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David F. Yankelevitz



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    ES08 - Critical Concerns in Screening (ID 11)

    • Event: WCLC 2019
    • Type: Educational Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
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      ES08.03 - The Magnitude of the Benefit (Now Available) (ID 3193)

      13:30 - 15:00  |  Presenting Author(s): David F. Yankelevitz

      • Abstract
      • Presentation
      • Slides

      Abstract

      Why do people get screened? The obvious answer is so that cancer can be detected early with a view towards a higher chance of cure with early treatment. Therefore the critical questions that must be addressed relate to the risk of cancer over time and then, how likely cure will be when screen-detected versus clinically detected. Current approaches to evaluate screening have relied on randomized controlled trials with a view towards demonstrating that a benefit actually exists but are not designed to quantify the magnitude of the benefit. Current trial designs have limited rounds of screening and long-term follow up after screening has stopped. When these parameters change, the results of the trial will also change. Several approaches currently exist to estimate that critical parameter regarding the curability of screen detected lung cancer. This includes modeling approaches which can use data extracted from a variety of sources, they can also be measured directly as was done in the I-ELCAP study which measures directly the reduction in case fatality rate by using long term survival as a measure of cure, and an additional approach would be to screen continuously in the context of a clinical trial and measure the reduction in mortality after several years of screening where the benefit of screening reaches its maximum and becomes equivalent to the reduction in case fatality rate. When applied to lung cancer it can be shown that this benefit is far greater than the 20% so commonly reported and instead is in the 60=80% range for cure. Were this to be fully understood the entire rationale behind requiring shared decision making would be called into question as it was thought that the balance between benefits and harms was so tenuous that shared decision making was necessary.

      When considering whether a particular type of screening is to be considered beneficial there is also a tendency to compare different types of screening and seeing how many screens are necessary to save a life. Here to, this approach suffers from the same mistake. Each of those screening exams estimates this number based on their own randomized trial and each of these differ in terms of the design parameters, therefore the comparisons are essentially meaningless.

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    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 96)

    • Event: WCLC 2019
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
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      S01.11 - Framing Current Status (Now Available) (ID 3637)

      07:00 - 12:00  |  Presenting Author(s): David F. Yankelevitz

      • Abstract
      • Presentation
      • Slides

      Abstract

      CT screening has gained increased acceptance due to results from recently reported randomized controlled trials. Nevertheless, there continues to be concerns regarding the benefits. Articles continue to appear describing a very marginal benefit versus harms. This concern has likely impacted its uptake both in the US and globally. There is a strong need to rethink what is the relevant information to provide to a person interested in screening. The most obvious answer would related to their frequency of being diagnosed with a potentially life threatening cancer and then how curable it would be if found early by screening versus later when symptom prompted. Without knowing these specifics there is no rational way to make a decision. Nevertheless, this type of information is not routinely available and is commonly misrepresented in the literature. It is vital that people understand that lung cancer can be found early in the majority of cases and that surgery is curative in the majority of them as well. Another aspect of screening that directly affects the overall usefulness relates to the management of screen detected findings. Currently there are several different protocols that are being used. It will be important to be able to learn from each of these how well they perform and in particular, which aspects of the protocols work best. Some standardized measure that compares their efficiency would be useful. This not only would apply to the management schemes but also to the various software that is being applied. The use of volumetrics has been gaining continued acceptance, but it has different roles, it can be used for setting size thresholds and also looking for change over time. Each of these represent important areas that can have a large impact and both aspects need to be studied separately. Finally there is continued advancement in our ability to look for other findings on the same basic scan. The overall benefits that are likely to come about as a result of the screening process will extend to other illnesses and how this will be integrated into an overall assessment of benefit should be a high priority for those interested in screening.

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