"Lung-RADS" Criteria Could Help Reduce False-Positives in Lung Cancer Screening

The gist: New criteria could keep CT scan screening tests from indicating that a person has lung cancer, when they really do not. So called “false-positives” can lead to unnecessary medical procedures and distress. The Lung-RADS criteria may lower the rate of false-positive screening tests. However, there are concerns that Lung-RADS might delay diagnosis for people with true lung cancer. 

“The use of Lung Imaging Reporting and Data System criteria during interpretation of low-dose CT scan results may yield lower false-positive results than observed in the National Lung Screening Trial, according to results of a retrospective study.

“However, the Lung Imaging Reporting and Data System (Lung-RADS) criteria — developed by the American College of Radiology — also were associated with reduced sensitivity.

“ ‘The findings suggest that the implementation of Lung-RADS can substantially reduce the false-positive rate in CT screening for lung cancer,’ William C. Black, MD, study author and professor of radiology at the Dartmouth-Hitchcock Medical Center, told HemOnc Today. ‘However, the findings also suggest that the diagnosis of some lung cancers may be delayed with the implementation of Lung-RADS. Whether this delay will substantively reduce the effectiveness of CT screening is unknown and will have to be further studied.’ “

Medicare Will Cover CT Lung Cancer Screening

“Current and former heavy smokers ages 55 to 77 can undergo annual low-dose CT screening for lung cancer paid by Medicare, the Centers for Medicare and Medicaid Services announced Thursday.

“The decision finalizes a preliminary plan the agency released in November with one important difference: a higher upper limit to the age range, which had previously been set at 74.

“As in the draft plan, individuals must still have a 30 pack-year history of smoking to qualify and must either be smoking currently or have quit in the past 15 years.

“Also, beneficiaries must obtain a written order from a physician for the first screening, stipulating that the patient underwent counseling on lung cancer screening and that it involved a shared decision-making process. Subsequent annual screenings will also require similar written orders.

“The counseling sessions must emphasize the importance of continued abstinence for ex-smokers and cessation for current smokers.”

Major Study Links Two New Genetic Variants to Breast Cancer

“A worldwide study of the DNA of 100,000 women has discovered two new genetic variants associated with an increased risk of breast cancer.

“The genetic variants are specifically linked to the most common form of breast cancer, oestrogen receptor positive, and provide important insights into how the disease develops.

“Scientists believe screening women for all the genetic variants so far identified could eventually pick out those at highest risk of breast cancer and improve strategies for preventing the disease.

“The study was led by scientists at The Institute of Cancer Research, London, and is published today in Human Molecular Genetics.

“It analysed the DNA of around 86,000 women of European, 12,000 of Asian and 2,000 of African ancestries, around half of whom had breast cancer.

“The study’s identification of two new genetic risk factors for breast cancer provides important clues about the causes of the disease – implicating a gene called KLF4, which is thought to help control the way cells grow and divide.”

Better Mammography Technique for Women with Dense Breast Tissue

“A new breast imaging technique pioneered at Mayo Clinic nearly quadruples detection rates of invasive breast cancers in women with dense breast tissue, according to the results of a major study published this week in the American Journal of Roentgenology.

“Molecular Breast Imaging (MBI) is a supplemental imaging technology designed to find tumors that would otherwise be obscured by surrounding dense breast tissue on a mammogram. Tumors and dense breast tissue can both appear white on a mammogram, making tumors indistinguishable from background tissue in women with dense breasts. About half of all screening-aged women have dense breast tissue, according to Deborah Rhodes, M.D., a Mayo Clinic Breast Clinic physician and the senior author of this study.

“MBI increased the detection rate of invasive breast cancers by more than 360 percent when used in addition to regular screening mammography, according to the study. MBI uses small, semiconductor-based gamma cameras to image the breast following injection of a radiotracer that tumors absorb avidly. Unlike conventional breast imaging techniques, such as mammography and ultrasound, MBI exploits the different behavior of tumors relative to background tissue, producing a functional image of the breast that can detect tumors not seen on mammography.”

'Screen More' for Cancer Risk Genes

“Mutations in BRCA genes can give women up to an 80% chance of developing breast cancer.

“A trial involving 1,034 Ashkenazi Jews, who are at high risk, suggested more than half of their cases were not being picked up under the current NHS guidelines.

“The Eve Appeal charity said wider testing would save lives and money.

“Mutations in BRCA genes stop DNA repairing itself and increase the risk of cancer developing.

“As well as breast cancer, they are also linked to ovarian and prostate cancers.”

Quality Cancer Care Still a Goal, Not a Reality, for Most Low-Income Americans

The American Society of Clinical Oncology (ASCO) today called for major reform of Medicaid to ensure access to life-saving screening, treatment and prevention services for low-income Americans with cancer.

“In the new ‘ASCO Policy Statement on Medicaid Reform,’ published today in the Journal of Clinical Oncology, the Society called for Medicaid expansion in all 50 states to close critical coverage gaps, to improve cancer screening and prevention services, and to end coverage restrictions that prevent Medicaid enrollees from receiving high-quality cancer care, among other recommendations.

“Currently, 67.9 million Americans — about one-fifth of the U.S. population — are enrolled in Medicaid, including those added under the Affordable Care Act expansion. Of these, an estimated 2.1 million are cancer patients or cancer survivors.* Yet studies show that Medicaid patients often do not receive the same quality of cancer care as patients with private insurance, and they are up to three times more likely to be diagnosed with cancer at a late stage, when treatment is less likely to be effective.[1]

” ‘Every patient should be able to receive high-quality cancer care, regardless of his or her financial circumstances,’ said ASCO President Peter Paul Yu, MD, FACP, FASCO. ‘Millions of Americans who rely on Medicaid won’t be able to take advantage of advances in cancer prevention and treatment unless meaningful reform occurs.’ “

Preliminary Decision by CMS to Cover Lung Cancer Screening

“The Centers for Medicare & Medicaid Services (CMS) has made a preliminary decision to cover lung cancer screening with low-dose computed tomography (LDCT) for eligible patients.

“The decision was welcomed by a number of professional societies, including the American Thoracic Society, the Lung Cancer Alliance, and the American College of Chest Physicians.

“In April, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) voted against recommending national Medicare coverage for annual screening for lung cancer with low-dose CT in high-risk individuals. Although the MEDCAC vote isn’t binding, their ruling ignited intense pushback from healthcare professionals, patient advocates, and professional associations. More than 40 medical societies have urged CMS to provide coverage for older adults. Even politicians have entered the fray, with members of the US House and Senate asking CMS to reimburse for screening.

” ‘LDCT has been shown to reduce mortality when used to screen individuals who are at high risk for developing lung cancer because of their age and smoking history,’ Charles Powell, MD, chief of pulmonary, critical care, and sleep medicine at Mount Sinai Hospital in New York City and chair of the American Thoracic Society’s thoracic oncology assembly, said in a statement.

” ‘While there is some risk of overdiagnosis, it is outweighed by the mortality benefit that has been demonstrated with screening targeted groups of high-risk patients,’ he said.”

Retesting Breast Cancer Axioms

“American women face conflicting advice about whether to be screened for breast cancer, at what age and how often. The decisions they make are often more strongly influenced by fear or a friend’s experience than by a thorough understanding of the benefits and risks of mammography.

“In 2009, the United States Preventive Services Task Force recommended that women 50 to 74 be screened with mammography every two years and that biennial screening of women younger than 50 be considered case by case. There is no good evidence on whether women older than 75 should be screened, the task force said.

“Yet, screening rates have not declined. Under the Affordable Care Act, free screening mammography is available to all women every one to two years.

“But is this really free, in the fullest sense of the word? Many experts cite hidden costs — financial, medical and emotional.”

CT Lung Screening Appears Cost-Effective

“A new statistical analysis of results from the National Lung Screening Trial (NLST) concludes that performing low-dose computerized tomography screening can be cost-effective compared to doing no screening for lung cancer in aging smokers.

” ‘This provides evidence, given the assumptions we used, that it is cost-effective,’ said Ilana Gareen, assistant professor (research) of epidemiology in Brown University’s School of Public Health and second author on the new study in the New England Journal of Medicine.

“Four years ago, the vast NLST showed that low-dose helical CT scanning reduced mortality from lung cancer by 20 percent compared to chest X-rays. The study involved more than 53,000 smokers aged 55-74. Chest X-rays, meanwhile, have been shown to be no better than doing nothing to screen for the cancer.

“With the NLST’s trove of medical and cost data to work from, a research team including Gareen, senior author Constantine Gatsonis, professor of biostatistics, and lead author Dr. William Black at Dartmouth College’s Geisel School of Medicine, set out to determine the financial implications of conducting CT screening compared to not screening. The standard for this is to calculate a ratio of the costs of CT screening per person—including the test, any follow-up testing and treatment, and indirect costs—and the number of ‘quality-adjusted life-years added’ per person across the population. The quality adjustment distinguishes between living in good health and surviving but with major health problems.”