Alberta Lung Cancer Screening Program

Conditions

Lung Neoplasms, Respiratory Tract Neoplasms

Keywords

Lung Cancer, Screening, Computed Tomography

Brief summary

Lung cancer is the leading cause of cancer death in North America and in the world. The vast majority of lung cancers are associated with cigarette smoking. Unfortunately, the majority of lung cancers are detected at an advanced stage when they have a very poor prognosis. A substantial amount of data has been reported on low-dose computed tomography (LDCT) screening. Yet endorsement of lung cancer screening has not been universal because of outstanding concerns which need to be addressed. Our study will aim to screen at risk Albertans for lung cancer with LDCT scan at baseline, year 1 and year 2 while attempting to fill some knowledge gaps on this topic.

Detailed description

Lung cancer is the leading cause of cancer death in North America and in the world. The vast majority of lung cancers are associated with cigarette smoking. Lung cancer incidence and mortality rates are similar because lung cancer is a highly fatal disease. Unfortunately, the majority of lung cancers are detected at an advanced stage when they have a very poor prognosis. A substantial amount of data has been reported on low-dose computed tomography (LDCT) screening. The results of the National Lung Screening Trial (NLST) showed a 20% reduction in mortality from lung cancer with LDCT screening in addition to a 6.7% decrease in all-cause mortality, the first ever screening intervention to demonstrate an improvement in this latter outcome. Yet endorsement of lung cancer screening has not been universal. Although the NLST results are encouraging, more investigation is needed. The objectives of this study are to prospectively compare the performance of a lung cancer risk prediction model (RPM) vs. NLST criteria to inform optimal inclusion criteria for a clinical screening program; to prospectively compare a novel screening based nodule malignancy probability calculation which has been developed in the Pan-Canadian Early Detection of Lung Cancer study vs. NLST criteria; to complete a randomized controlled trial as a substudy comparing an intensive tobacco cessation counseling program to a usual care arm for subjects with ongoing tobacco use; to perform a cost analysis evaluating the incremental costs associated with LDCT screening for lung cancer compared to no screening; to determine the average cost associated with incidental findings, false positive findings and lung cancers found during the screening period; and to compare cost implications of both screening enrollment criteria. The backbone of this research project will be the screening of at risk individuals for lung cancer with LDCT scan. Eight hundred at risk Albertans will be screened at baseline, year 1 and year 2. Additional clinical LDCT or other investigations may result from findings on the study CT scans.

Tammemägi MC, Ruparel M, Tremblay A, Myers R, Mayo J, Yee J, Atkar-Khattra S, Yuan R, Cressman S, English J, Bedard E, MacEachern P, Burrowes P, Quaife SL, Marshall H, Yang I, Bowman R, Passmore L, McWilliams A, Brims F, Lim KP, Mo L, Melsom S, Saffar B, Teh M, Sheehan R, Kuok Y, Manser R, Irving L, Steinfort D, McCusker M, Pascoe D, Fogarty P, Stone E, Lam DCL, Ng MY, Vardhanabhuti V, Berg CD, Hung RJ, Janes SM, Fong K, Lam S.

2021-12-11113 citations

10.1016/s1470-2045(21)00590-8

Two-Year Follow-Up of a Randomized Controlled Study of Integrated Smoking Cessation in a Lung Cancer Screening Program

Alain Tremblay, Niloofar Taghizadeh, Paul MacEachern, Paul Burrowes, Andrew J. Graham et al. (11 authors)

JTO Clinical and Research Reports2020-09-147 citations

10.1016/j.jtocrr.2020.100097

A Randomized Controlled Study of Integrated Smoking Cessation in a Lung Cancer Screening Program.

Tremblay A, Taghizadeh N, Huang J, Kasowski D, MacEachern P, Burrowes P, Graham AJ, Dickinson JA, Lam SC, Yang H, Koetzler R, Tammemagi M, Taylor K, Bédard ELR.

2019-05-0847 citations

10.1016/j.jtho.2019.04.024

Interventions

PROCEDUREComputed Tomography

Low dose chest CT screening annually x 3

BEHAVIORALActive smokers - Smoking cessation arm

Phone based smoking cessation counseling

BEHAVIORALActive smokers - Control arm

Subjects will be provided with general information on available smoking cessation resources

Study design

Allocation

RANDOMIZED

Intervention model

SINGLE_GROUP

Primary purpose

SCREENING

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

55 Years to 80 Years

Healthy volunteers

Yes

Inclusion criteria

* Subjects between the ages of 55 and 80 with a risk prediction model (RPM) ≥1.5% (≥ 1.5% risk of lung cancer over 6 years) OR NLST criteria (age 55-74; ≥ 30 pack-year smoking history; ongoing smoking or quit within 15 years). * Ability to provide informed consent and participate in study procedures.

Exclusion criteria

* Any medical condition, such as severe heart disease (e.g. unstable angina, chronic congestive heart failure), severe lung disease or lung disease requiring supplemental oxygen that in the opinion of the physician unlikely to benefit from screening due to shortened life-expectancy from the co-morbidities or inability to tolerate diagnosis and treatment of a screen detected abnormality. European Cooperative Oncology Group performance status \> 2. * History of lung cancer. * Have had other cancer or treatment for cancer within the past 5 years with the exception of the following cancers: non-melanomatous skin cancer, localized prostate cancer, carcinoma in situ (CIS) of the cervix, or superficial bladder cancer. Treatment of the exceptions must have ended \> 6 months before registration into this study. * Pregnancy. * Hemoptysis in past 12 months. * Unexplained weight loss \>15 pounds / 7kg in past 12 months. * Unwilling to have a LDCT of chest. * Unwilling to sign a consent. * Have had a CT scan of the chest in the last 2 years.

Design outcomes

Primary

Measure	Time frame	Description
Comparison of screening enrollment criteria (Risk prediction model (RPM) vs. NLST criteria)	5 years	The proportion of individuals selected by RPM or NLST will be calculated as the number of subjects qualifying and consenting to the screening intervention / total number of subjects enrolled with either criteria. Superiority of the risk prediction model over NLST criteria will be considered established if it identifies at least as many cases of lung cancer as the NLST while sampling fewer individuals.
Randomized trial of smoking cessation intervention in screened individuals (smoking status [smoking rates assessed via questionnaire and abstinence confirmed by saliva nicotine or exhaled carbon minoxide])	3 years	The primary study endpoint will be an assessment of smoking status at 12 months following randomization. Smoking rates will be assessed via phone questionnaire and abstinence confirmed by saliva nicotine test or exhaled carbon monoxide in subjects using nicotine replacement therapies (to avoid false positive nicotine test).

Secondary

Measure	Time frame	Description
Evaluation of nodule risk calculator	3 years	We will prospectively validate a nodule risk calculator by comparing the proportion of baseline CT examinations reported as positive by the calculator vs. NLST criteria on a per subject basis
Health Economics Analysis (healthcare payer and all direct health-care related cost)	4 years	Costs will be estimated for the cohort of individuals who enroll in the screening program and consent to receive a LDCT scan. Costs will also be estimated for a group of individuals who are eligible for the screening program however do not undergo screening. We will include costs for all relevant health care categories for a 2 year period from the date of risk stratification. The perspective of the analysis will be that of the healthcare payer and all direct health-care related costs would be captured and reported in Canadian dollars.

Countries

Canada

Outcome results

None listed