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Impact of Lung Cancer Screening on Lung Cancer Mortality in COPD Patients

Principal Investigator
Name
Juan Wisnivesky
Degrees
M.D., DrPH
Institution
Icahn School of Medicine at Mount Sinai
Position Title
Professor of Medicine
Email
About this CDAS Project
Study
NLST (Learn more about this study)
Project ID
NLST-380
Initial CDAS Request Approval
Dec 26, 2017
Title
Impact of Lung Cancer Screening on Lung Cancer Mortality in COPD Patients
Summary
Annual lung cancer screening with low-dose computed tomography (LDCT) has demonstrated a mortality benefit in high-risk smokers. Selection of appropriate eligibility criteria using lung cancer risk models is essential for optimizing screening. Lung cancer prediction models rely on sociodemographic characteristics, smoking history, and other exposures. However, reassessing the optimal screening regimen, based on the presence or absence of emphysema, is important among subjects who have a negative baseline screen, a group at a lower risk for lung cancer. Emphysema is an independent lung cancer risk factor that may have additional predictive value, but often would only be reliably identified after a baseline lung cancer screen. In this study, we investigate the role of radiologically confirmed emphysema as a predictor of lung cancer in patients with negative initial LDCT screens using data from the NLST.
Aims

1. Calculate the lung cancer risk scores of participants randomized to LDCT who receive a negative baseline screen using three risk validated lung cancer prediction models: the Bach model, the PLCOm2012 model (also known as the Tammemägi model), and the Liverpool Lung Project (LLP) model
2. Assess whether emphysema is independently a predictor of lung cancer risk after controlling for the risk factors included in the Bach, PLCOm2012, and LLP models
3. Compare the cumulative lung cancer incidence curves for participants with and without emphysema
4. Compare the number needed to screen to diagnose one case of lung cancer in participants with vs. without emphysema
5. Compare the discrimination of the lung cancer risk prediction models with and without emphysema as a predictor

Collaborators

Patrick C. Yong, BS
Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Keith M. Sigel, MD, PhD
Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Grace Mhango
Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Minal Kale, MD
Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Chung Yin Kong, PhD
Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.
Javier Zulueta, MD, PhD
Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain
Juan Pablo de Torres, MD
Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain
David Wilson, MD
Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain
Juan P. Wisnivesky, MD, DrPH
Division of General Internal Medicine and Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

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