Adopting helical CT screening for lung cancer

Potential health consequences during a 15-year period

Authors

  • Pamela M. McMahon PhD,

    Corresponding author
    1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
    2. Departments of Medicine and Radiology, Harvard Medical School, Boston, Massachusetts
    • Institute for Technology Assessment, 101 Merrimac Street 10th floor, Boston, MA 02114
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  • Chung Yin Kong PhD,

    1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
    2. Departments of Medicine and Radiology, Harvard Medical School, Boston, Massachusetts
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  • Milton C. Weinstein PhD,

    1. Departments of Medicine and Radiology, Harvard Medical School, Boston, Massachusetts
    2. Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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  • Angela C. Tramontano MPH,

    1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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  • Lauren E. Cipriano BSc, BA,

    1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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  • Bruce E. Johnson MD,

    1. Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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  • Jane C. Weeks MD, MS,

    1. Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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  • G. Scott Gazelle MD, MPH, PhD

    1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
    2. Departments of Medicine and Radiology, Harvard Medical School, Boston, Massachusetts
    3. Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
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  • This study used only publicly available, de-identified patient data.

Abstract

BACKGROUND.

Simulation modeling can synthesize data from single-arm studies of lung cancer screening and tumor registries to investigate computed tomography (CT) screening. This study estimated changes in lung cancer outcomes through 2005, had chest CT screening been introduced in 1990.

METHODS.

Hypothetical individuals with smoking histories representative of 6 US cohorts (white males and females aged 50, 60, and 70 years in 1990) were simulated in the Lung Cancer Policy Model, a comprehensive patient-level simulation model of lung cancer development, screening, and treatment. A no screening scenario corresponded to observed outcomes. We simulated 3 screening scenarios in current or former smokers with ≥20 pack-years as follows: 1-time screen in 1990; and annual, and twice-annually screenings beginning in 1990 and ending in 2005. Main outcomes were days of life between 1990 and 2005 and life expectancy in 1990 (estimated by simulating life histories past 2005).

RESULTS.

All screening scenarios yielded reductions (compared with no screening) in lung cancer-specific mortality by 2005, with larger reductions predicted for more frequent screening. Compared with no screening, annual screening of ever-smokers with at least 20 pack-years of cigarette exposure provided ever-smokers with an additional 11 to 33 days of life by 2005, or an additional 3-10 weeks of (undiscounted) life expectancy. In sensitivity analyses, the largest effects on gains from annual screening were due to reductions in screening adherence and increased smoking cessation.

CONCLUSIONS.

The adoption of CT screening, had it been available in 1990, might have resulted in a modest gain in life expectancy. Cancer 2008. © 2008 American Cancer Society.

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