Evidence builds to support lung cancer screening in high-risk

Lung cancer

By Mardi Chapman

27 Nov 2017

Lung cancer screening for people at high risk is feasible with risk prediction tools helping to refine the process, the Asian Pacific Society of Respirology (APSR) Congress was told.

Research from the Lungscreen WA Project presented at the Congress showed use of the PLCO 2012 helped stratify patients as either low risk or high risk requiring immediate or early investigation.

The PCLO 2012 incorporates not just age and smoking history but additional parameters such as socioeconomic status, previous malignancy and physician diagnosed COPD or emphysema.

Associate Professor Fraser Brims, from the Institute for Respiratory Health at the Sir Charles Gairdner Hospital and Curtin University, told the limbic the pre-screening for eligibility could be done over the phone or sent in.

“We know lung cancer screening is effective at picking up early lung cancer but only in high-risk groups, not everybody who has ever smoked.”

“Currently 8 out of 10 lung cancers are diagnosed at a time when we can’t offer curative treatment. Whereas in 80% of lung cancers diagnosed from screening a high-risk population, we can offer curative treatment.”

“However any screening program has got to be carefully controlled, uniform and protocol driven. We can’t have people just performing it ad hoc in the community as we know they won’t be selecting high risk people properly or following up the nodules appropriately.”

He said Lungscreen WA was also using the PanCan lung cancer risk prediction model to inform management of indeterminate pulmonary nodules.

“Up until this time, we’ve been relying on guidelines which are considered to be best practice and very conservative – often encouraging frequent CT scans just in case we were missing something.”

However the study found 70% of the cohort with nodules on an initial screen didn’t need any additional tests or scans within 12 months.

Associate Professor Brims said he was confident that research, including the International Lung Screen Trial (ILST), was ‘slowly and methodically’ showing a way forward for lung cancer screening.

“A lot of important questions need answering and ILST, of which 2,000 patients will be recruited from Australia, will answer almost all of those.”

One of the challenges was how to recruit people at high risk from the community, especially when many of those at the highest risk probably did not have a GP.

“Something needs to be done and I’m optimistic. If we find lung cancer early then potentially patients will be fit and eligible for curative treatment.”

As well as surgery, he said stereotactic ablative body radiotherapy (SABR) offered promise for some patients.

He added that while tobacco control remained critically important, the lag time of 20 to 30 years for lung cancer to develop meant many people remained at high risk.

“Tobacco control remains probably the most effective way of reducing lung cancer and many other diseases such as COPD, heart disease and strokes.”

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