Abstract:
Background: Lung cancer (LC) is the leading cause of cancer death in the
developed world. Most cancers are associated with tobacco smoking. A primary
hope for reducing lung cancer has been prevention of smoking and successful
smoking cessation programs. To date, these programs have not been as
successful as anticipated.
Objective: The aim of the current study was to evaluate whether lung cancer
screening combining low dose computed tomography with autofluorescence
bronchoscopy (combined CT & AFB) is superior to CT or AFB screening alone in
improving lung cancer specific survival. In addition, the extent of improvement
and ideal conditions for combined CT & AFB screening were evaluated.
Methods: We applied decision analysis and Monte Carlo simulation modeling
using TreeAge Software to evaluate our study aims. Histology- and stage
specific probabilities of lung cancer 5-year survival proportions were taken from
Surveillance and Epidemiologic End Results (SEER) Registry data. Screeningassociated
data was taken from the US NCI Prostate, Lung, Colorectal and
Ovarian Cancer Screening Trial (PLCO), National Lung Screening Trial (NLST),
and US NCI Lung Screening Study (LSS), other relevant published data and
expert opinion.
Results: Decision Analysis - Combined CT and AFB was the best approach at
Improving 5-year survival (Overall Expected Survival (OES) in the entire
screened population was 0.9863) and in lung cancer patients only (Lung Cancer
Specific Expected Survival (LOSES) was 0.3256). Combined screening was slightly better than CT screening alone (OES = 0.9859; LCSES = 0.2966), and
substantially better than AFB screening alone (OES = 0.9842; LCSES = 0.2124),
which was considerably better than no screening (OES = 0.9829; LCSES =
0.1445). Monte Carlo simulation modeling revealed that expected survival in the
screened population and lung cancer patients is highest when screened using
CT and combined CT and AFB. CT alone and combined screening was
substantially better than AFB screening alone or no screening. For LCSES,
combined CT and AFB screening is significantly better than CT alone (0.3126 vs.
0.2938, p< 0.0001).
Conclusions: Overall, these analyses suggest that combined CT and AFB is
slightly better than CT alone at improving lung cancer survival, and both
approaches are substantially better than AFB screening alone or no screening.
