Earlydetection - Early Detection of lung cancer Dr. Alok...

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Dr. Alok Nath Senior Resident Department of Pulmonary Medicine PGIMER Chandigarh Early Detection of lung cancer INTRODUCTION y Lung cancer - most common cause of cancer death worldwide y Fifty per cent of newly diagnosed lung cancer patients are former smokers y Lung cancer - major health issue for decades to come y The overall 5-year survival of lung cancer is only 10% in Europe and 15% in the United States
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INTRODUCTION y Progress in curative treatments during the last 20 years has been modest y Late diagnosis of extensive disease is the main reason of failure y Screening -effective in reducing the incidence and mortality of cancer of the cervix, breast and colon y Similar results not reported in lung cancer INTRODUCTION y Screening for lung cancer has unique challenges compared with other organs y Lung cancer consists of different cell types with different molecular profiles and growth characteristics y Pre-invasive cancer in the entire bronchial epithelium – difficult to identify y Tissue sampling for pathological or cytological diagnosis – difficult to obtain y Different paradigm compared with cervical or breast cancer screening is needed
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INTRODUCTION y Modalities used for early diagnosis y Chest X-ray y CT scan y Newer bronchoscopic methods y Molecular markers Screening has been the essence of early detection Definition Systematic testing of individuals who are asymptomatic with respect to some target disease. Purpose – to prevent, interrupt, or delay the development of advanced disease Hillman et al. JACR 2004;1(11):861-864
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Screening vs Diagnosis Asymptomatic Test non-diagnostic Non-patients Patients Symptomatic Test diagnostic High prevalence Low prevalence Principles of screening y Screening should detect a cancer in its preclinical stage y An effective treatment should be available in the preclinical stage y Early intervention in the preclinical stage should change the course of the disease and decrease mortality y Accessibility, cost and morbidity associated with a screening test should be reasonable
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Timeline of disease PRECLINICAL CLINICAL DPCP Onset of Disease Detectable by Test Signs or Symptoms Death from Disease or Other causes Death from Disease or Other causes Signs or Symptoms Detectable by Test Onset of Disease DPCP Screening Effective Critical Point
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Death from Disease or Other causes Signs or Symptoms Detectable by Test Onset of Disease DPCP Screening Ineffective Critical Point Death from Disease or Other causes Signs or Symptoms Detectable by Test Onset of Disease DPCP Screening Unnecessary Critical Point
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¾ Lead time bias ¾ Length bias ¾ Over diagnosis bias Biases of Early Detection Death from Disease Signs or symptoms Positive test LEAD TIME SURVIVAL WITHOUT TEST SURVIVAL Lead Time Bias
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TIME Slowly progressive Rapidly progressive Length Bias TEST
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Results and criticisms y JHLP and MSKLP studied the beneficial effects of sputum cytology screening and demonstrated no additional benefit from the addition of sputum cytology to
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Earlydetection - Early Detection of lung cancer Dr. Alok...

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