programas cribado cancer

Nota bibliográfica cribado c pulmón 2014-10

Ten Haaf K, van Rosmalen J, de Koning HJ. Lung cancer detectability by test, histology, stage and gender: estimates from the NLST and the PLCO trials.Cancer Epidemiol Biomarkers Prev. 2014; Available from: doi: 10.1158/1055-9965.EPI-14-0745. PMID: 25312998.

Conclusions We estimate longer MPSTs for lung cancer compared to previous research, suggesting a greater window of opportunity for lung cancer screening. Impact This study provides detailed insights into the natural history of lung cancer and CT screening effectiveness.

Horeweg N, Th Scholten E, de Jong PA, van der Aalst CM, Weenink C, Lammers J-WJ, et al. Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers. Lancet Oncol. 2014;(0). Available from: doi:

 SummaryBackground Low-dose CT screening is recommended for individuals at high risk of developing lung cancer. However, CT screening does not detect all lung cancers: some might be missed at screening, and others can develop in the interval between screens. The NELSON trial is a randomised trial to assess the effect of screening with increasing screening intervals on lung cancer mortality. In this prespecified analysis, we aimed to assess screening test performance, and the epidemiological, radiological, and clinical characteristics of interval cancers in NELSON trial participants assigned to the screening group. Methods Eligible participants in the NELSON trial were those aged 50–75 years, who had smoked 15 or more cigarettes per day for more than 25 years or ten or more cigarettes for more than 30 years, and were still smoking or had quit less than 10 years ago. We included all participants assigned to the screening group who had attended at least one round of screening. Screening test results were based on volumetry using a two-step approach. Initially, screening test results were classified as negative, indeterminate, or positive based on nodule presence and volume. Subsequently, participants with an initial indeterminate result underwent follow-up screening to classify their final screening test result as negative or positive, based on nodule volume doubling time. We obtained information about all lung cancer diagnoses made during the first three rounds of screening, plus an additional 2 years of follow-up from the national cancer registry. We determined epidemiological, radiological, participant, and tumour characteristics by reassessing medical files, screening CTs, and clinical CTs. The NELSON trial is registered at, number ISRCTN63545820. Findings 15 822 participants were enrolled in the NELSON trial, of whom 7915 were assigned to low-dose CT screening with increasing interval between screens, and 7907 to no screening. We included 7155 participants in our study, with median follow-up of 8·16 years (IQR 7·56–8·56). 187 (3%) of 7155 screened participants were diagnosed with 196 screen-detected lung cancers, and another 34 (

Wood DE. The Importance of Lung Cancer Screening With Low-Dose Computed Tomography for Medicare Beneficiaries. JAMA Intern Med. 2014; Available from: doi: 10.1001/jamainternmed.2014.5623. PMID: 25317992.

 The National Lung Screening Trial has provided convincing evidence of a substantial mortality benefit of lung cancer screening with low-dose computed tomography (CT) for current and former smokers at high risk. The United States Preventive Services Task Force has recommended screening, triggering coverage of low-dose CT by private health insurers under provisions of the Affordable Care Act. The Centers for Medicare & Medicaid Services (CMS) are currently evaluating coverage of lung cancer screening for Medicare beneficiaries. Since 70% of lung cancer occurs in patients 65 years or older, CMS should cover low-dose CT, thus avoiding the situation of at-risk patients being screened up to age 64 through private insurers and then abruptly ceasing screening at exactly the ages when their risk for developing lung cancer is increasing. Legitimate concerns include false-positive findings that lead to further testing and invasive procedures, overdiagnosis (detection of clinically unimportant cancers), the morbidity and mortality of surgery, and the overall costs of follow-up tests and procedures. These concerns can be mitigated by clear criteria for screening high-risk patients, disciplined management of abnormalities based on algorithms, and high-quality multidisciplinary care. Lung cancer screening with low-dose CT can lead to early diagnosis and cure for thousands of patients each year. Professional societies can help CMS responsibly implement a program that is patient-centered and minimizes unintended harms and costs.

Horeweg N, van Rosmalen J, Heuvelmans MA, van der Aalst CM, Vliegenthart R, Th Scholten E, et al. Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol. 2014;(0). Available from: doi:

 SummaryBackground The main challenge in CT screening for lung cancer is the high prevalence of pulmonary nodules and the relatively low incidence of lung cancer. Management protocols use thresholds for nodule size and growth rate to determine which nodules require additional diagnostic procedures, but these should be based on individuals’ probabilities of developing lung cancer. In this prespecified analysis, using data from the NELSON CT screening trial, we aimed to quantify how nodule diameter, volume, and volume doubling time affect the probability of developing lung cancer within 2 years of a CT scan, and to propose and evaluate thresholds for management protocols. Methods Eligible participants in the NELSON trial were those aged 50–75 years, who have smoked 15 cigarettes or more per day for more than 25 years, or ten cigarettes or more for more than 30 years and were still smoking, or had stopped smoking less than 10 years ago. Participants were randomly assigned to low-dose CT screening at increasing intervals, or no screening. We included all participants assigned to the screening group who had attended at least one round of screening, and whose results were available from the national cancer registry database. We calculated lung cancer probabilities, stratified by nodule diameter, volume, and volume doubling time and did logistic regression analysis using diameter, volume, volume doubling time, and multinodularity as potential predictor variables. We assessed management strategies based on nodule threshold characteristics for specificity and sensitivity, and compared them to the American College of Chest Physicians (ACCP) guidelines. The NELSON trial is registered at, number ISRCTN63545820. Findings Volume, volume doubling time, and volumetry-based diameter of 9681 non-calcified nodules detected by CT screening in 7155 participants in the screening group of NELSON were used to quantify lung cancer probability. Lung cancer probability was low in participants with a nodule volume of 100 mm3 or smaller (0·6% [95% CI 0·4–0·8]) or maximum transverse diameter smaller than 5 mm (0·4% [0·2–0·7]), and not significantly different from participants without nodules (0·4% [0·3–0·6], p=0·17 and p=1·00, respectively). Lung cancer probability was intermediate (requiring follow-up CT) if nodules had a volume of 100–300 mm3 (2·4% [95% CI 1·7–3·5]) or a diameter 5–10 mm (1·3% [1·0–1·8]). Volume doubling time further stratified the probabilitie…

Vannier MW. Nodule size and overdiagnosis in lung cancer CT screening. J. Natl. Cancer Inst. United States; 2014. doi: 10.1093/jnci/dju325. PMID: 25326639.

Filippo L, Principe R, Cesario A, Apolone G, Carleo F, Ialongo P, et al. Smoking Cessation Intervention Within the Framework of a Lung Cancer Screening Program: Preliminary Results and Clinical Perspectives from the “Cosmos-II” Trial.Lung. 2014; doi: 10.1007/s00408-014-9661-y. PMID: 25323328.

 Data coming from the literature investigating the effectiveness and interaction between smoking cessation (SC) and lung cancer screening (LCScr) are still sparse and inconsistent. Herein, we report the preliminary results from the ongoing lung cancer screening trial (“Cosmos-II”) focusing our analysis on the inter-relationship between the SC program and the LCScr.

Hutchinson L. Screening: NELSON shows less is more in lung cancer screening. Nat Rev Clin Oncol. 2014; doi: 10.1038/nrclinonc.2014.182. PMID: 25331180.

Mazzone P, Powell CA, Arenberg D, Bach P, Detterbeck F, Gould M, et al. Components Necessary for High Quality Lung Cancer Screening: American College of  Chest Physicians and American Thoracic Society Policy Statement. Chest. 2014; doi: 10.1378/chest.14-2500. PMID: 25356819.

Lung cancer screening with a low dose chest CT scan can result in more  benefit than harm when performed in settings committed to developing and maintaining high quality programs. This project aimed to identify the components of screening that should be a part of all lung cancer screening programs. To do so, committees with expertise in lung cancer screening were assembled by the Thoracic Oncology Network of the ACCP and the Thoracic Oncology Assembly of the ATS. Lung cancer program components were derived from evidence-based reviews of lung cancer screening, and supplemented by expert opinion. This statement was developed and modified based on iterative feedback of the committees. Nine essential components of a lung cancer screening program were identified. Within these components twenty one Policy Statements were developed and translated into criteria that could be used to assess the qualification of a program as a screening facility. Two additional Policy Statements related to the need for multi-society governance of lung cancer screening were developed. High quality lung cancer screening programs can be developed within the presented framework of nine essential program components outlined by our committees. This document has been formally endorsed by several professional organizations (ACCP, ATS, American Association of Thoracic Surgery, American Cancer Society, American Society of Preventive Oncology).

Parker MS, Groves RC, Fowler AA 3rd, Shepherd RW, Cassano AD, Cafaro PL, et al. Lung Cancer Screening With Low-dose Computed Tomography: An Analysis of the MEDCAC Decision. J Thorac Imaging. 2014; doi: 10.1097/RTI.0000000000000119. PMID: 25286290.

 Lung cancer is the leading cause of cancer death in the United States and worldwide. However, among the top 4 deadliest cancers, lung cancer is the only one not subject to routine screening. Optimism for an effective lung cancer-screening examination soared after the release of the National Lung Screening Trial results in November 2011. Since then, nearly 40 major medical societies and organizations have endorsed low-dose computed tomography (LDCT) screening. In December 2013, the United States Preventive Services Task Force also endorsed LDCT. However, the momentum for LDCT screening slowed in April 2014 when the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) panel concluded that there was not enough evidence to justify the annual use of LDCT scans for the detection of early lung cancer. This article briefly reviews the epidemiology of lung cancer, the National Lung Screening Trial study results, and the growing national endorsement of LDCT from a variety of key stakeholder organizations. We subsequently analyze and offer our evidence-based counterpoints to the major assumptions underlying the MEDCAC decision.

Woolf SH, Harris RP, Campos-Outcalt D. Low-Dose Computed Tomography Screening for Lung Cancer: How Strong Is the Evidence?. JAMA Intern Med. 2014; doi: 10.1001/jamainternmed.2014.5626. PMID: 25317533.

 In 2013, the US Preventive Services Task Force (USPSTF) recommended low-dose computed tomographic (CT) screening for high-risk current and former smokers with a B recommendation (indicating a level of certainty that it offered moderate to substantial net benefit). Under the Affordable Care Act, the USPSTF recommendation requires commercial insurers to fully cover low-dose CT. The Centers for Medicare & Medicaid Services (CMS) is now considering whether to also offer coverage for Medicare beneficiaries. Although the National Lung Screening Trial (NLST) demonstrated the efficacy of low-dose CT, implementation of national screening may be premature. The magnitude of benefit from routine screening is uncertain; estimates are based on data from a single study and simulation models commissioned by the USPSTF. The potential harms-which could affect a large population-include false-positive results, anxiety, radiation exposure, diagnostic workups, and the resulting complications. It is unclear if routine screening would result in net benefit or net harm. The NLST may not be generalizable to a national screening program for the Medicare age group because 73% of NLST participants were younger than 65 years. Moreover, screening outside of trial conditions is less likely to be restricted to high-risk smokers and qualified imaging centers with responsible referral protocols. Until better data are available for older adults who are screened in ordinary (nontrial) community settings, CMS should postpone coverage of low-dose CT screening for Medicare beneficiaries.

Xu DM, Lee IJ, Zhao S, Rowena Y, Farooqi A, Cheung EH, et al. CT Screening for Lung Cancer: Value of Expert Review of Initial Baseline Screenings. Am J Roentgenol. 2014;1–6. doi: 10.2214/AJR.14.12526. PMID: 25349980.

CONCLUSION. The quality assurance process helped focus educational programs and provided an excellent vehicle for review of the protocol with participating physicians. It also suggests that the rate of positive results can be reduced by such measures.

Gierada DS, Pinsky P, Nath H, Chiles C, Duan F, Aberle DR. Projected outcomes using different nodule sizes to define a positive CT lung cancer screening examination.J Natl Cancer Inst. United States; 2014;106(11). doi: 10.1093/jnci/dju284. PMID: 25326638.

CONCLUSION: Raising the nodule size threshold for a positive screen would substantially reduce false-positive CT screenings and medical resource utilization with a variable impact on screening outcomes.

Horeweg N, de Koning H. The importance of screening for lung cancer. Expert Rev Respir Med. England; 2014;8(5):597–614. doi: 10.1586/17476348.2014.937428. PMID: 25158921.

 Lung cancer is a major public health problem as it causes the most cancer-related deaths worldwide. As the disease often causes no symptoms at early stages, diagnosis at advanced stages, wherein cure is no longer possible, is common. Improvements in lung cancer treatment have been made, but yielded only modest improvement in survival over the last decades. Continuous efforts should be made to force back exposure to causative agents of lung cancer, tobacco smoking in particular. However, this is not expected to reverse the lung cancer epidemic in the next decades. Lung cancer screening can reduce morbidity and mortality by detecting lung cancer at an early and curable stage. Initial estimates of many harms and benefits of screening have been made, suggesting that the benefits of low-dose computed tomography screening outweigh the harms. Finally, the success of an implemented screening program is determined by the benefit it will yield for public health.

Baldwin D, O’Dowd E. Next Steps and Barriers to Implementing Lung Cancer Screening With Low Dose Computed Tomography. Br J Radiol. 2014;20140416. doi: 10.1259/bjr.20140416. PMID: 25315795.

 The mortality from lung cancer exceeds that from breast, colorectal and pancreatic cancer combined. This is because three-quarters of patients present with late stage disease when treatment is palliative and survival is short. If detected early, lung cancer can be cured so screening would seem to be an important intervention. Until the publication of the National Lung Screening Trial there was no evidence to support the implementation of screening with low-dose CT. This publication has sparked a different approach to the subject from asking whether it works to what we still need to know to implement with least harm and cost. These remaining issues will be reviewed.

Song J, Zhang A. Screening for lung cancer. Clin J Oncol Nurs. United States; 2014;18(5):601. doi: 10.1188/14.CJON.601. PMID: 25253117.
 To assess whether screening methods of the chest (sputum examinations, chest radiography, or computed tomography [CT] scanning) are effective in reducing lung cancer mortality.

Mulshine JL, Henschke CI. Lung cancer screening: achieving more by intervening less. Lancet Oncol. 2014;(0). Available from: doi:

Kinsinger LS, Atkins D, Provenzale D, Anderson C, Petzel R. Implementation of a New Screening Recommendation in Health Care: The Veterans Health Administration’s Approach to Lung Cancer Screening. Ann Intern Med. United States; 2014;161(8):597–8. doi: 10.7326/M14-1070. PMID: 25111673.

Steinbrook R. LUng cancer screening with low-dose computed tomography for medicare beneficiaries. JAMA Intern Med. 2014; Available from:

 Although the prevention of deaths from lung cancer is a public health priority, the role of screening has been unclear. In 2011, the National Lung Screening Trial found that screening with low-dose computed tomography (CT) reduced mortality.2 In 2013, the US Preventive Services Task Force issued a B recommendation for screening with low-dose CT for high-risk current and former smokers, concluding that the screening was likely to offer moderate to substantial net benefit.
web desarrollada y mantenida por :