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Fnais N, Laxague F, Mascarella MA, Chowdhury R, Zhao H, Jatana S, Aljassim A, Roy CF, Alrasheed AS, Chan DS, Agulnik J, Forghani R, Sultanem K, Mlynarek A, Hier MP. Lung Cancer Surveillance for Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2025; 151:328-334. [PMID: 40048159 PMCID: PMC11886864 DOI: 10.1001/jamaoto.2024.3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 09/03/2024] [Indexed: 03/09/2025]
Abstract
Importance Patients with head and neck squamous cell cancer (HNSCC) are at a greater risk of developing pulmonary metastases and/or second primary lung cancer. However, it remains uncertain whether lung screening in these patients, when the initial staging studies are negative, confers any survival benefit. Objective To evaluate long-term cancer survival outcomes in patients with HNSCC undergoing chest radiography vs low-dose computed tomography screening for pulmonary metastasis and/or second primary lung cancer. Design, Setting, and Participants This randomized parallel trial was conducted at a large academic hospital in Canada enrolling treatment-naive patients with de novo HNSCC from September 2015 to December 2022. Eligible patients did not meet the criteria for lung screening established by the US National Comprehensive Cancer Network guidelines. Participants were randomized to chest radiography or low-dose computed tomography screening groups. Data were analyzed from March to August 2024. Intervention or Exposure Comparison of chest radiography vs low-dose computed tomography screening methods. Main Outcomes and Measures Primary outcomes were the lung cancer detection rate measured by comparing the sensitivity and specificity of low-dose computed tomography with chest radiography. Secondary outcomes were overall survival and disease-free survival. Results A total of 137 patients (mean [SD] age, 65.1 [14.1] years; 34 [24.8%] females and 103 [75.2%] males) were included and randomized, 68 (49.6%) to chest radiography and 69 (50.4%) to low-dose computed tomography. Nine of 137 patients (6.5%) developed a second primary lung cancer (6 patients) or lung metastases (3 patients). There were no clinically meaningful differences in survival outcomes between the 2 groups (hazard ratio, 1.2; 95% CI, 0.4-3.9). Chest radiography exhibited a relatively low sensitivity of 66.7% but a specificity of 100%. Low-dose computed tomography demonstrated both high sensitivity (100%) and specificity (100%), for an overall accuracy of 100%. Conclusions and Relevance The findings of this randomized parallel trial indicate that low-dose computed tomography exhibits statistically significant superior sensitivity compared with chest radiography for diagnosing lung metastases and second primary lung cancer. However, there were no important differences in survival rates. These results hold practical significance, offering valuable insights to clinicians who are guiding decisions regarding lung screening protocols. Trial Registration ISRCTN10954990.
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Affiliation(s)
- Naif Fnais
- Department of Otolaryngology–Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Francisco Laxague
- Department of Head and Neck Surgery, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Marco A. Mascarella
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Raisa Chowdhury
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Hedi Zhao
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sukhdeep Jatana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Abrar Aljassim
- Department of Otolaryngology–Head and Neck Surgery, The University of Western Ontario, London, Ontario, Canada
| | - Catherine F. Roy
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Abdulaziz S. Alrasheed
- Department of Otolaryngology–Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - David S. Chan
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Jason Agulnik
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Reza Forghani
- Department of Medical Imaging, Division of Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael P. Hier
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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Nofal S, Niu J, Resong P, Jin J, Merriman KW, Le X, Katki H, Heymach J, Antonoff MB, Ostrin E, Wu J, Zhang J, Toumazis I. Personal history of cancer as a risk factor for second primary lung cancer: Implications for lung cancer screening. Cancer Med 2024; 13:e7069. [PMID: 38466021 PMCID: PMC10926882 DOI: 10.1002/cam4.7069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Personal history of cancer is an independent risk factor for lung cancer but is omitted from existing lung cancer screening eligibility criteria. In this study, we assess the lung cancer risk among cancer survivors and discuss potential implications for screening. METHODS This was a retrospective, secondary analysis of data from the Surveillance, Epidemiology and End Results (SEER) registry and the MD Anderson Cancer Center (MDACC). We estimated the standardized incidence ratios (SIRs) for lung cancer by site of first primary cancer using data from SEER. We assessed the lung cancer risk among head and neck cancer survivors from MDACC using cumulative incidence and compared the risk ratios (RR) by individuals' screening eligibility status. RESULTS Other than first primary lung cancer (SIR: 5.10, 95% CI: 5.01-5.18), cancer survivors in SEER with personal history of head and neck cancer (SIR: 3.71, 95% CI: 3.63-3.80) had the highest risk of developing second primary lung cancer, followed by bladder (SIR: 1.86, 95% CI: 1.81-1.90) and esophageal cancers (SIR: 1.78, 95% CI: 1.61-1.96). Head and neck cancer survivors had higher risk to develop lung cancer compared to the National Lung Screening Trial's subjects, (781 vs. 572 per 100,000 person-years, respectively). Head and neck cancer survivors ineligible for lung cancer screening seen at MDACC had significantly higher lung cancer risk than head and neck cancer survivors from SEER (RR: 1.9, p < 0.001). CONCLUSION Personal history of cancer, primarily head and neck cancer, is an independent risk factor for lung cancer and may be considered as an eligibility criterion in future lung cancer screening recommendations.
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Affiliation(s)
- Sara Nofal
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Thoracic/Head and Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jiangong Niu
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Paul Resong
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jeff Jin
- Information Services, Enterprise Development and IntegrationThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kelly W. Merriman
- Department of Tumor RegistryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Hormuzd Katki
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, US Department of Health and Human ServicesBethesdaMarylandUSA
| | - John Heymach
- Department of Thoracic/Head and Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Edwin Ostrin
- Department of General Internal MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jia Wu
- Department of Imaging PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Iakovos Toumazis
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Diaz EM, Tu J, Diaz EM, Antonoff MB. Lung Cancer Screening in Head and Neck Cancer Patients: An Untapped Opportunity. Ann Thorac Surg 2024; 117:305-309. [PMID: 36940898 DOI: 10.1016/j.athoracsur.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/21/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Despite evidence demonstrating that lung cancer screening (LCS) decreases mortality, widespread implementation is lagging. Efforts to identify and recruit patients for LCS are in need. Candidacy for LCS is based on identifiable risk factors, many of which overlap with those of head and neck malignancies. Thus, we aimed to evaluate the prevalence of candidacy for LCS in the head and neck cancer patient population. METHODS We performed a review of anonymous surveys collected from patients who presented to a head and neck cancer clinic. Variables collected from these surveys included age, biologic sex, smoking history, and head and neck cancer history. Patients' candidacy for screening was determined, and descriptive analyses were performed. RESULTS A total of 321 patient surveys were reviewed. Mean age was 63.7 years, and 195 (60.7%) were men. In this sample, 19 (5.91%) were current smokers, and 112 (34.9%) were former smokers, having quit an average of 19.4 years prior to completing the survey. Average pack-years was 29.3. Of the 321 patients surveyed, 60 (18.7%) would qualify for LCS using current guidelines. However, among those 60 patients who qualified for LCS, only 15 (25%) patients had been offered screening and only 14 (23.3%) had been screened. CONCLUSIONS We have importantly demonstrated both a substantial prevalence of candidacy for LCS in the head and neck cancer population as well as disappointingly low levels of screening utilization in this group of patients. We have identified this setting as a key patient population that ought to be targeted for information about and access to LCS.
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Affiliation(s)
- Edward M Diaz
- General Surgery Residency Program, University of Texas Rio Grande Valley, Harlingen, Texas
| | - Janet Tu
- Division of Cancer Medicine, Department of General Oncology and Thoracic, Head and Neck Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo M Diaz
- Division of Surgery, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Division of Surgery, Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Fourdrain A. The Added Burden of Previous Head and Neck Cancer in Patients Facing Lung Cancer. Ann Thorac Surg 2024; 117:188-189. [PMID: 35598709 DOI: 10.1016/j.athoracsur.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Alex Fourdrain
- Department of Thoracic Surgery, Marseille University Hospital, Chemin des Bourrely 13015 Marseille, France.
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Zhou J, Wang T, Xia L, Zheng Q, Wu D, Lin M, Lu T, Ma L. Effect of a prior thyroid cancer on the survival of lung cancer patients: a retrospective study based on SEER database. Endocrine 2024; 83:142-149. [PMID: 37632636 DOI: 10.1007/s12020-023-03474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The effect of a history of thyroid cancer on the prognosis of lung cancer patients has not been fully investigated. Therefore, we aimed to evaluate this effect based on a large cohort. METHODS Data of 154844 lung cancer patients, of whom 406 had prior thyroid cancer, were collected from SEER database. Primary survival analysis was conducted between patients with and without prior thyroid cancer using Kaplan-Meier method. Secondary survival analysis was conducted to investigate the effects of the stage and histological subtype of the prior thyroid cancer on the survival of lung cancer patients. Propensity adjustment was used to reduce confounding effect. RESULTS Compared to patients without prior malignancy, patients with prior thyroid cancer were predominantly female (72.4% vs. 48.7%, p < 0.001), had lower stage (proportion of localized tumor: 40.4% vs. 25.6%, p < 0.001), and larger proportion of surgery (52.2% vs. 29.4%, p < 0.001), and had better survival (5-year survival rate: 55.53% vs. 33.16%, p < 0.001). After propensity adjustment, the survival was similar between the groups (5-year survival rate: 55.53% vs. 51.78%, p = 0.24). The survival of patients with different stages (localized tumor vs. regional tumor: p = 0.88) or different histological subtypes (p = 0.46) of prior thyroid cancer were comparable. CONCLUSION Survival of lung cancer patients with or without prior thyroid cancer was similar after propensity adjustment, and the stage or histological subtype of the prior thyroid cancer had no significant effect on the survival of lung cancer patients.
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Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tengyong Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Quan Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Dongsheng Wu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mingying Lin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Tianyi Lu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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León X, Gimenez A, de Juan J, Rodríguez C, Quer M, Pujol A. Is long-term screening for lung cancer justified in patients with head and neck carcinoma? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:271-276. [PMID: 36241026 DOI: 10.1016/j.otoeng.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/30/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patients with head and neck squamous cell carcinoma (HNSCC) have a higher risk of second lung neoplasms than the general population. The aim of the present study is to evaluate the long-term incidence of second lung malignancies after the diagnosis of a HNSCC and to consider the convenience of the screening for lung cancer in these patients. MATERIAL AND METHODS We conducted a retrospective study performed on 4954 patients with an index tumor located in the oral cavity, oropharynx, hypopharynx, or larynx during the period 1985-2017. RESULTS During the follow-up period 469 patients (9.5%) presented a second pulmonary neoplasm. The incidence of second lung neoplasm was 1.26% per year and remained practically constant throughout the 25-year follow-up period analyzed. According to the results of a multivariate study, male patients, aged between 50 and 80 years, with a history of tobacco use, and with tumors located in the oropharynx or the supraglottis were those with the highest risk of second lung neoplasms. CONCLUSION Patients with a HNSCC index tumor have a high risk of second neoplasms located in the lung. In order to achieve an early diagnosis of these second neoplasms, it would be advisable to establish screening protocols based on the use of low-dose lung CT, which should be maintained indefinitely during the follow-up period.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain; Universitat de Vic (UVIC), Universitat Central de Catalunya, Vic, Barcelona, Spain.
| | - Ana Gimenez
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Julia de Juan
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Camilo Rodríguez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Albert Pujol
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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León X, Gimenez A, de Juan J, Rodríguez C, Quer M, Pujol A. ¿Está justificado hacer un screening a largo plazo para el cáncer de pulmón en los pacientes con un carcinoma de cabeza y cuello? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shao YF, Kim S, Cramer JD, Farhat D, Hotaling J, Raza SN, Yoo G, Lin HS, Kim H, Sukari A, Nagasaka M. African American race as a risk factor associated with a second primary lung cancer after initial primary head and neck cancer. Head Neck 2022; 44:2069-2076. [PMID: 35713967 PMCID: PMC9543059 DOI: 10.1002/hed.27107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/24/2022] [Accepted: 05/16/2022] [Indexed: 11/12/2022] Open
Abstract
Background Initial primary head and neck cancer (IPHNC) is associated with second primary lung cancer (SPLC). We studied this association in a population with a high proportion of African American (AA) patients. Methods Patients with IPHNC and SPLC treated between 2000 and 2017 were reviewed for demographic, disease, and treatment‐related characteristics and compared to age‐and‐stage‐matched controls without SPLC. Logistic and Cox regression models were used to analyze the relationship of these characteristics with the development of SPLC and overall survival (OS). Results Eighty‐seven patients and controls were compared respectively. AA race was associated with a significantly higher risk of developing SPLC (OR 2.92, 95% CI 1.35–6.66). After correcting for immortal time bias, patients with SPLC had a significantly lower OS when compared with controls (HR 0.248, 95% CI 0.170–0.362). Conclusions We show that AA race is associated with an increased risk of SPLC after IPHNC; reasons of this increased risk warrant further investigation.
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Affiliation(s)
- Yusra F Shao
- Department of Oncology, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Seongho Kim
- Department of Oncology, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dina Farhat
- Department of Oncology, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Jeffrey Hotaling
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Syed Naweed Raza
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - George Yoo
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ho-Sheng Lin
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Harold Kim
- Department of Radiation Oncology, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Ammar Sukari
- Department of Oncology, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Misako Nagasaka
- Division of Hematology and Oncology, Department of Medicine, University of California Irvine School of Medicine, Orange, CA, USA.,Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Cramer JD, Grauer J, Sukari A, Nagasaka M. Incidence of Second Primary Lung Cancer After Low-Dose Computed Tomography vs Chest Radiography Screening in Survivors of Head and Neck Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2021; 147:1071-1078. [PMID: 34709369 DOI: 10.1001/jamaoto.2021.2776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance In head and neck cancer survivors, lung cancer screening may aid in detecting a second primary lung cancer or metastatic head and neck cancer earlier in the course of disease, which may improve treatment outcomes. However, no randomized data exist to assess the value of lung cancer screening in this population. Objective To evaluate the incidence of second primary lung cancer in survivors of head and neck cancer survivors with screening low-dose computed tomography (CT) vs chest radiography (CXR). Design, Setting and Participants For this ad hoc secondary analysis of a randomized clinical trial, head and neck cancer survivors were identified from the National Lung Screening Trial, which enrolled participants from August 2002 to April 2004. This randomized clinical trial compared screening using low-dose CT chest vs CXR in patients aged 55 to 74 years with at least a 30 pack-year history of cigarette smoking and who were current smokers or had quit within the past 15 years and who were at high risk for lung cancer. The incidences of second primary lung cancer and second primary head and neck cancer were compared with screening using low-dose CT vs CXR. Data were analyzed from December 1, 2020, to June 30, 2021. Interventions Screening low-dose CT of the chest vs CXR. Main Outcomes and Measures The primary outcome was the incidence of a second primary lung cancer. Results Among 53 452 enrolled participants, we identified 171 survivors of head and neck cancer, of whom 82 were screened with low-dose CT of the chest and 89 with CXR. Participants' mean (SD) age was 61 (5) years, and 132 were men (77.2%). The incidence of lung cancer was higher among head and neck cancer survivors compared with participants without head and neck cancer (2080 per 100 000 person-years [2.1%] vs 609 per 100 000 person-years [0.6%]; adjusted rate ratio, 2.54; 95% CI, 1.63-3.95). In head and neck cancer survivors, the incidence of second primary lung cancer was 2610 cases per 100 000 person-years in the low-dose CT group vs 1594 cases per 100 000 person-years in the CXR group (rate ratio, 1.55; 95% CI, 0.59-3.63). In head and neck cancer survivors, overall survival was 7.07 years with low-dose CT vs 6.66 years with CXR (log-rank P = .48). Conclusions and Relevance The results of this ad hoc secondary analysis of a randomized clinical trial suggest that head and neck cancer survivors are at especially high risk for a second primary lung cancer. These findings underscore the importance of low-dose CT screening in head and neck cancer survivors with significant cigarette smoking history who are fit to undergo treatment with curative intent.
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Affiliation(s)
- John D Cramer
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan
| | - Jordan Grauer
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan
| | - Ammar Sukari
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Misako Nagasaka
- Division of Hematology and Oncology, University of California Irvine School of Medicine, Orange.,Division of Neurology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Survival analysis of patients with primary breast duct carcinoma and lung adenocarcinoma: a population-based study from SEER. Sci Rep 2021; 11:14790. [PMID: 34285322 PMCID: PMC8292419 DOI: 10.1038/s41598-021-94357-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/08/2021] [Indexed: 11/09/2022] Open
Abstract
The appeal to enroll patients with primary breast and lung cancer in clinical trials is increasing, but survival of these two primary cancers remains to be elucidated. This study analyzed the prognosis of primary breast duct carcinoma with subsequent lung adenocarcinoma (BCLA) and primary breast duct carcinoma with prior lung adenocarcinoma (LABC). Cohorts of 3,515 patients with BCLA and 654 patients with LABC were identified from the Surveillance, Epidemiology, and End Results database. Patients were classified into simultaneous two primary cancer (sTPC), metachronous two primary cancer (mTPC1), or mTPC2 groups when the interval times between breast and lung cancer were within 6 months, between 7 and 60 months, or over 60 months, respectively. The propensity score matching program (PSM) was applied to determine the survival of BCLA/LABC relative to single breast/lung cancer. Cox proportional hazard regression model and competing risk modes were performed to identify confounders associated with all-cause and cancer-specific death, respectively. Survival of patients with LABC/BCLA relative to single breast/lung cancer was accessed via median survival time. The survival of patients with BCLA/LABC was generally poor compared with the survival of those with single breast cancer. The PSM-estimated HR in the sTPC group with BCLA and in the mTPC1 and mTPC2 groups with LABC were 0.75 (95% CI 0.62–0.90), 0.52 (95% CI 0.27–0.98), and 0.36 (95% CI 0.20–0.65), respectively, whereas the SHRs were 0.80 (95% CI 0.66–0.97), 0.68 (95% CI 0.34–1.34), and 0.46 (95% CI 0.27–0.80), respectively, compared with those in the single lung cancer group. By contrast, the survival rates of the remaining patients did not differ. The median survival times since secondary malignancy were 42, 23, and 20 months in the sTPC, mTPC1, and mTPC2 groups with BCLA, respectively, and 18, 60, and 180 months in those with LABC, respectively. For patients with BCLA, the adjusted Cox regression suggested incidences of all-cause deaths in mTPC1group were statically higher than those in sTPC group, whereas the incidences of all-cause and cancer-specific death in the mTPC1 and mTPC2 groups were statistically lower than those in the sTPC group. The prognosis of patients with breast cancer and subsequent lung cancer of over 18 months was not significantly different than that of single lung cancer, which supported the profound appeal to increase the involvement of these two primary cancers in potential beneficial clinical trials. For patients with lung cancer and prior breast cancer of within 6 months and subsequent breast cancer of over 18 months, prognosis was improved relative to single lung cancer. Therefore, additional attention is needed to eliminate the potential bias may when these patients are recruited in the clinical trials.
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Bugter O, van Iwaarden DLP, van Leeuwen N, Nieboer D, Dronkers EAC, Hardillo JAU, Baatenburg de Jong RJ. A cause-specific Cox model for second primary tumors in patients with head and neck cancer: A RONCDOC study. Head Neck 2021; 43:1881-1889. [PMID: 33655596 PMCID: PMC8247881 DOI: 10.1002/hed.26666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/12/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background The aim of this study was to identify risk factors for the development of second primary tumors (SPTs) in the head and neck region, lungs, and esophagus in patients with head and neck cancer. Methods We collected data from 1581 patients. A cause‐specific Cox model for the development of an SPT was fitted, accounting for the competing risks residual/recurrent tumor and mortality. Results Of all patients, 246 (15.6%) developed SPTs. Analysis showed that tobacco and alcohol use, comorbidity, and the oral cavity subsite were risk factors for SPTs. The C‐index, the discriminative accuracy, of the model for SPT was 0.65 (95% confidence interval, 0.61–0.68). Conclusions Our results show that there is potential to identify patients who have an increased risk to develop an SPT. This might increase their survival chances and quality of life. More research is needed to provide head and neck clinicians with definitive recommendations.
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Affiliation(s)
- Oisín Bugter
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk L P van Iwaarden
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Medical Decision Making, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Medical Decision Making, Rotterdam, The Netherlands
| | - Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - José A U Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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O'Dwyer E, Halpenny DF, Ginsberg MS. Lung cancer screening in patients with previous malignancy: Is this cohort at increased risk for malignancy? Eur Radiol 2020; 31:458-467. [PMID: 32728771 DOI: 10.1007/s00330-020-07026-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/09/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the rate of second primary lung cancer (SPLC) and describe the clinical characteristics and radiological findings in individuals with a prior history of cancer presenting to a low-dose computed tomography (LDCT) lung cancer screening program at a tertiary cancer center. METHODS Patients with a previous history of malignancy, a life expectancy ≥ 5 years referred for CT lung cancer screening between May 2, 2011, and November 28, 2018, were included. Demographics regarding risk factors including smoking history and prior history of thoracic radiation were collected. CT scan features assessed nodule size, morphologic features, and number. The Lung-CT Reporting and Data System (Lung-RADS) scoring system was retrospectively applied to studies performed before October 2014 and prospectively applied to remainder of studies. Data was collected in a Health Insurance Portability and Accountability Act (HIPAA)-compliant manner. RESULTS A total of 543 patients were studied (mean age of 66 years). All had a previous history of cancer, most commonly breast cancer 205 (38%), head and neck cancer 105 (19%), and lung cancer 87 (16%). Of screening CTs performed, 17.5% were positive screening study results as per Lung-RADS scoring system. SPLC was diagnosed in 35 patients (6.4%) with 21 prevalence cancers detected and 14 interval cancers detected in subsequent screening rounds. CONCLUSIONS The rate of screen-detected SPLC in patients with prior malignancy is higher than reported rates seen in historical prospective screening studies. Our study suggests the need for prospective research to evaluate any mortality benefit that screening may have in this population. KEY POINTS • The rate of screen-detected second primary lung cancer in patients with prior malignancy is higher than reported rates seen in historical prospective randomized lung cancer screening studies in a general screened population. • Patients with a prior malignancy undergoing lung cancer screening have higher rates of positive screening studies and higher rates of invasive diagnostic procedures than those reported in a general screening population. • Prospective research is required to evaluate if screening offers a mortality benefit in this population.
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Affiliation(s)
- Elisabeth O'Dwyer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Darragh F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Dukes K, Seaman AT, Hoffman RM, Christensen AJ, Kendell N, Sussman AL, Vélez-Bermúdez M, Volk RJ, Pagedar NA. Attitudes of Clinicians about Screening Head and Neck Cancer Survivors for Lung Cancer Using Low-Dose Computed Tomography. Ann Otol Rhinol Laryngol 2020; 129:23-31. [PMID: 31409114 PMCID: PMC6945809 DOI: 10.1177/0003489419868245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE National guidelines recommend lung cancer screening (LCS) using low-dose computed tomography (LDCT) for high-risk patients, including survivors of other tobacco-related cancers like head and neck cancer (HNC). This qualitative study investigated clinicians' practices and attitudes toward LCS with LDCT with patients who have survived HNC, in the context of mandated requirements for shared decision making (SDM) using decision aids. METHODS Thematic analysis of transcribed semi-structured clinician interviews and focus group. RESULTS Clinicians recognized LCS' utility for some HNC survivors with smoking histories. However, they identified many challenges to SDM in diverse clinic settings, including time, workflow, uncertainty about guidelines and reimbursement, decision aids, competing patient priorities, unclear evidence, potentially heightened patient receptivity and stress, and the complexity of discussions. They also identified challenges to LCS implementation. CONCLUSIONS While clinicians feel that LDCT LCS may benefit some HNC survivors, there are barriers both to implementing LCS SDM for these patients in primary care as currently recommended and to integrating it into cancer clinics. Challenges for SDM across settings include a lack of decision aids tailored to patients with cancer histories. Given recommendations to broaden LCS eligibility criteria, more research may be required before refinement of current guidelines.
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Affiliation(s)
- Kimberly Dukes
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Aaron T. Seaman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Richard M. Hoffman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Alan J. Christensen
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Nicholas Kendell
- Department of Otolaryngology—Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Andrew L. Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Miriam Vélez-Bermúdez
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nitin A. Pagedar
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
- Department of Otolaryngology—Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Second primary lung cancer following laryngeal cancer: retrospective study of incidence and multivariate analysis of risk factors in 209 patients. The Journal of Laryngology & Otology 2019; 133:974-979. [PMID: 31668148 DOI: 10.1017/s0022215119002147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyse the incidence of second primary lung cancer following treatment for laryngeal cancer and to identify risk factors for its development. METHOD Retrospective case series. RESULTS The five-year actuarial incidence of second primary lung cancer was 8 per cent (1.6 per cent per year). This was associated with a very poor median survival of seven months following diagnosis. Supraglottic tumours were associated with an increased risk of second primary lung cancer compared to glottic tumours in both univariate (hazard ratio = 4.32, p = 0.005) and multivariate analyses (hazard ratio = 4.14, p = 0.03). CONCLUSION Second primary lung cancer occurs at a rate of 1.6 per cent per year following a diagnosis of laryngeal cancer, and this is associated in a statistically significant manner with supraglottic primary tumour. The recent National Lung Cancer Screening Trial suggests a survival advantage of 20 per cent at five years with annual screening using low-dose computed tomography scanning of the chest in a comparable cohort to ours. These findings have the potential to inform post-treatment surveillance protocols in the future.
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15
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Rivera MP, Henderson LM. Lung cancer screening and shared decision making in cancer survivors: the long and winding road. Transl Lung Cancer Res 2019; 8:119-123. [PMID: 31106122 DOI: 10.21037/tlcr.2018.12.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M Patricia Rivera
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Mets OM, Schaefer-Prokop CM, de Jong PA. Primary lung cancer in patients with previous malignancies: a nationwide study. Thorax 2018; 74:492-495. [PMID: 30385691 DOI: 10.1136/thoraxjnl-2018-211891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/27/2018] [Accepted: 10/01/2018] [Indexed: 11/03/2022]
Abstract
Overall survival of patients with cancer continues to increase and so they receive more frequent CT imaging, making oncological patients a growing population that effectively receives lung cancer screening in the course of daily practice. However, it is currently uncertain how early lung cancer detection in this subgroup of patients should be optimally managed. We describe the relationship between primary lung cancer and prior malignancies in a nationwide cohort, in an attempt to identify possible areas of improvement in nodule management. We found that a substantial number of subjects with lung cancer suffered from a prior malignancy; however, with the exception of otorhinolaryngeal malignancies, they did not show a high absolute risk for lung cancer. Future research should provide more data on how to handle this subgroup of patients in clinical and screening setting.
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Affiliation(s)
- Onno M Mets
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelia M Schaefer-Prokop
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands.,Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Seaman AT, Dukes K, Hoffman RM, Christensen AJ, Kendell N, Sussman AL, Veléz-Bermúdez M, Volk RJ, Pagedar NA. The complicated 'Yes': Decision-making processes and receptivity to lung cancer screening among head and neck cancer survivors. PATIENT EDUCATION AND COUNSELING 2018; 101:1741-1747. [PMID: 29709410 PMCID: PMC6119119 DOI: 10.1016/j.pec.2018.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/17/2018] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is recommended when offering lung cancer screening (LCS)-which presents challenges with tobacco-related cancer survivors because they were excluded from clinical trials. Our objective was to characterize head and neck cancer (HNC) survivors' knowledge, attitudes, and beliefs toward LCS and SDM. METHODS Between November 2017 and June 2018, we conducted semi-structured qualitative interviews with 19 HNC survivors, focusing on patients' cancer and smoking history, receptivity to and perceptions of LCS, and decision-making preferences RESULTS: Participants were receptive to LCS, referencing their successful HNC outcomes. They perceived that LCS might reduce uncertainty and emphasized the potential benefits of early diagnosis. Some expressed concern over costs or overdiagnosis, but most minimized potential harms, including false positives and radiation exposure. Participants preferred in-person LCS discussions, often ideally with their cancer specialist. CONCLUSION AND PRACTICE IMPLICATIONS HNC survivors may have overly optimistic expectations for LCS, and clinicians need to account for this in SDM discussions. Supporting these patients in making informed decisions will be challenging because we lack clinical data on the potential benefits and harms of LCS for cancer survivors. While some patients prefer discussing LCS with their cancer specialists, the ability of specialists to support high-quality decision making is uncertain.
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Affiliation(s)
- Aaron T Seaman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, USA.
| | - Kimberly Dukes
- Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Richard M Hoffman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Alan J Christensen
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, USA
| | - Nicholas Kendell
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Andrew L Sussman
- Family and Community Medicine, University of New Mexico, Albuquerque, USA
| | | | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, USA
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Carmona-Bayonas A, Jiménez-Fonseca P, Castañón E, Ramchandani-Vaswani A, Sánchez-Bayona R, Custodio A, Calvo-Temprano D, Virizuela JA. Chronic opioid therapy in long-term cancer survivors. Clin Transl Oncol 2016; 19:236-250. [PMID: 27443415 DOI: 10.1007/s12094-016-1529-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/27/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Long-term cancer survivors develop special health issues and specific needs. Chronic pain, whether the consequence of their cancer or as a side effect of treatment, is one of their most prevalent concerns. METHODS We conducted a review of the English-language literature on long-term cancer survivorship and chronic opioid therapy, with the objective of determining the efficacy, safety and tolerability in this group of patients. Practical management recommendations are made on the basis of this review. RESULTS Pain syndromes encountered in the long-term cancer survivors are diverse. Opioid receptor pathways possess complex and pleiotropic functions and continuous over-activation may lead to de novo endocrinopathies, immunosuppression, neurocognitive impairment, or cell cycle disturbances with potential clinical connotations. However, there are insufficient data to support evidence-based decision making with respect to patient selection, doses, administration, monitoring and follow-up. Data about long-term treatment effectiveness and safety are limited and often aggravated by the overlapping of several diseases prevalent among long-term cancer survivors, as well as chronic opiate-induced toxicity. CONCLUSIONS Chronic opioid therapy is frequent in long-term cancer survivors, and may negatively affect the immune system, and produce health problems such as endocrinopathies, osteoporosis, neurological or cardiopulmonary effects, alterations of cell cycle kinetics, abuse and addiction. This review highlights the need for specialized teams to treat chronic pain in long-term cancer survivors from an integrative perspective.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), Avenue Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Principado de Asturias, Spain
| | - E Castañón
- Medical Oncology Department, Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Avenida Pío XII, 36, Pamplona, Spain
| | - A Ramchandani-Vaswani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur, s/n, 35016, Las Palmas de Gran Canaria, Spain
| | - R Sánchez-Bayona
- Medical Oncology Department, Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Avenida Pío XII, 36, Pamplona, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain
| | - D Calvo-Temprano
- Radiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Principado de Asturias, Spain
| | - J A Virizuela
- Medical Oncology Department, Hospital Virgen de la Macarena, Avd. Doctor Fedriani, 3, 41071, Seville, Spain
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Follow-up and Survivorship in Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2016; 28:451-8. [DOI: 10.1016/j.clon.2016.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/23/2016] [Accepted: 03/03/2016] [Indexed: 12/14/2022]
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Halpenny DF, Cunningham JD, Long NM, Sosa RE, Ginsberg MS. Patients with a Previous History of Malignancy Undergoing Lung Cancer Screening: Clinical Characteristics and Radiologic Findings. J Thorac Oncol 2016; 11:1447-52. [PMID: 27223458 DOI: 10.1016/j.jtho.2016.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The aim of this study was to describe the clinical characteristics and radiologic findings in patients with a previous history of malignancy who underwent computed tomography (CT) screening for lung cancer. METHODS Patients with a previous history of malignancy and a life expectancy of at least 5 years who were referred for lung cancer screening between May 2, 2011, and September 24, 2014, were included. CT scan features assessed included nodule size, morphologic features, and number. The Lung-CT Reporting and Data System scoring system was retrospectively applied to all studies. RESULTS A total of 139 patients were studied (mean age of 66 years and median smoking history of 50 pack-years). All had a previous history of cancer, most often breast cancer (60 patients [43%]), head or neck cancer (26 patients [19%]), and lung cancer (16 patients [12%]). Of these patients, 42 (30%) had a positive screening study result. Lung cancer was diagnosed in seven patients (5%), and a radiation-induced chest wall sarcoma was diagnosed in one patient (1%); 42 patients (30%) had a positive chest CT scan per the National Comprehensive Cancer Network lung cancer screening nodule follow-up algorithm. CONCLUSION The rate of diagnosis of lung cancer in our patient population is higher than in several previously published studies. Smokers with a history of malignancy may be a group at particularly high risk for the development of subsequent lung cancer.
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Affiliation(s)
| | | | - Niamh M Long
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ramon E Sosa
- Memorial Sloan Kettering Cancer Center, New York, New York
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Erkmen CP, Kaiser LR, Ehret AL. Lung cancer screening: Should we be excluding people with previous malignancy? World J Respirol 2016; 6:1-13. [DOI: 10.5320/wjr.v6.i1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/16/2016] [Indexed: 02/06/2023] Open
Abstract
The National Lung Screening Trial (NLST) was a large, randomized, controlled study showing a 20% reduction of lung cancer mortality and 7% reduction of all cause mortality using annual low dose computed tomography (LDCT) in a high risk population. NLST excluded people with a previous history of cancer treatment within the past 5 years and all people with a history lung cancer. The aim of this work is to review how lung cancer screening trials addressed the confounding effect of previous malignancy. We also review the subsequent recommendations by the United States Preventative Task Force Services, multiple professional societies and the Center for Medicaid and Medicare Services which defer either to NLST criteria or, clinician judgment or refrain from asserting any recommendation on the topic, respectively. Implications of lung cancer screening in the setting of previous malignancies, specifically lung, head and neck, esophageal, gastric, breast, colorectal cancer and lymphoma are also discussed. With lung cancer screening, an antecedent malignancy introduces the possibility of discovering metastasis as well as lung cancer. In some circumstances diagnosis and treatment of oligometastatic disease may confer a survival benefit. The survival benefit of treating either lung cancer or oligometastatic disease as result of lung cancer screening has yet to be determined. Further studies are needed to determine the role of lung cancer screening in the setting of previous malignancy.
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