lung cancer screening: a paradigm shift...nov 17, 2017 · the facts about lung cancer • not...
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Lung Cancer Screening:
A Paradigm Shift
Ziv Gamliel, MD, FACS
Thoracic Surgery
MedStar Franklin Square Medical Center
Friday, November 17, 2017
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TOBACCO: THE TRUE COST OF SMOKING
AMERICAN CANCER SOCIETY - 2016
• Tobacco use remains the single largest preventable cause of disease and
premature death in the U.S.
• According to the “National Survey on Drug Use and Health,” more than
51.3 million (19.1%) Americans still smoke cigarettes.
• As of 2016, there were also:
- 12.3 million (4.6%) cigar smokers
- 10.7 million (4%) e-cigarette users
- 8.8 million (3.3%) smokeless tobacco users (chewing tobacco & snuff)
- 2.3 million (0.8%) who smoke tobacco in pipes
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The Facts About Lung Cancer
• Not counting skin cancer, lung cancer is the 2nd most common cancer
in both men and women:
– In men, prostate cancer is more common.
– In women, breast cancer is more common.
• Lung cancer accounts for 13% of all new cancers.
• Lung cancer is the leading cause of cancer death in the United States.
• Lung cancer causes 26% of all cancer deaths.
• Lung cancer is the leading cancer killer among Caucasians, African-
Americans, Asians and Hispanic males.
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Lung and Bronchus Cancer
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Based upon 2010-2014 statistics, there were 55.8 new lung cancer cases per year per 100,000 men and women in the U.S.
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Based upon 2010-2014 statistics, there were 44.7 lung cancer deaths per year per 100,000 men and women in the U.S.
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Lung and Bronchus Cancer Statistics
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Lung and Bronchus Cancer Statistics
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How Common is Lung and Bronchus Cancer?
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How Many People Survive 5 Years or More
After Being Diagnosed With
Lung and Bronchus Cancer?
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Cumulative Survival by Pathologic Stage
Chest 2009; 136:260-71 © 2009 American College of Chest Physicians
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• Over 50% of new lung cancer cases will be diagnosed
at a very late stage:
– stage III-B or
– stage IV
• Less than 5% of those cases will live for 5 years.
The Facts About Lung Cancer
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The Facts About Lung Cancer
Lung cancer will kill more people this year than:
• breast cancer
• prostate cancer
• colon cancer
• skin melanoma
• bladder cancer
• endometrial cancer
… COMBINED!
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• Lung cancer will kill more than 3x as many
men as prostate cancer this year.
• Lung cancer will kill nearly twice as many
women as breast cancer this year.
The Facts About Lung Cancer
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Myth:
After you stop smoking, your lungs go “back to normal” in 10 years.
Truth:
The lungs never go completely “back to normal.” Most former smokers remain at elevated risk.
• Current smokers: 20.9% of new lung cancer cases.
• Former smokers: 61.2% of new lung cancer cases.
• Never smoked: 17.9% of new lung cancer cases.
The Facts About Lung Cancer
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Lung Cancer Research Funding and Mortality
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Screening by Chest Radiograph and Lung Cancer Mortality The Prostate, Lung, Colorectal, and Ovarian (PLCO) Randomized Trial
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Screening by Chest Radiograph and Lung Cancer Mortality The Prostate, Lung, Colorectal, and Ovarian (PLCO) Randomized Trial
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N Engl J Med 2011;365:395-409.
Eligibility
• Age 55-74
• Smoking history ≥30 pack-years
• Smoking within the previous 15 years
Exclusion Criteria
• Previous diagnosis of lung cancer
• CT within 18 months before enrollment
• Hemoptysis
• Unexplained weight loss >15 lbs. in preceding year
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N Engl J Med 2011;365:395-409.
Schema
Random assignment to 3 annual screenings with either
• Chest X-ray
or
• Low-dose CT scan
Study Period
• Enrollment from August 2002 until April 2004
• Screening from August 2002 until September 2007
• Followup until December 31, 2009
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N Engl J Med 2011;365:395-409.
Enrollment
• 53,454 participants
• 33 U.S. medical centers
Findings
• High rate of false positive studies (>90%).
• Low-dose CT arm:
– 20% reduction in mortality from lung cancer.
– 6.7% reduction in mortality from all causes.
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© 2011 Massachusetts Medical Society N Engl J Med 2011;365:395-409.
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© 2011 Massachusetts Medical Society N Engl J Med 2011;365:395-409.
P = 0.004
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VATS the Difference?
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American Cancer Society Guidelines:
Lung Cancer Screening
• Age 55 - 74.
• Asymptomatic.
• Smoking history of at least 30 pack-years.
• History of active smoking within last 15 years.
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