National lung cancer screening program feasibility study in Estonia

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Abstract

OBJECTIVES

The main aim of the lung cancer screening (LCS) feasibility study was to investigate the plausibility of and bottlenecks to systematic enrolment in family physician practices by evaluating all their patients.

METHODS

In 3 family physician practices, for each individual born in 1947–1966 (target age group 55–74 years), information on ever smoking was gathered by a family physician/nurse. All current and ex-smokers were invited to an ‘LCS visit’. In parallel, 2 inclusion criteria were used: (1) current smoker (≥20 pack-years) or ex-smoker (quit <15 years ago and smoking history ≥20 pack-years) and (2) PLCO _m2012noRace risk score >1.5. All individuals with elevated lung cancer risk were assigned low-dose computed tomography.

RESULTS

Among the total 7035 individuals in the 3 family physician practices, the LCS target age group comprised 1208 individuals, including 649 (46.3–57.1%) males and 559 (42.9–53.7%) females. Of the 1208 applicable age group individuals, 395 (all current or ex-smokers) were invited to the ‘LCS visit’. According to either 1 or both the LCS inclusion criteria, 206 individuals were referred to low-dose computed tomography, and 201 (97.6% of those referred) ended up taking it. The estimated participation rate in LCS, based on data from our feasibility study, would have been 87.4%.

CONCLUSIONS

In LCS, systematic enrolment of individuals by family physicians results in high uptake, and thus, effectiveness of the LCS in the setting of a well-functioning family physician system like in Estonia. Also, the feasibility study provided excellent input to the currently ongoing regional LCS pilot study in Estonia.

Abstract

Lung cancer screening (LCS), using low-dose computed tomography (LDCT), has been proved to reduce mortality in 2 large, randomized controlled studies: National Lung Cancer Screening Trial (NLST) in the USA and Dutch-Belgian Randomized Lung Cancer Screening Trial (Dutch acronym: NELSON) in Europe [1, 2].

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Most cited references 26

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Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Hyuna Sung, Jacques Ferlay, Rebecca Siegel … (2021)

This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

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Reduced lung-cancer mortality with low-dose computed tomographic screening.

(2011)

The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009. The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P=0.02). Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.).

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The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer.

Peter Goldstraw, Kari Chansky, John Crowley … (2016)

The IASLC Staging and Prognostic Factors Committee has collected a new database of 94,708 cases donated from 35 sources in 16 countries around the globe. This has now been analysed by our statistical partners at Cancer Research And Biostatistics and, in close collaboration with the members of the committee proposals have been developed for the T, N, and M categories of the 8th edition of the TNM Classification for lung cancer due to be published late 2016. In this publication we describe the methods used to evaluate the resultant Stage groupings and the proposals put forward for the 8th edition.

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Author and article information

Contributors

Kadi Kallavus:

ORCID: https://orcid.org/0000-0002-9768-4327

Kaja-Triin Laisaar

Anneli Rätsep

Tarvo Kiudma

Urmas Takker

Anneli Poola

Vahur Makke

Marianna Frik

Piret Viiklepp

Merily Taur

Tanel Laisaar

Journal

Journal ID (nlm-ta): Interdiscip Cardiovasc Thorac Surg

Journal ID (iso-abbrev): Interdiscip Cardiovasc Thorac Surg

Journal ID (publisher-id): icvts

Title: Interdisciplinary Cardiovascular and Thoracic Surgery

Publisher: Oxford University Press

ISSN (Electronic): 2753-670X

Publication date Collection: June 2023

Publication date (Electronic): 21 February 2023

Publication date PMC-release: 21 February 2023

Volume: 36

Issue: 6

Electronic Location Identifier: ivad041

Affiliations

Institute of Clinical Medicine, University of Tartu , Tartu, Estonia

Institute of Family Medicine and Public Health, University of Tartu , Tartu, Estonia

Ränilinna Health Centre , Tartu, Estonia

Puusepa Health Centre , Tartu, Estonia

Family Physicians Takker and Sarapuu , Tartu, Estonia

Radiology Clinic, Tartu University Hospital , Tartu, Estonia

Head of Department of Registries, National Institute for Health Development , Tallinn, Estonia

Lung Clinic, Tartu University Hospital , Tartu, Estonia

Institute of Clinical Medicine, University of Tartu , Tartu, Estonia

Lung Clinic, Tartu University Hospital , Tartu, Estonia

Author notes

Corresponding author. Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia. Tel: +372-5699-1617; e-mail: kadi.kallavus@ 123456ut.ee (K. Kallavus).

Author information

Kadi Kallavus https://orcid.org/0000-0002-9768-4327

Article

Publisher ID: ivad041

DOI: 10.1093/icvts/ivad041

PMC ID: 10279650

PubMed ID: 36807427

SO-VID: b2f57f26-c3a5-4e9f-a89b-3179ec03dc65

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 22 December 2022

Date revision received : 30 January 2023

Date accepted : 21 February 2023

Date: 19 June 2023

Page count

Pages: 7

Funding

Funded by: National Institute for Health Development;

National lung cancer screening program feasibility study in Estonia

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Abstract

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RESULTS

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Most cited references 26

Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Reduced lung-cancer mortality with low-dose computed tomographic screening.

The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer.

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