Report from the World Conference on Lung Cancer (WCLC)
Cheryl Ho, MD FRCPC, Medical Oncologist, BC Cancer, and Clinical Associate Professor, UBC;
and Alexandra Pender MB BChir MRCP PhD, BC Cancer
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Commentary: Smoking remains the leading risk factor
for developing lung cancer. Falling lung cancer incidence
is correlated with increasingly stringent tobacco legislation
in developed countries, while increased tobacco consumption in
developing countries is bringing a rising incidence of lung
cancer in those countries.
The US National Lung Cancer Screening Trial
showed that screening using annual low-dose computerized
tomography (CT) for 3 years reduces the
risk of lung cancer mortality by 20% after a median
6.5 years of followup. There may be a greater benefit
to screening in women than in men.
Approximately 20% of all low-dose CTs performed
in NLST had false-positive results.
The rate of at least one complication from a diagnostic
evaluation following a positive screening test
was between 1.4% and 1.6%.
What this study showed
NELSON showed that low-dose lung cancer screening
reduces the risk of lung cancer mortality by 26%
in men and 39% in women after 10 years of followup.
In NELSON, 9.3% of CT scans showed false positive
results. Use of nodule characteristics and a
repeat CT at a short interval was used to determine
the need for a diagnostic evaluation.
Next steps
Implement nationwide low-dose CT screening in
populations at high risk of lung cancer, with consideration
of different screening protocols for men and
women.
