Predicting the Mortality Benefit of CT Screening for Second Lung Cancer in a High-Risk Population.
Patients who survive an index lung cancer (ILC) after surgical resection continue to be at significant risk for a metachronous lung cancer (MLC). Indeed, this risk is much higher than the risk of developing an ILC in heavy smokers. There is currently little evidence upon which to base guidelines for screening at-risk patients for MLC, and the risk-reward tradeoffs for screening this patient population are unknown. The goal of this investigation was to estimate the maximum mortality benefit of CT screening for MLC. We developed a computational model to estimate the maximum rates of CT detection of MLC and surgical resection to be expected in a given population as a function of time after resection of an ILC. Applying the model to a hypothetical high-risk population suggests that screening for MLC within 5 years after resection of an ILC may identify only a very small number of treatable cancers. The risk of death from a potentially resectable MLC increases dramatically past this point, however, suggesting that screening after 5 years is imperative. The model also predicts a substantial detection gap for MLC that demonstrates the benefit to be gained as more sensitive screening methods are developed.
Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America.
C Matthew
CM
Kinsey
Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America.
Katharine L
KL
Hamlington
Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States of America.
Jacqueline
J
O'Toole
Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America.
Renee
R
Stapleton
Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America.
Jason H T
JH
Bates
D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000401:mortality*; D011379:Prognosis; D012907:Smoking / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods*