Virtual Library
Start Your Search
Hilary Robbins
Author of
-
+
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 | Presenting Author(s): Hilary Robbins
- 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.
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 | Presenting Author(s): Hilary Robbins
- Abstract
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).
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.
-
+
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
- Moderators:John Kirkpatrick Field, James L Mulshine
- Coordinates: 9/07/2019, 07:00 - 12:00, Colorado Springs (1994)
-
+
S01.19 - Biomarkers (Now Available) (ID 3644)
07:00 - 12:00 | Author(s): Hilary Robbins
- Abstract
- Presentation
Abstract
Improved risk stratification has the potential to enhance the ratio of benefit to harm for lung cancer screening. Risk biomarkers for lung cancer have been identified that have the potential to contribute to risk stratification, and efforts in this area are ongoing, although whether they are practical or cost-effective remains to be clarified. Recent progress in the use of biomarkers for lung cancer risk stratification and their cost-effectiveness will be discussed.
References
Guida F, et al. .Integrative Analysis of Lung Cancer Etiology and Risk (INTEGRAL) Consortium for Early Detection of Lung Cancer, Assessment of Lung Cancer Risk on the Basis of a Biomarker Panel of Circulating Proteins. JAMA Oncol. 2018 Oct 1;4(10)
Robbins HA, et al. .Benefits and harms in the National Lung Screening Trial: expected outcomes with a modern management protocol. Lancet Respir Med. 2019 May 7
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.
