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Expert Point of View: Paul Wheatley-Price, MRCP


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During an International Association for the Study of Lung Cancer (IASLC) press briefing, Paul Wheatley-Price, MRCP, commented as the patient advocate on the panel. Dr. Wheatley-Price is Associate Professor of Medicine at the University of Ottawa, lung cancer disease site lead at Ottawa Hospital Cancer Centre, Past-President of Lung Cancer Canada, and a member of the IASLC Patient Advocacy Committee.

Paul Wheatley-Price, MRCP

Paul Wheatley-Price, MRCP

Dr. Wheatley-Price agreed that the value of low-dose computed tomography (CT) screening of high-risk individuals is no longer in doubt. What is needed now is implementation.

“Strictly speaking, the UKLS was not a positive study,1 but it wasn’t powered to show a reduction in lung cancer mortality, which is why they did a meta-analysis,” he said. “The results are very much in keeping with the National Lung Screening Trial,2 the NELSON trial,3 the PanCan [Pan-Canadian Early Detection of Lung Cancer] trial,4 and others. Studies are very consistent. We don’t need more evidence that [low-dose] CT screening is effective.”

He continued: “We can talk about immunotherapies, circulating tumor DNA, and other nice technologies, but ultimately, if we want to save lives, we need to identify patients at an earlier stage. “[Low-dose] CT screening has the potential to be the single most important intervention to do so. Now, we have to move to implementing it and making it equitable.”

A big obstacle is stigma: “If this were a breast cancer issue, we would not be having a discussion about implementation. Yet it’s my understanding that the number needed to screen, to save one life from lung cancer, is fewer than the number of mammograms needed to save lives from breast cancer.”

Another issue pertains to cost-effectiveness. “I believe some studies do show cost-effectiveness [with low-dose CT screening], but it depends on the jurisdiction and how health care is delivered,” he added.

Education is paramount, particularly among primary care providers, who can identify individuals at risk. “Family doctors are good at colorectal cancer screening, mammograms, Pap smears. We just need to educate them,” he said.

“These challenges are faced globally,” he added. About half of lung cancer in the Western world is diagnosed at an advanced stage. In some parts of the world—and even for some subsets of the U.S. population—the proportion is much higher. One could argue that their need for screening is even greater, he said. “When we think about screening, we now need to look more at implementation and equity.” 

DISCLOSURE: Dr. Wheatley-Price reported no conflicts of interest.

REFERENCES

1. Field JK, Vulkan D, Davies MPA, et al: UKLS trial outcome results: Lung cancer mortality reduction by LDCT screening confirmed in an international meta-analysis. 2021 World Conference on Lung Cancer. Abstract OA19.02. Presented September 12, 2021.

2. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al: Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395-409, 2011.

3. De Koning HJ, van der Aalst CM, de Jong PA, et al: Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 382:503-513, 2020.

4. Tammemagi MC, Schmidt H, Martel S, et al: Participant selection for lung cancer screening by risk modelling (the Pan-Canadian Early Detection of Lung Cancer [PanCan] study): A single-arm, prospective study. Lancet Oncol 18:1523-1531, 2017.


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