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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

  • 31331

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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): Peter Sasieni
    • 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).

    

    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.

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