- Email: [email protected]
Lung Cancer Screening in Patients With a Previous History of Cancer
Lung Cancer SESSION TITLE: Lung Cancer I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
Lung Cancer Screening in Patients With a Previous History of Cancer Joshua Lopez* Leanne Goldstein PhD Brian Tiep MD Argelia Sandoval MD Arnold Rotter MD Loretta Erhunmwunsee MD Dan Raz MD; and Jae Kim MD City of Hope Cancer Center, Duarte, CA PURPOSE: Lung cancer screening with low-dose CT (LDCT) has been shown to decrease mortality in high risk patients. The United States Preventive Services Task Force recommends LDCT for patients age 55 to 80 with at least a 30 pack year history of smoking. Lung cancer screening in patients with a previous history of malignancy raises a complex set of issues. Patients with a previous history of malignancy may be at higher risk for developing lung cancer. Those with a history of solid tumors are also at risk of metastatic disease to the lung. It is unclear whether the same management strategies can be used in assessing nodules among these patients. METHODS: We analyzed data from a prospective database of lung cancer screening performed at a National Comprehensive Cancer Network designated comprehensive cancer center and identified all patients enrolled in the lung cancer screening program who had a previous history of cancer. Patients were enrolled in the lung cancer screening program if they met NCCN guidelines for screening and if their treating oncologist estimated their life expectancy to be greater than 5 years. Patients were excluded if they were already undergoing chest CT scans as part of surveillance for their previous cancer. After a discussion of the risks and benefits of lung cancer screening along with smoking cessation counseling when applicable, patients underwent LDCT. All scans were read by a single radiologist with training as part of a previous lung cancer screening clinical trial. A cut-off of 4mm for solid nodules or 6mm for part-solid nodules was used to designate a positive scan. Patients with negative scans underwent repeat annual LDCT. Management of all positive scans was determined in a multidisciplinary lung cancer screening board. RESULTS: From 2012-2015, 142 patients with a previous history of cancer were enrolled in our lung cancer screening program. The mean age of patients was 65 9 years. 58/142 (40%) were current smokers and the mean smoking history was 44 pack years. Breast cancer was the most common previous cancer diagnosis (51/142, 36%) and prostate cancer was second (40/142, 28%). 20 patients (14%) had a previous, remote history of lung cancer, but were not undergoing active surveillance. Of the initial scans, 89 (62%) were positive, with a mean nodule size of 8 mm. Among the initial scans, 53/142(37%) were Lung CT Screening Reporting and Data System (Lung-RADS) category 1, 52 (37%) were category 2, 15 (10%) category 3, 15 (10%) category 4a, 6 (4%) category 4b, and 1 (1%) category 4s . A total of 7 cancers were detected (5%) - 6 new primary lung cancers and 1 metastatic melanoma. CONCLUSIONS: Patients with a significant smoking history who also have a previous history of malignancy may be at increased risk for development of lung cancer. Nodule assessment in these patients is more complicated due to the possibility of metastatic disease. In our experience, the diagnosis of a new primary lung cancer was much more common than the identification of metastatic disease. CLINICAL IMPLICATIONS: Additional studies of lung cancer screening in patients with previous malignancies are warranted. DISCLOSURE: The following authors have nothing to disclose: Joshua Lopez, Leanne Goldstein, Brian Tiep, Argelia Sandoval, Arnold Rotter, Loretta Erhunmwunsee, Dan Raz, Jae Kim No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.796
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
701A
Lung Cancer Screening in Patients With a Previous History of Cancer Joshua Lopez* Leanne Goldstein PhD Brian Tiep MD Argelia Sandoval MD Arnold Rotter MD Loretta Erhunmwunsee MD Dan Raz MD; and Jae Kim MD City of Hope Cancer Center, Duarte, CA PURPOSE: Lung cancer screening with low-dose CT (LDCT) has been shown to decrease mortality in high risk patients. The United States Preventive Services Task Force recommends LDCT for patients age 55 to 80 with at least a 30 pack year history of smoking. Lung cancer screening in patients with a previous history of malignancy raises a complex set of issues. Patients with a previous history of malignancy may be at higher risk for developing lung cancer. Those with a history of solid tumors are also at risk of metastatic disease to the lung. It is unclear whether the same management strategies can be used in assessing nodules among these patients. METHODS: We analyzed data from a prospective database of lung cancer screening performed at a National Comprehensive Cancer Network designated comprehensive cancer center and identified all patients enrolled in the lung cancer screening program who had a previous history of cancer. Patients were enrolled in the lung cancer screening program if they met NCCN guidelines for screening and if their treating oncologist estimated their life expectancy to be greater than 5 years. Patients were excluded if they were already undergoing chest CT scans as part of surveillance for their previous cancer. After a discussion of the risks and benefits of lung cancer screening along with smoking cessation counseling when applicable, patients underwent LDCT. All scans were read by a single radiologist with training as part of a previous lung cancer screening clinical trial. A cut-off of 4mm for solid nodules or 6mm for part-solid nodules was used to designate a positive scan. Patients with negative scans underwent repeat annual LDCT. Management of all positive scans was determined in a multidisciplinary lung cancer screening board. RESULTS: From 2012-2015, 142 patients with a previous history of cancer were enrolled in our lung cancer screening program. The mean age of patients was 65 9 years. 58/142 (40%) were current smokers and the mean smoking history was 44 pack years. Breast cancer was the most common previous cancer diagnosis (51/142, 36%) and prostate cancer was second (40/142, 28%). 20 patients (14%) had a previous, remote history of lung cancer, but were not undergoing active surveillance. Of the initial scans, 89 (62%) were positive, with a mean nodule size of 8 mm. Among the initial scans, 53/142(37%) were Lung CT Screening Reporting and Data System (Lung-RADS) category 1, 52 (37%) were category 2, 15 (10%) category 3, 15 (10%) category 4a, 6 (4%) category 4b, and 1 (1%) category 4s . A total of 7 cancers were detected (5%) - 6 new primary lung cancers and 1 metastatic melanoma. CONCLUSIONS: Patients with a significant smoking history who also have a previous history of malignancy may be at increased risk for development of lung cancer. Nodule assessment in these patients is more complicated due to the possibility of metastatic disease. In our experience, the diagnosis of a new primary lung cancer was much more common than the identification of metastatic disease. CLINICAL IMPLICATIONS: Additional studies of lung cancer screening in patients with previous malignancies are warranted. DISCLOSURE: The following authors have nothing to disclose: Joshua Lopez, Leanne Goldstein, Brian Tiep, Argelia Sandoval, Arnold Rotter, Loretta Erhunmwunsee, Dan Raz, Jae Kim No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.796
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
701A