Ahmed Zeeneldin

¨ High risk population¡ Heavy smoker or former smoker (quit within last 15 years)ú Smoked 30 pack years equivalent to 1 pack /day x 30 years

¡ Age: 55 to 74 years¨ Randomized to:

¡ low-dose helical CT OR¡ standard chest X-ray

¨ Duration: yearly x 3 years and follow up for 5 years¨ Positive cases are further verified¨ Endpoint: death from lung cancer

Process and outcomes in the NLST.

Radiology doi:10.1148/radiol.10091808

©2010 by Radiological Society of North America

¨ Started 2002¨ Accrued 53 000 in 33 sites in USA over 20 months¨ DSMB stopped the trial in October 2010

Spiral CT Chest xray PNumbers 26500 26500No of cases ? ?Lung cancer mortality 354 442 <0.05RR of lung cancer death 0.8 (20% lower) 1All-cause mortality 7% lowerPositive findings on imaging during study 24% 7%False positives 95-98% 93-96%Compliance 91%

¨ Primary Prevention:¡ Prevent initial disease occurrence

¨ Secondary Prevention:¡ Detect the disease early in the asymptomatic

stage

¨ Tertiary Prevention:¡ Prevent re-occurrence and complications and

disability and improve QOL

¨ High risk groups:¡ Heavy cigarette smokers

¨ Asymptomatic

¨ Primary Prevention:ú Anti-smoking measures bilat mastectomyú HBV vaccinationú HPV vaccination

¨ Secondary Prevention:ú Breast cancer screeningú HCC screening

¨ Tertiary Prevention:ú Proper treatmentsú Adj Tam in breast cancer

Lung cancer¨ Clinical exam: X

¡ BSE, CBE¡ DRE

¨ Lab tests: X¡ Serum biomarkers:ú PSAú AFP

¡ Cytology ¨ Radiology: YES

¡ Mammography - Chest X-ray XXXX¡ TRUS - CT chest¡ ABD US - MRI?

¨ Other: XXX¡ Colonoscpoy - Bronchoscopy

A. ConventionalB. Spiral (low dose helical):

¡ scans the entire chest in about 7-15 seconds during a single, breath-hold. The CT scanner rotates around the person, who is lying still on a table as the table passes through the center of the scanner.

¨ Lead time bias¨ Length bias¨ Overdiagnosis bias

¨ Survival is the time from Diagnosis to death¨ It is longer if cancer is detected early by screening¨ Lead time= screening survival – symptom survival¨ To avoid it

measure mortality

¨ Indolent cancers have long preclinical phase and more amenable to early detection

¨ Diagnosis and treatment of non-fatal disease

¨ High risk population¡ Heavy smoker or former smoker (quit within last 15 years)¡ Age: 55 to 74 years

¨ Randomized to:¡ low-dose helical CT OR¡ standard chest X-ray

¨ Duration: yearly x 3 years and follow up for 5 years¨ Positive cases are further verified¨ Endpoint: death from lung cancer

Process and outcomes in the NLST.

Radiology doi:10.1148/radiol.10091808

©2010 by Radiological Society of North America

¨ Started 2002¨ Accrued 53 000 in 33 sites in USA over 20 months¨ DSMB stopped the trial in October 2010

Spiral CT Chest xray PNumbers 26500 26500Lung cancer mortality 354 442 <0.05Mortality /100 000 245 308RR 0.8 (20% lower) 1All-cause mortality 7% lowerPositive findings on imaging during study 24% 7%False positives 95-98% 93-96%Compliance 91%

¨ Who is at high risk?¨ Age?¨ Schedule?¨ Compliance?¨ False positive rates?¨ Stop or not to stop smoking?

Lung cancer (cases)

No lung cancer(non-cases)

Spiral CT mass True positive (TP)5%

False positive (FP)95%

PPV: TP/test positive

Spiral CT no mass False negative (FN) True negative (TN) NPV:TN/test negative

Test Sensitivity: TP/cases

Test Specificity:TN/non-cases

¨ Positivity rate or prevalence of positivity = Total positives / Total tested x 10049.70%

¨

¨ Negativity rate or prevalenve of negativity = Total negatives / Total tested x 10050.30%

¨

¨ Rate of Disagreement = (False positives + False negatives) / Total tested x 1008.73%

¨

¨ Rate of Agreement = (True positives + True negatives) / Total tested x 10091.27%

¨

¨ Sensitivity = True positives / Total positives x 10084.85%

¨

¨ Specificity = True negatives / Total negatives x 10097.60%

¨

¨ Predictive value positivity = True positives / Tested positive x 10097.22%

¨

¨ Predictive value negativity = True negatives / Tested negative x 100

86.70%

¨ Females:¡ Breast¡ Cervix

¨ Males:¡ Prostate

¨ Both sexes:¡ Colorectal¡ Lung ¡ ? HCC in Egypt in high risk groups