Virtual Library

Start Your Search

Christine Dorothy Berg



Author of

  • +

    MA10 - Emerging Technologies for Lung Cancer Detection (ID 129)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • +

      MA10.12 - Discussant - MA10.09, MA10.10, MA10.11 (Now Available) (ID 3752)

      15:15 - 16:45  |  Presenting Author(s): Christine Dorothy Berg

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P1.11 - Screening and Early Detection (ID 177)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
    • +

      P1.11-36 - A Simple Tool to Prioritize US Ever-Smokers for CT Screening Eligibility Assessment (ID 1233)

      09:45 - 18:00  |  Author(s): Christine Dorothy Berg

      • Abstract

      Background

      CT lung cancer screening can be more efficient when risk models are used to determine eligibility. However, detailed risk assessment requires time spent by a healthcare provider and may present a barrier to screening when resources are limited. Here, we developed a tool to identify ever-smokers with low probability of risk-based eligibility.

      Method

      We analyzed ever-smokers aged 50-80 in the representative 2015 US National Health Interview Survey. We defined ever-smokers with 6-year risk ≥1.3% by the 12-question PLCOm2012 model as screening-eligible. We considered that detailed risk assessment may be inefficient when the probability of eligibility is less than 5%. Accordingly, we used cross-tabulations of age, cigarettes-per-day, and quit-years to identify groups in whom risk assessment might be avoided.

      Result

      There are approximately 44,140,774 U.S. ever-smokers aged 50-80 who could consider detailed risk assessment. However, a simple decision-tree tool identified 22,293,477 ever-smokers (50.5%) who are less than 5% likely to be screening-eligible (Figure). This includes all those who smoke(d) less than 5 cigarettes-per-day. Over 1 year, approximately 103,512 lung cancers were predicted among eligible ever-smokers. If our tool were used, then 1,784 of these eligible cases (1.7%) would not undergo detailed risk assessment or screening.

      nhis risk diagram v3.png

      Conclusion

      When resources are limited, a simple decision-tree tool could avoid detailed risk assessment for more than half of U.S. ever smokers aged 50-80, while still identifying 98.3% of eligible cases. Such a tool could be self-administered by patients in the waiting room or applied automatically to electronic health records to optimize use of provider time.

  • +

    P2.11 - Screening and Early Detection (ID 178)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
    • +

      P2.11-07 - Benefits and Harms of Contemporary Lung Cancer Screening: An Infographic to Support Public and Patient Education (ID 1354)

      10:15 - 18:15  |  Author(s): Christine Dorothy Berg

      • Abstract
      • Slides

      Background

      Quantifying and communicating the benefits and harms of low-dose CT (LDCT) lung cancer screening is a complex challenge. Multiple tools have been developed based on the US National Lung Screening Trial (NLST). However, some of these have produced debate and confusion in the public-facing media due to the outdatedness of the NLST protocol and the complexity of the information presented.

      Method

      We developed a new infographic to represent the benefits and harms of contemporary lung screening. We applied the current US nodule management protocol (Lung-RADS v1.0) to the NLST retrospectively. Across the 3 NLST screens and 4 years of follow-up, we used individual-level data to quantify the number of people per 1000 who would have had (a) all normal results (Lung-RADS categories 1 and 2) without lung cancer; (b) any abnormal results (Lung-RADS 3 and 4A/B/X) without lung cancer; (c) invasive diagnostic procedures without lung cancer; and (d) lung cancer diagnosed. We estimated overdiagnosis using the published NLST estimate (18.5%) and reduced the mortality benefit from screening using the reduction in sensitivity from Lung-RADS (13.3%).

      Result

      Applying Lung-RADS to NLST, we found that 779 per 1000 people would have had all normal results, 180 any abnormal results without lung cancer, and 41 lung cancer. Among the 180, 13 would have had an invasive procedure, 0.4 (1 in 2500) a major complication, and 0.2 (1 in 5000) death from any cause within 60 days of the procedure. Finally, among 41 lung cancers, 4 represent overdiagnosis and 3 prevented lung cancer deaths. We compiled these results into an infographic (Figure).

      iarc benefits and harms of lung cancer screening.png

      Conclusion

      Compared with the NLST protocol, modern nodule management reduces harms from screening. Our infographic tool may facilitate communication about lung screening to providers, patients, and the public. It should be updated as additional trial data become available.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    PL02 - Presidential Symposium including Top 7 Rated Abstracts (ID 89)

    • Event: WCLC 2019
    • Type: Plenary Session
    • Track:
    • Presentations: 1
    • Now Available
    • +

      PL02.02 - Lung Cancer Screenee Selection by USPSTF Versus PLCOm2012 Criteria – Interim ILST Findings (Now Available) (ID 2804)

      08:00 - 10:15  |  Author(s): Christine Dorothy Berg

      • Abstract
      • Presentation
      • Slides

      Background

      The National Lung Screening Trial showed that lung cancer screening of high-risk individuals with low dose computed tomography can reduce lung cancer mortality by 20%. Critically important is enrolling high-risk individuals. Most current guidelines including the United States Preventive Services Task Force (USPSTF) and Center for Medicare and Medicaid Services (CMS) recommend screening using variants of the NLST eligibility criteria: smoking ≥30 pack-years, smoking within 15 years, and age 55-80 and 55-77 years. Many studies indicate that using accurate risk prediction models is superior for selecting individuals for screening, but these findings are based on retrospective analyses. The International Lung Screen Trial (ILST) was implemented to prospectively identify which approach is superior.

      Method

      ILST is a multi-centred trial enrolling 4000 participants. Individuals will be offered screening if they are USPSTF criteria positive or have PLCOm2012 model 6-year risk ≥1.5%. Participants will receive two annual screens and will be followed for six years for lung cancer outcomes. Individuals not qualifying by either criteria will not be offered screening, but samples of them will be followed for lung cancer outcomes. Outcomes in discordant groups, USPSTF+ve/PLCOm2012-ve and PLCOm2012+ve/USPSTF-ve, are informative. Numbers of lung cancers and individuals enrolled, sensitivity, specificity and positive predictive values (PPV) of the two criteria will be compared.

      Result

      As of March 2019, ILST centers in Canada (British Columbia), Australia, Hong Kong, and the United Kingdom had enrolled and scanned 3673 individuals. Study results are summarized in Figure 1.

      presentation5.jpg

      Conclusion

      Interim analysis of ILST data, indicates that classification accuracy of lung cancer screening outcomes support the PLCOm2012 criteria over the USPSTF criteria. The PLCOm2012 criteria detected significantly more lung cancers. Individuals who are USPSTF+ve and PLCOm2012-ve appear to be at such low baseline risk (0.2%) that they may be unlikely to benefit from screening.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.