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Lung Cancer Screening in Patients with a Personal History of Cancer

Principal Investigator
Name
Louise Henderson
Degrees
PhD
Institution
The University of North Carolina at Chapel Hill
Position Title
Associate Professor of Radiology
Email
About this CDAS Project
Study
NLST (Learn more about this study)
Project ID
NLST-525
Initial CDAS Request Approval
Jun 17, 2019
Title
Lung Cancer Screening in Patients with a Personal History of Cancer
Summary
Survivors of common cancers have an overall risk of 8.1% for developing a second primary malignancy (SPM) (1). Lung cancer is the most commonly diagnosed SPM (1) and second primary lung cancers (SPLC) account for about 8-14% of all lung cancer diagnoses (2). Patients at increased risk for SPLC are more likely to be smokers with a prior history of breast, lung, and head and neck cancer (3). Extending lung cancer screening (LCS) to individuals with prior history of cancer (PHC) after 4 years of surveillance without recurrence has been recommended (4) however, the US Preventive Services Task Force (USPSTF) recommends LCS in patients with the same age and smoking history eligibility criteria as the NLST cohort without mentioning other risk factors such as a PHC.

While lung cancer detection rate in patients with PHC may be higher due to increased risk, the clinical heterogeneity of this group of patients including variability in underlying comorbidities and prior cancer treatments may confound the benefits of LCS, improved survival. As such, extending LCS to smokers with a PHC is a complicated decision because the benefit of LCS in this group of patients is not known and the risk for developing lung cancer must be balanced against potential complications related to diagnosis and treatment of lung cancer, and recurrence or dying from prior cancer (5).

Approximately 4% of patients enrolled in the NLST were patients with a PHC (6). The objective of this application is to evaluate the NLST data on patients with a PHC who underwent LCS to compare benefits and risks of LCS between those with a PHC and those without.

References:
1. Donin N, et al. Cancer 2016; 122:3075-3086.
2. Hofmann HS, et al. Eur J Cardiothorac Surg. 2007;32:653e8.
3. Halpenny DF, et al. J Thorac Oncol. 2016. 11: 1447-1452.
4. Jaklitsch MT et al. J Thorac Cardiovasc Surgery 2012;144:33–38.
5. Rivera MP, et al. Am J Respir Crit Care Med 2018; 198:e3–e13.
6. National Lung Screening Trial Research Team. J Natl Cancer Inst 2010;102:1771–1779.
Aims

1. Assess the impact of a PHC on LDCT findings, both nodules and incidental findings. We hypothesize that patients with a PHC may be more likely to have LungRADS 3-4 findings. (Although this is not what we found in our study, this is what most people believe is likely in this group)
2. Evaluate the association of a PHC with comorbid conditions. We hypothesize that otherwise healthy patients with a PHC do not have increased comorbidities that preclude LCS.
3. Assess the impact of a PHC on lung cancer detection rate and outcomes from treatment for lung cancer. We hypothesize that patients with a PHC will be in higher risk quintile and more likely to have a diagnosis of lung cancer. We hypothesize outcome from treatment for lung cancer will be the same as in those without a PHC
4. Compare our healthcare system data to NLST data on patients with PHC undergoing LCS. We hypothesize that there will be differences in the two groups with regard to patient characteristics, LDCT findings, lung cancer detection rate and outcomes.

Collaborators

M. Patricia Rivera, MD - The University of North Carolina at Chapel Hill
Martin Tammemagi, PhD - Brock University

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