Predicting the Mortality Benefit of CT Screening for Second Lung Cancer in a High-Risk Population

• Published in: PloS one Vol. 11; no. 11; p. e0165471
• Main Authors: Kinsey, C Matthew, Hamlington, Katharine L, O'Toole, Jacqueline, Stapleton, Renee, Bates, Jason H T
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02-11-2016; Public Library of Science (PLoS)
• Subjects: Age; Aged; Aged, 80 and over; Biology and Life Sciences; Cancer; Cancer screening; Computer applications; Early Detection of Cancer; Female; Health aspects; Health risks; Histology; Humans; Lung cancer; Lung diseases; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Male; Mathematical models; Medical imaging; Medical research; Medical screening; Medicine and Health Sciences; Middle Aged; Models, Theoretical; Mortality; Neoplasms, Second Primary - diagnostic imaging; Neoplasms, Second Primary - mortality; Patients; Population; Prognosis; Reinforcement; Risk; Screening; Smoking; Smoking - adverse effects; Surgery; Surveillance; Tomography; Tomography, X-Ray Computed - methods; Vermont; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0165471

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.