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A5980 - Evaluating the Effectiveness of Lung Cancer Screening in Patients with Chronic Obstructive Lung Disease
Author Block: M. S. Kale1, B. Ferket2, C. Kong3, J. P. Wisnivesky4; 1Medicine, Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, United States, 2Population Health Science and Policy, Mount Sinai School of Medicine, New York, NY, United States, 3Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, United States, 4Mount Sinai School of Medicine, New York, NY, United States.
Introduction: Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease that shares a common risk factor and is independently associated with lung cancer. Moreover, lung cancer is a major cause of death in patients with COPD. Thus, patients with COPD are important candidates for lung cancer screening. However, it is difficult to generalize the results from the National Lung Cancer Screening Trial (NLST) to this population due to differences in the risk of lung cancer, eligibility and complications from surgery, and higher burden of competing risks.
Objective: We used an individual-level microsimulation model of lung cancer screening, diagnosis, and treatment to estimate the health benefits of low dose computed tomography (LDCT) screening in individuals with COPD who meet the eligibility criteria recommended by the United States Preventive Services Task Force (USPSTF).
Methods: We created a microsimulation model that simulated the experience of individuals with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-3, between the ages of 55-80 years undergoing annual LDCT screening for 3 years compared to no screening with a 10 year time horizon. The screening cohort consisted of the expected United States population of patients with GOLD 1-3 COPD estimated based on data from the National Health and Nutrition Examination Survey. The sensitivity and specificity of LDCT were based on Lung-RADS and probability of lung cancer was estimated using the Bach index. Diagnostic work-up parameters (including death from complications) were derived from the NLST. Overall survival for individuals with lung cancer was estimated from Surveillance, Epidemiology, and End Results program. All-cause mortality was based on US life tables accounting for sex and stage of COPD. We estimated the effect of LDCT screening on the difference in life expectancy and lung cancer mortality.
Results: We found that that thrice annual lung cancer screening with LDCT in individuals with GOLD 1-3 COPD leads to a mean difference in life expectancy of 0.26 months. LDCT lead to a 13% relative reduction in lung cancer mortality (10-year risk of lung cancer death 7% vs 8% in the LDCT vs. control group).
Conclusions: We found that LDCT screening leads to improved life expectancy as well as a reduction in lung cancer mortality in individuals with GOLD 1-3 COPD who meet the USPSTF eligibility requirements. These findings suggest that higher risk of perioperative complications or non-lung cancer mortality in patients with COPD do not attenuate the beneficial effect of screening.