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Samantha L Quaife
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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
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P1.11-19 - Trial in Progress: Cancer Screening Study With or Without Low Dose Lung CT to Validate a Multi-Cancer Early Detection Blood Test (ID 1840)
09:45 - 18:00 | Author(s): Samantha L Quaife
- Abstract
Background
Few effective screening tests exist for cancer, and each is specific to a single cancer type. A single blood test that directly measures tumor cell-free DNA and can detect several cancer types, including lung, pancreatic, colon, and head & neck cancers, with high specificity may reduce cancer burden. The SUMMIT Study is designed to validate the ability of an investigational blood test to detect multiple cancer types among a high-risk population undergoing LDCT for lung cancer screening, as well as in a lower risk population.
Method
SUMMIT is designed to enroll 50,000 participants aged 50-77, and will follow participants for up to 10 years via medical records and the national cancer registry. There will be two groups: Group A (n=25,000), individuals at high-risk for lung and other cancers due to substantial smoking history (per United States Preventive Services Task Force LDCT screening criteria, or PLCOm2012 six-year risk estimate of ≥1.3%); and Group B (n=25,000), individuals not meeting Group A criteria. Exclusion criteria include active cancer treatments. Potential participants are identified from the records of 540 general practices across North Central and East London, and are invited by letter to attend a dedicated LDCT scanning unit (Group A) or clinical unit (Group B), where eligibility is confirmed and consent obtained.
Group A participants will provide a blood sample, complete a questionnaire, and receive a baseline LDCT, and then provide a blood sample and complete a questionnaire at 12 and 24 months post-baseline. Those with a negative baseline LDCT (without lung nodules) will be randomised to either have a LDCT at 12 and 24 months or no further scans. Participants with lung nodules at baseline could have more frequent scans. Group B participants complete a questionnaire and provide a blood sample at three study appointments (baseline, 12 months, 24 months). The primary endpoint is cancer incidence and stage. Blood test performance will be determined by sensitivity and false-positive rates (specificity). Blood test results will not be returned to physicians or participants. Group A enrollment began in April 2019, and Group B enrollment is targeted to start later in 2019.
The study is designed to determine the performance and cost-effectiveness of this investigational multi-cancer blood test compared to or combined with LDCT for identifying lung cancer, and in detecting cancers for which there are no effective screening tests. The SUMMIT Study may therefore inform new approaches to finding cancer early.
Result
Section not applicable
Conclusion
Section not applicable
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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
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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): Samantha L Quaife
- 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.
