Tables
- TABLE 1
Eligibility criteria for early detection of lung cancer by low dose computed tomography, according to guidelines issued in 2012–2013 by various organisations [5]
Guidelines by organisation Date Age years Smoking history pack-years Smoking cessation years Category/level NCCN Jan 2015 55–74 ≥30 <15 1
2A≥50 ≥20 (and one additional risk factor#) ALA Apr 2012 55–74 ≥30 <15 NA Collaborative work of ACCP/ASCO/NCCN May 2012 55–74 ≥30 <15 2B AATS June 2012 55–79 ≥30 Any active or former smoker 1
2
350–79 ≥20 and added risk ≥5% of developing lung cancer within 5 years¶ Any Any and ≥4 years remission after bronchogenic carcinoma ACS Jan 2013 55–74 ≥30 <15 NA ACCP May 2013 55–74 ≥30 <15 2B USPSTF July 2013 55–79 ≥30 <15 B -
NCCN: National Comprehensive Cancer Network; ALA: American Lung Association; ACCP: American College of Chest Physicians; ASCO: American Society of Clinical Oncology; AATS: American Association for Thoracic Surgery; ACS: American Cancer Society; USPSTF: US Preventive Services Task Force; NA: not available. Levels of evidence: category 1: based upon high level evidence, there is uniform consensus that the intervention is appropriate; category 2A: based upon lower level evidence, there is uniform consensus that the intervention is appropriate; category 2B: based upon lower level evidence, there is consensus that the intervention is appropriate; category 3: based upon any level of evidence, there is major disagreement that the intervention is appropriate. #: radon exposure, occupational exposure (silica, cadmium, asbestos, arsenic, beryllium, chromium, diesel fumes and nickel), cancer history (survivors of lung cancer, lymphomas, cancers of the head and neck, or smoking-related cancers), family history of lung cancer, disease history (chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis; ¶: such as COPD with forced expiratory volume in 1 s of 70% or less than predicted, environmental or occupational exposures, any prior cancer or thoracic radiation, genetic or family history.
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- TABLE 2
Selection criteria, number of enrolled individuals and the rate of diagnosed lung cancer of major randomised controlled trials
Study Selection criteria Patients screened n (follow-up) Lung cancer diagnosed at initial screening (total in follow-up) Age years Tobacco smoking (delay since weaning) DLCST 50–70 ≥20 pack-years (0–9 years) 2052 (58 months) 0.8% (3.4%) DANTE 60–74 ≥20 pack-years (0–9 years) 1276 (34 months) 2.2% (4.7%) (only men) ITALUNG 55–69 ≥20 pack-years (active or former) 1406 (36 months) 1.5% (2.8%) MILD ≥49 ≥20 pack-years (0–9 years) 1190# (120 months) 0.8% (2.4%) 1186¶ (53 months) NELSON 50–75 ≥15 pack-years+ (0–9 years) 7907 (60 months) 0.9% (2.6%) NLST 55–74 ≥30 pack-years (0–15 years) 26 722 (78 months) 1.1% (2.4%) -
#: annual computed tomography; ¶: biannual computed tomography; +: NELSON inclusion criteria: number of cigarettes smoked is ≥ 15 per day for 25 years OR ≥10 cigarettes per day for 30 years AND still smoking or have quit <10 years ago.
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- TABLE 3
Risk prediction models used in different lung cancer screening trials
Model Risk factors included Period of prediction of lung cancer diagnosis or death Reference for algorithm LLP (detection) Age 5 years Raji et al. [36] Sex Years of smoking Family history of lung cancer by age of affected relatives History of a previous cancer History of pneumonia History of exposure to asbestos PLCO (detection) Age 6 years Tammemägi et al. [37] Race/ethnicity Education Body mass index Chronic obstructive pulmonary disease Personal history of cancer Family history of lung cancer Smoking status (current versus former) Smoking intensity (average cigarettes/day) Smoking duration Smoking quit time NLST (death) Age 5 years Kovalchik et al. [38] Sex Ethnicity Body-mass index Pack-years of smoking Years since smoking cessation Presence of emphysema First-degree relative with lung cancer Key points
Lung cancer screening using low dose computed tomography reduces mortality Leading US medical societies recommend large scale screening for high risk individuals There are no lung cancer screening recommendations or reimbursed screening programmes in Europe as yet The European Society of Radiology and the European Respiratory Society recommend lung cancer screening within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres High risk, eligible individuals should be enrolled in comprehensive, quality-controlled longitudinal programmes
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