Can low-dose CT screening for lung cancer really effectively reduce mortality?

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The Lancet: Can low-dose CT screening for lung cancer really effectively reduce mortality?

The Lancet: Can low-dose CT screening for lung cancer really effectively reduce mortality? British scientists will show you the answer through experiments!

Introduction:

Lung cancer is a malignant tumor, and its malignant degree is very high. The specific hazard is actually that its growth in the lung may cause a decline in lung function and a series of symptoms in the lung. The other is that lung cancer can metastasize to a series of distant organs such as the liver, brain, bones, etc., which can cause corresponding symptoms and even seriously threaten the life of the patient.

Recently, the British scientific research discovered that a low-dose CT screening method can reduce the mortality of lung cancer patients… How did they come to this conclusion? What is the credibility of this conclusion?

Lung cancer is a respiratory disease. Lung and bronchial tumors are primary and metastatic. Malignant primary tumors are more common. Bronchial lung cancer with bronchial epithelial cells is common, and sarcoma is rare. The more common primary benign tumors are adenomas and hamartomas. Secondly, malignant tumors of the whole body organs may metastasize to the lungs in advanced stages.

The principle of modern surgical treatment of lung cancer is: Strive for early surgery. For patients with advanced lung cancer, chemotherapy and radiotherapy can be given first, and large tumors can be reduced before elective surgery, or surgery should be performed before chemotherapy or radiotherapy.

Lung cancer screening is of great significance to improve the survival rate of lung cancer patients. When lung cancer is relatively young, the human body has no symptoms at all. When the human body has symptoms, for example, the tumor has affected the pleura, causing pleural effusion, atelectasis, or inflammation. This kind of lung cancer is a very serious clinical stage. Most patients cannot be screened at this stage, or after the procedure is completed, the clinical effect is not satisfactory even if it is removed. If lung cancer can be screened at an early stage and detected at an early stage, this is the real goal of scientists and clinicians studying lung cancer. Recently, scientists have discovered a very effective way to reduce lung cancer mortality.

Compared with those ordinary procedures that do not use low-dose CT to screen for lung cancer, using low-dose CT (LDCT) to screen for lung cancer can even reduce the mortality of lung cancer patients by 16%! This is the result of their experiment announced by Professor John Field and the British cancer screening trial team at the International Association for the Study of Lung Cancer (IASLC) in 2021 today. They published the results of this research in the journal “The Lancet Regional Health-Europe”. In the article titled “Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis”:

The Lancet: Can low-dose CT screening for lung cancer really effectively reduce mortality?

Previous studies, such as the National Lung Cancer Screening Trial and the Nielsen Low-dose CT Lung Cancer Screening Trial, showed that the mortality rate of lung cancer patients was significantly reduced by 20% and 24%, respectively. Second, the UKLS trial used by scientists is a randomized controlled trial. In this trial, they selected a group of high-risk populations, used low-dose screening methods and routine care methods for these patients, and then used the LLPv2 risk model to screen two types of lung cancer. Comparison of screening modes; this test has a unique Wald test design for single low-dose lung cancer screening in high-risk populations.

The risk coefficient of UKLS is calculated using the LLPv2 risk model. This LLPv2 risk model is an improved version of the marketed LLP model. The model includes age, smoking duration, family history of lung cancer, and previous malignancies. History, history of asbestos lung exposure and other potential risk factors related to breathing (bronchitis, emphysema, lung cancer, asbestos lung). He believes that smoking cigars and pipes are as risky as smoking and will cause the same serious consequences.

This pilot study was led by Professor John Field from the University of Liverpool in the United Kingdom. Their research team randomly assigned 4,055 participants from October 2011 to February 2013 and used low-dose CT lung cancer screening methods and The method of conventional care is used for treatment. Through contact with the National Registry, their research team collected data on lung cancer cases and deaths as of February 29, 2020. The main result they came up with was the fatality rate of lung cancer.

Professor John Field’s team analyzed 1987 patients who used low-dose CT lung cancer screening methods for intervention and 1981 patients who used conventional care methods for treatment, and followed them for 7.4 years. During this period, the low-dose CT screening group reported 30 lung cancer deaths, while the routine care control group reported 46 cases. Preliminary analysis showed that the relative ratio of the two sets of data was 0.65 [95% CI 0.41 -1·03]; p = 0·065. It should be pointed out that the relative benefit in lung cancer mortality is most obvious 3 to 6 years after randomization.

In addition, Professor John Field and his team at the British Base Center also incorporated their results into a random effects meta-analysis to provide a synthesis of the latest randomized trial evidence. This meta-analysis included 9 previous low-dose CT lung cancer screening trials. The results of the included 9 randomized controlled trials showed that by using low-dose CT lung cancer screening methods, the mortality rate of lung cancer patients was significantly reduced.

Compared with the control group using conventional nursing methods, the use of low-dose CT screening can reduce lung cancer mortality by 16% (RR 0.84[0.76-0.92]), and there is no significant heterogeneity (p= 0.32, I 2= 13.7%).

The UKLS mortality data and recent meta-analysis have provided impetus for the implementation of long-term lung cancer screening projects internationally. In particular, it has encouraged European countries to start their own design and research and development projects, and gradually implement them into practice. Early detection of lung cancer and surgical intervention can save many lives.

This shows that lung cancer screening is of great significance, especially low-dose, high-definition, thin-slice CT screening of the lungs, which is more deterministic. Lung cancer screening can be used for early detection, diagnosis, and early minimally invasive treatment, which is conducive to the health management of the life cycle and enables lung cancer to enter a new stage of development and treatment. Lung cancer screening should remind everyone, especially patients with a family history, patients with a history of smoking, as well as patients with a history of lung cancer and dust exposure, they are also prone to lung cancer. Especially with environmental pollution, the incidence of lung cancer has increased significantly, so people over 40 should pay attention to lung cancer screening.

Reference:

https://www.eurekalert.org/news-releases/927536

(source:internet, reference only)

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