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Fraser Brims
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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
- Moderators:Fabrizio Bianchi, Marcelo Sanchez
- Coordinates: 9/08/2019, 15:15 - 16:45, Dublin (1997)
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MA10.09 - Evaluation of the Clinical Utility of the PanCan, EU-NELSON and Lung-RADS Protocols for Management of Screen Detected Lung Nodules at Baseline (Now Available) (ID 2137)
15:15 - 16:45 | Author(s): Fraser Brims
- Abstract
- Presentation
Background
Several protocols are available to guide management of lung nodules identified by the first (baseline) low-dose screening CT. It is important to objectively assess their clinical utility, health care resource utilization and potential harms. We aim to compare the PanCan (NEJM 2013;369:908 & J Thorac Oncol 2018; 13(10): S362-S363), EU-NELSON (Lancet Oncol. 2017 Dec;18(12):e754-e766 & Lung Cancer 2006;54:177-184) and Lung-RADS(https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Lung-Rads) lung nodule management protocols on our data set from two sites of the International Lung Screen Trial (ILST), in Vancouver, Canada and Perth, Western Australia.
Method
Ever smokers age 55 to 80 years were enrolled into ILST if they had a ≥30 pack-years smoking history and smoked within 15 years or if their PLCO m2012 6 year lung cancer risk was ≥1.51%. The participants were managed via the PanCan lung nodule risk based protocol. The NELSON and Lung-RADS nodule protocols were applied to the ILST data set. The potential difference in the proportion of the participants having an early recall CT scan (< 1 year) or referral to a clinical diagnostic pathway was compared between the PanCan, NELSON, Lung-RADS protocols. The participants were divided into 3 groups: Group 1 (next scheduled annual/biennial CT) included PanCan CAT 1, 2, NELSON NODCAT I, II, Lung-RADS CAT 1, 2. Group 2 (early recall CT <1 year) included PanCan CAT 3, NELSON NODCAT III, Lung-RADS CAT 3, 4A and Group 3 (Diagnostic Pathway) included PanCan CAT 4, 5, NELSON NODCAT IV (solid nodule), Lung-RADS CAT 4B, 4X. The number of participants and the lung cancer rate in each group was compared between the three protocols.
Result
A total of 1386 participants with a median follow-up of 10 months (ranging from 4-31 mos) were evaluated. The results are shown in Table 1.
PanCan selected the fewest individuals to early recall (Group 2 & 3) versus NELSON p=0.004 and detected the same number of lung cancers as did the NELSON and more than by Lung-RADS.
In addition, 81% of the PanCan group 1 participants were triaged to biennial repeat screening instead of annual screening in the NELSON and Lung-RADS protocols, which has substantial resource utilization and radiation exposure implications.
Conclusion
The personalized risk-based PanCan Protocol may decrease resource utilization and potentially minimize risk of screening for participants.
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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
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.11-09 - Australia-Wide Cross-Sectional Survey of General Practitioners’ Knowledge and Practice of Lung Cancer Screening (Now Available) (ID 1767)
10:15 - 18:15 | Author(s): Fraser Brims
- Abstract
Background
High quality randomised controlled trials have demonstrated that low dose computed tomography (LDCT) screening reduce lung cancer deaths in high risk individuals yet current Australian guidelines do not recommend nor fund screening. 1-3 Little is known about current screening practices in Australia.
Method
A survey was distributed to a nationally representative sample of 4 000 Australian general practitioners (GPs) registered with the commercial database of the Australasian Medical Publishing Company. The questionnaire included, respondent demographics, self-reported screening practices, knowledge of screening recommendations, recent screening education and potential factors influencing GPs’ screening practice. Two logistic regression models identified factors associated with self-reported chest X-ray (CXR) or LDCT screening within the last 12 months.
Result
A total of 323 General Practitioners attempted the survey (participation rate 8.1%); 21 were excluded as they did not report recent screening practice. Participants were mostly females (153/302, 50.6%), from collective/group practices (239/302, 79.1%) and metropolitan-based practices (222/302, 73.5%).
Despite the majority of responders understanding that screening is not recommended by Australian professional societies (215/302, 71.2%) a substantial proportion of participants requested a CXR or LDCT screening (140/302, 46.4% and 63/302, 20.8% respectively).
A variety of shared factors (GP reassurance, perceived cost-effectiveness of screening, believing screening is funded) and unique practice, educational and cognitive factors were associated with self-reported LDCT and CXR screening, with the strongest association being recent education about screening from radiology practices (aOR for LDCT screening 10.443, p<0.001, Table 1).
Conclusion
In Australia, lung cancer screening is occurring outside a coordinated programme and there is discordance between reported screening practice and national recommendations due to a variety of factors. This highlights an urgent need for clearer guidance and direction from national and professional bodies.
