TY - JOUR
T1 - Baseline and annual repeat rounds of screening
T2 - implications for optimal regimens of screening
AU - International Early Lung Cancer Action Program Investigators
AU - Henschke, Claudia I.
AU - Salvatore, Mary
AU - Cham, Matthew
AU - Powell, Charles A.
AU - DiFabrizio, Larry
AU - Flores, Raja
AU - Kaufman, Andrew
AU - Eber, Corey
AU - Yip, Rowena
AU - Yankelevitz, David F.
AU - Henschke, Claudia I.
AU - Yankelevitz, David F.
AU - Yip, Rowena
AU - Xu, Dongming
AU - Flores, Raja
AU - Wolf, Andrea
AU - McCauley, Dorothy I.
AU - Chen, Mildred
AU - Libby, Daniel M.
AU - Smith, James P.
AU - Pasmantier, Mark
AU - Reeves, Anthony P.
AU - Markowitz, Steven
AU - Miller, Albert
AU - Deval, Jose Cervera
AU - Roberts, Heidi
AU - Patsios, Demetris
AU - Sone, Shusuke
AU - Hanaoka, Takaomi
AU - Zulueta, Javier
AU - de-Torres, Juan P.
AU - Lozano, Maria D.
AU - Aye, Ralph
AU - Manning, Kristin
AU - Bauer, Thomas
AU - Canitano, Stefano
AU - Giunta, Salvatore
AU - Cole, Enser
AU - Klingler, Karl
AU - Austin, John H.M.
AU - Pearson, Gregory D.N.
AU - Shaham, Dorith
AU - Aylesworth, Cheryl
AU - Meyers, Patrick
AU - Andaz, Shahriyour
AU - Vafai, Davood
AU - Naidich, David
AU - McGuinness, Georgeann
AU - Thurer, Richard
AU - Villamizar, Nestor
N1 - Funding Information:
The I-ELCAP Investigators Mount Sinai School of Medicine, New York, NY: Claudia I. Henschke, Principal Investigator, David F. Yankelevitz, Rowena Yip, Dongming Xu, Mary Salvatore, Raja Flores, Andrea Wolf; Weill Cornell Medical College: Dorothy I. McCauley, Mildred Chen, Daniel M. Libby, James P. Smith, Mark Pasmantier; Cornell University: Anthony P. Reeves; CBNS, City University of New York at Queens College, Queens, NY; Steven Markowitz, Albert Miller; Fundacion Instituto Valenciano de Oncologia, Valencia, Spain: Jose Cervera Deval; University of Toronto, Princess Margaret Hospital, Toronto, Canada: Heidi Roberts, Demetris Patsios; Azumi General Hospital, Nagano, Japan: Shusuke Sone, Takaomi Hanaoka; Clinica Universitaria de Navarra, Pamplona, Spain: Javier Zulueta, Juan P. de-Torres, Maria D. Lozano; Swedish Medical Center, Seattle, WA: Ralph Aye, Kristin Manning; Christiana Care, Helen F. Graham Cancer Center, Newark, DE: Thomas Bauer; National Cancer Institute Regina Elena, Rome, Italy: Stefano Canitano, Salvatore Giunta; St.Agnes Cancer Center, Baltimore, MD: Enser Cole; LungenZentrum Hirslanden, Zurich, Switzerland: Karl Klingler; Columbia University Medical Center, New York, NY: John H.M. Austin, Gregory D. N. Pearson; Hadassah Medical Organization, Jerusalem, Israel: Dorith Shaham; Holy Cross Hospital Cancer Institute, Silver Spring, MD: Cheryl Aylesworth; Nebraska Methodist Hospital, Omaha NE: Patrick Meyers; South Nassau Communities Hospital, Long Island, NY: Shahriyour Andaz; Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA; Davood Vafai; New York University Medical Center, New York, NY: David Naidich, Georgeann McGuinness; Dorothy E. Schneider Cancer Center, Mills-Peninsula Health Services, San Mateo, CA: Barry Sheppard; State University of New York at Stony Brook, Stony Brook, NY: Matthew Rifkin; ProHealth Care Regional Cancer Center, Waukesha & Oconomowoc Memorial Hospitals, Oconomowoc, WI: M. Kristin Thorsen, Richard Hansen; Maimonides Medical Center, Brooklyn, NY: Samuel Kopel; Wellstar Health System, Marietta GA: William Mayfield; St. Joseph Health Center, St. Charles, MO: Dan Luedke; Roswell Park Cancer Institute, Buffalo, NY: Donald Klippenstein, Alan Litwin, Peter A. Loud; Upstate Medical Center, Syracuse, NY: Leslie J. Kohman, Ernest M. Scalzetti; Jackson Memorial Hospital, University of Miami, Miami, FL; Richard Thurer, Nestor Villamizar; State University of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY: Arfa Khan, Rakesh Shah; The 5th Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China: Xueguo Liu; Mercy Medical Center, Rockville Center, NY: Gary Herzog; Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan: Diana Yeh; National Cancer Institute of China, Beijing, China: Ning Wu; Staten Island University Hospital, Staten Island NY: Joseph Lowry, Mary Salvatore; Central Main Medical Center: Carmine Frumiento; Mount Sinai School of Medicine, New York, NY: David S. Mendelson; Georgia Institute for Lung Cancer Research, Atlanta, GA: Michael V. Smith; The Valley Hospital Cancer Center, Paramus NJ: Robert Korst; Health Group Physimed/McGill University, Montreal, CA: Jana Taylor; Memorial Sloan-Kettering Cancer Center, New York, NY: Michelle S. Ginsberg; John Muir Cancer Institute, Concord CA: Michaela Straznicka; Atlantic Health Morristown Memorial Hospital, Morristown NJ: Mark Widmann; Alta Bates Summit Medical Center, Berkeley CA: Gary Cecchi; New York Medical College, Valhalla, NY: Terence A.S. Matalon; St. Joseph’s Hospital, Atlanta GA: Paul Scheinberg; Mount Sinai Comprehensive Cancer Center, Miami Beach, FL: Shari-Lynn Odzer; Aurora St. Luke’s Medical Center, Milwaukee WI: David Olsen; City of Hope National Medical Center, Duarte, CA: Fred Grannis, Arnold Rotter; Evanston Northwestern Healthcare Medical Group, Evanston, IL: Daniel Ray; Greenwich Hospital, Greenwich, CT: David Mullen; Our Lady of Mercy Medical Center, Bronx, NY: Peter H. Wiernik; Baylor University Medical Center, Dallas TX: Edson H. Cheung; Sequoia Hospital, Redwood City CA: Melissa Lim; Glens Falls Hospital, Glens Falls NY: Louis DeCunzo; Atlantic Medical Imaging, Atlantic City NJ: Robert Glassberg; Karmanos Cancer Institute, Detroit, MI: Harvey Pass, Carmen Endress; Rush University, Chicago IL: Mark Yoder, Palmi Shah; Building Trades, Oak Ridge TN: Laura Welch; Sharp Memorial Hospital, San Diego, CA: Michael Kalafer; Newark Beth Israel Medical Center, Newark NJ Jeremy Green; Guthrie Cancer Center, Sayre PA: James Walsh, David Bertsch; Comprehensive Cancer Centers of the Desert, Palm Springs CA: Elmer Camacho; Dickstein Cancer Treatment Center, White Plains Hospital, White Plains NY: Cynthia Chin; Presbyterian Healthcare, Charlotte NC: James O’Brien; University of Toledo, Toledo OH: James C. Willey Funding This study is sponsored in part by the Flight Attendant Medical Research Institute (FAMRI) and a generous gift by Sonia Lasry Gardner given in loving memory of her father, Moise Lasry, to support lung cancer research, outreach and treatment. The FAMRI supports research on never smokers, including assessment of the benefit of screening never smokers.
Funding Information:
Acknowledgements The screenings in the I-ELCAP pooled database have been supported in part by National Institutes of Health R01-CA-63393l and R01-CA-78905; Department of Energy DE-FG02-96SF21260; The City of New York, Department of Health and Mental Hygiene; New York State Office of Science, Technology and Academic Research (NYSTAR); American Cancer Society; The Starr Foundation; The New York Community Trust; The Rogers Family Fund; The Foundation for Lung Cancer: Early Detection, Prevention, and Treatment (including an unrestricted gift in 2000–2003 from the Vector Group, the parent company of Liggett Tobacco); Dorothy R. Cohen Foundation, Jacob and Malka Goldfarb Charitable Foundation; Auen/ Berger Foundation; Berger Foundation; Mills Peninsula Hospital Foundation, Tenet Healthcare Foundation; Ernest E. Stempel Foundation; Academic Medical Development Corporation; Columbia University Medical Center, Empire Blue Cross and Blue Shield; Eastman-Kodak Corporation; General Electric Corporation; Weill Medical College of Cornell University; Cornell University; New York Presbyterian Hospital; Swedish Hospital; Christiana Care Helen F. Graham Cancer Center; Holy Cross Hospital; Eisenhower Hospital; Jackson Memorial Hospital Health System; Evanston Northwestern Healthcare.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Objectives: Differences in results of baseline and subsequent annual repeat rounds provide important information for optimising the regimen of screening. Methods: A prospective cohort study of 65,374 was reviewed to examine the frequency/percentages of the largest noncalcified nodule (NCN), lung cancer cell types and Kaplan–Meier (K-M) survival rates, separately for baseline and annual rounds. Results: Of 65,374 baseline screenings, NCNs were identified in 28,279 (43.3%); lung cancer in 737 (1.1%). Of 74,482 annual repeat screenings, new NCNs were identified in 4959 (7%); lung cancer in 179 (0.24%). Only adenocarcinoma was diagnosed in subsolid NCNs. Percentages of lung cancers by cell type were significantly different (p < 0.0001) in the baseline round compared with annual rounds, reflecting length bias, as were the ratios, reflecting lead times. Long-term K-M survival rate was 100% for typical carcinoids and for adenocarcinomas manifesting as subsolid NCNs; 85% (95% CI 81–89%) for adenocarcinoma, 74% (95% CI 63–85%) for squamous cell, 48% (95% CI 34–62%) for small cell. The rank ordering by lead time was the same as the rank ordering by survival rates. Conclusions: The significant differences in the frequency of NCNs and frequency and aggressiveness of diagnosed cancers in baseline and annual repeat need to be recognised for an optimal regimen of screening. Key Points: • Lung cancer aggressiveness varies considerably by cell type and nodule consistency. • Kaplan–Meier survival rates varied by cell type between 100% and 48%. • The percentages of lung cancers by cell type in screening rounds reflect screening biases. • Rank ordering by cell type survival is consistent with that by lead times. • Empirical evidence provides critical information for the regimen of screening.
AB - Objectives: Differences in results of baseline and subsequent annual repeat rounds provide important information for optimising the regimen of screening. Methods: A prospective cohort study of 65,374 was reviewed to examine the frequency/percentages of the largest noncalcified nodule (NCN), lung cancer cell types and Kaplan–Meier (K-M) survival rates, separately for baseline and annual rounds. Results: Of 65,374 baseline screenings, NCNs were identified in 28,279 (43.3%); lung cancer in 737 (1.1%). Of 74,482 annual repeat screenings, new NCNs were identified in 4959 (7%); lung cancer in 179 (0.24%). Only adenocarcinoma was diagnosed in subsolid NCNs. Percentages of lung cancers by cell type were significantly different (p < 0.0001) in the baseline round compared with annual rounds, reflecting length bias, as were the ratios, reflecting lead times. Long-term K-M survival rate was 100% for typical carcinoids and for adenocarcinomas manifesting as subsolid NCNs; 85% (95% CI 81–89%) for adenocarcinoma, 74% (95% CI 63–85%) for squamous cell, 48% (95% CI 34–62%) for small cell. The rank ordering by lead time was the same as the rank ordering by survival rates. Conclusions: The significant differences in the frequency of NCNs and frequency and aggressiveness of diagnosed cancers in baseline and annual repeat need to be recognised for an optimal regimen of screening. Key Points: • Lung cancer aggressiveness varies considerably by cell type and nodule consistency. • Kaplan–Meier survival rates varied by cell type between 100% and 48%. • The percentages of lung cancers by cell type in screening rounds reflect screening biases. • Rank ordering by cell type survival is consistent with that by lead times. • Empirical evidence provides critical information for the regimen of screening.
KW - CT screening
KW - Lead-time bias
KW - Length bias
KW - Solid nodules
KW - Subsolid nodules
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U2 - 10.1007/s00330-017-5029-z
DO - 10.1007/s00330-017-5029-z
M3 - Article
C2 - 28983713
AN - SCOPUS:85030693100
VL - 28
SP - 1085
EP - 1094
JO - European Radiology
JF - European Radiology
SN - 0938-7994
IS - 3
ER -