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Yue Ivy Cheng
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EP1.11 - Screening and Early Detection (ID 201)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.11-02 - Implementation Planning of Lung Cancer Screening in China (Now Available) (ID 961)
08:00 - 18:00 | Presenting Author(s): Yue Ivy Cheng
- Abstract
Background
Lung cancer is the leading cause of cancer-related deaths in China, with approximately 690,000 lung cancer deaths estimated in 2018; this has increased about fivefold from the mid-1970s. Lung cancer low-dose CT (LDCT) screening in smokers was shown to improve the survival in the US National Lung Screening Trial and more recently in the European NELSON trial. However, the predominant risk factor smoking contributes to a lower fraction of lung cancers in China than in Europe and the US. Therefore, it is necessary to establish Chinese-specific screening strategies.
Method
To curate data on Chinese lung cancer screening programmes, we searched four Chinese and four English databases, and other sources including references in papers, policies or news from government websites and personal communications with principal investigators. We reviewed the current evidence for the implementation of lung cancer screening in China to generate Chinese-targeted recommendations.
Result
There are 23 associated programmes completed or ongoing in China since the 1980s, mainly after 2000; and one has recently been planned. Municipal or city-level screening programmes are increasing, particularly after two central government-supported feasibility programmes: the Rural Cancer Screening Programme in 2009 and the Cancer Screening Programmes in Urban China in 2012. Some institutes have established collaborations with international lung cancer screening research groups, i.e. I-ELCAP and NELSON. Most of the programmes targeted community-based high-risk urban residents. Generally, their entry criteria are not smoking-stringent but involve other risk factors, e.g. second-hand smoking, family history of cancer, occupational exposures and air pollution. Some programmes have reported their preliminary results, which demonstrated a different high-risk subpopulation of lung cancer in China and the potential importance of risk-based selection. Evidence concerning LDCT screening implementation is mainly based on randomised controlled trials outside China, which indicates population recruitment, screening protocol and nodule management need more delicate considerations. In addition, LDCT screening programmes combining tobacco control would produce more benefits. Targeting populations to support cost-effectiveness will be important, especially in China where almost half of the lung cancer sufferers are non-smokers.
Conclusion
In China, the high-risk subpopulation eligible for lung cancer screening has not as yet been confirmed, as all the risk parameters have not yet been determined. Though evidence on best practice for implementation of lung cancer screening has been accumulating in other countries, further research in China is urgently required, as China is now facing a lung cancer epidemic.
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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
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.11-21 - Liverpool Health Lung Project: Significant Incidental Findings in a Smoker-Predominant Cohort (Now Available) (ID 1879)
09:45 - 18:00 | Author(s): Yue Ivy Cheng
- Abstract
Background
The Liverpool Healthy Lung Project (LHLP) is a prospective screening cohort which recruits ever-smokers or subjects with COPD aged 58-75 with a lung cancer risk of ≥5% in 5 years by the LLPv2 model. It aims to identify lung cancers at a treatable stage. On chest computed tomography scans, it is common to detect incidental findings with the frequency ranging 36% - 55%, but most of them are minor findings requiring no further management. Thus, it is presumed to be cost-effective if the most significant incidental findings are managed as appropriate in lung cancer screening programmes.
Method
In the LHLP, radiologists alert a significant incidental finding (SIF, not relevant to suspicious lung cancer or indeterminate lung nodule) in the radiological reports if the Radiologist considers an urgent intervention is required; it’s referred to a specialist or general practitioner outside the project. This paper reviewed the alerted reports with SIFs and followed up their final diagnosis and corresponding interventions in three hospital clinical databases.
Result
Among a total of 3336 eligible participants who have completed the baseline scans during Apr 2016 - Feb 2019, 124 SIFs have been identified in 122 individuals (3.7%). The most frequently reported SIFs at baseline are possible extra-pulmonary cancers (45 of 124, 36.3%), followed by lung infections (39 of 124, 31.5%) which often need (post-antibiotic) follow-up to confirm resolution. Nine extra-pulmonary malignancies (7.4% in SIFs, 0.3% in the LHLP) have been pathologically or radiologically confirmed, including 5 lymphomas/leukaemias (4.1%), 2 renal cancers (1.6%), 1 breast cancers (0.8%) and 1 liver metastasis with unknown origin (0.8%). Two lymphoma/leukaemia patients have been treated with chemotherapy and/or radiotherapy, and the other three are currently under active monitoring. Both of the two renal cancer patients have undergone laterally radical nephrectomy, without recurrence in 6 and 20 months after surgery, respectively. The remaining two established cancer patients are still under further investigation. Other common SIFs included 14 interstitial lung diseases (11.3%), three of which have progressed during a post-baseline follow-up time of 6 months - 2 years, and 10 aneurysms/dilated aortas (8.0%), of which two patients have undergone surgical repair and another one has commenced a preventive therapy of statin and anti-plate agent.
Conclusion
Identification by radiology of these SIFs in 3.7% of our screened population facilitates urgent clinical review, and appropriate management of these important, but unexpected findings.
