPD (9). Finding from both of these thoracic CT-detected diseases are frequently being reported on the radiologists’ report for lung cancer screening.

      Considerable progress has been made in developing predictive risk models for lung cancer in the screening setting (10, 11). However, from a screening subjects’ perspective, a lung cancer-only risk analysis does not include the vast majority of risk-for-death information that is relevant to a heavy smoker that could be available on their screening CT in regard to the first and third leading cause of death (IHD or COPD) (2-9). Therefore when considering developing future risk outcomes tools for an individual deciding on whether or not to undergo CT screening for lung cancer, we perhaps need a more inclusive evaluation of health outcomes that consider the major knowable consequences of extensive tobacco exposure. The most recent Surgeon General's Report released in 2014 and summarizing 50 years of studying tobacco health consequences, reaffirmed the causal inference of tobacco smoke to a lengthy list of diseases including most prominently, cancers, cardiovascular disease and chronic obstructive pulmonary disease (12). In discussions about other major chronic diseases such as diabetes or hypertension, people are educated about the multi-organ involvement of these diseases, so they have the information to better protect their health.

      The three leading causes of loss of life (IHD, lung cancer and COPD) in the United States cumulatively account for over 13,500 years of loss of life per year. However, from a heavily tobacco-exposed individual’s perspective, lung cancer only accounts for 26% of this mortality burden. A thoracic CT scan can provide actionable risk information for all three leading tobacco-related causes of death. The most recent draft research plan for the United States Preventive Services Task Force is explicitly evaluating lung cancer screening outcomes for impact on all-cause mortality. It is a critical time to consider more comprehensive tools to transparently inform about the relevant health information available with the use of thoracic CT imaging in heavily tobacco-exposed individuals.

      References:

      1) Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 Mar 4;160(5):330-8. doi: 10.7326/M13-2771.

      2) PMID: 24378917The Burden of Disease Collaborators; Mokdad AH, Murray CJL, Khan AR, et al. The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states. JAMA. doi:10.1001/jama.2018.0158.

      3)Seijo LM and Zulueta JJ. Understanding the links between lung cancer, COPD and emphysema: A key to more effective treatment and screening. Oncology 2017; 31: 93-100.

      4) Shemesh J, Henschke CI, Shaham D, et al. Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology. 2010;257(2):541-548.

      5) Chiles C, Duan F, Gladish GW, et al. Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: A Comparison of Three Scoring Methods. Radiology. 2015;276(1):82-90.

      6) Takx RA, de Jong PA, Leiner T, et al. Automated coronary artery calcification scoring in non-gated chest CT: agreement and reliability. PLoS One. 2014 Mar 13;9(3):e91239. doi: 10.1371/journal.pone.0091239. eCollection 2014.

      7) Malcolm KB, Dinwoodey DL, Cundiff MC et al. Qualitative coronary artery calcium assessment on CT lung screening exam helps predict first cardiac events. J Thorac Dis. 2018. 10: 2740-2751 doi: 10.21037/jtd.2018.04.76.

      8) Harvey S. Hecht, Paul Cronin, et al.SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. Journal of Cardiovascular Computed Tomography, Volume 11: 74-84, 2016.

      9) Bhatt SP, Kazerooni EA, Newell JD Jr et al. Visual estimate of coronary artery calcium predicts cardiovascular disease in COPD, CHEST (2018), doi: 10.1016/j.chest.2018.05.037.

      10) ten Haaf K, Jeon J, Tammemägi MC et al. Risk prediction models for selection of lung cancer screening candidates: a retrospective validation study., PLoS Med, 2017, vol. 14 pg. e1002277.

      11) Katki HA, Kovalchik SA, Petito LC, et al. Implications of Nine Risk Prediction Models for Selecting Ever-Smokers for Computed Tomography Lung Cancer Screening. Ann Intern Med. 2018 May 15. doi: 10.7326/M17-2701. [Epub ahead of print].

      12) US Department of Health and Human Services, The Health Consequences of Smoking: 50 Years of Progress: a Report of the Surgeon General, 2014 Atlanta, GAUS Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

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    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 853)

    • Event: WCLC 2018
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
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      S01.18 - IASLC Leads the International Collaboration on Data Sharing (IASLC- ELIC-CCTRR) (Now Available) (ID 11899)

      11:30 - 11:50  |  Presenting Author(s): James L Mulshine

      • Abstract
      • Presentation
      • Slides

      Abstract

      The IASLC ELIC-CCTR vision is to create a globally-accessible, privacy-secured environment to enable the analysis and study of extremely large collections of quality-controlled internationally assembled CT lung cancer images and associated biomedical data for research and healthcare delivery. This initiative will rapidly accelerate improvements to the multi-disciplinary management of early curable, lung cancer and other major thoracic diseases. This new research environment will be deployed and used to conduct global studies within the first two years of this project and is designed to one day scale to enabling coherent analysis across millions of cases.

      The current problem is that the implementation and advancement of lung cancer low dose CT screening (LDCT) screening requires large and high-quality collections of data obtained from global populations with currently deployed scanning equipment 1-5. Furthermore, there are new opportunities to develop deep learning methods for lung cancer imaging, which requires large quality-controlled datasets. As a community we have to very aware of the privacy challenges around data sharing. Lack of high quality data has been a barrier to LDCT screening progress.

      The way forward has been developed at the recent IASLC Confederation of CT Screened Patients Registry & Resource (CCTRR) Roundtable Workshop, as outlined in figure 1.

      figure 1.jpg

      IASLC will develop and run a new international collaborative (the ELIC framework) building on the processes established in the successful TNM Staging project. An internationally-federated Hub and Spoke system will be deployed to permit analysis of CT images and associated data in a secure environment, without any requirement to reveal data itself (i.e. privacy-protecting). No identifiable data ever leaves sources under local governance (PI) control. Existing imaging collections remain in the geographic regions where they were collected, so the resulting environment remains consistent with local regulations without privacy or data disclosure risk. In addition to connecting the world’s largest lung cancer screening registries, which is necessary for exploiting advanced computing capabilities with trustworthy security, enabling the rapid ramp up and participation of new global screening groups.

      The structure will provide the ability to interrogate large, high-quality, and internationally sourced image data sets will allow the lung cancer screening community to identify key insights, publish studies, and make lung cancer recommendations based on potentially millions of screening participants. By validating and distributing common data standards for CT imaging as well as for additional clinical follow-up information, the framework can be applied to the collaborative study of related intrathoracic disease processes.

      1. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354(9173): 99-105.

      2. National Lung Screening Trial Research T, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365(5): 395-409.

      3. van Klaveren RJ, Oudkerk M, Prokop M, et al. Management of lung nodules detected by volume CT scanning. N Engl J Med 2009; 361(23): 2221-9.

      4. Tammemagi MC, Schmidt H, Martel S, et al. Participant selection for lung cancer screening by risk modelling (the Pan-Canadian Early Detection of Lung Cancer [PanCan] study): a single-arm, prospective study. Lancet Oncol 2017; 18(11): 1523-31.

      5. Field JK, Duffy SW, Baldwin DR, et al. The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer. Health Technol Assess 2016; 20(40): 1-146.

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