programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c pulmón 2013-06

Mitka M. Chest physicians recommend CT screening for lung cancer only for older smokers. JAMA 2013 Jun 12;309(22):2314. DOI:10.1001/jama.2013.6949; 10.1001/jama.2013.6949. PMID:23757062.


Nota bibliográfica cribado c pulmón 2013-05

Yankelevitz DF, Smith JP. Understanding the core result of the National Lung Screening Trial. (carta). N Engl J Med 2013 Apr 11;368(15):1460-1461. DOI:10.1056/NEJMc1213744; 10.1056/NEJMc1213744. PMID:23574139.

Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM. Executive summary: Diagnosis and management of lung cancer, 3rd ed: american college of chest physicians evidence-based clinical practice guidelines. CHEST Journal 2013 May 1;143(5_suppl):7S-37S. DOI:10.1378/chest.12-2377.
For many years, lung cancer was a relatively neglected disease, shrouded in pessimism and with little research funding. However, many advances have occurred, and it is now a vibrant field with a rapid pace of new information. The explosion of literature makes it difficult for anyone to stay current. With more insight comes the identification of many nuances that are important to correctly understand new studies and choose the optimal treatments for patients. Lung cancer has evolved to where it takes a team of individuals, each with lung cancer expertise within their specialty, to be able to provide the necessary up-to-date knowledge base. The crucial aspect here is not to simply have multiple specialties but to develop a forum for ongoing interaction, so that the individuals think and function as a team, making decisions collectively. Such integration and collaboration allow collective knowledge and judgment to be brought to bear on caring for patients. Even for such a team, however, staying abreast of advances is challenging.

The National Lung Screening Trial Research Team. Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer. N Engl J Med 2013 05/23; 2013/05;368(21):1980-1991. DOI:10.1056/NEJMoa1209120. Enlace:


Nota bibliográfica cribado c pulmón 2013-04

Ma J, Ward EM, Smith R, Jemal A. Annual number of lung cancer deaths potentially avertable by screening in the United States. Cancer 2013 Apr 1;119(7):1381-1385. DOI:10.1002/cncr.27813; 10.1002/cncr.27813. PMID:23440730.
CONCLUSIONS: The data from the current study indicate that LDCT screening could potentially avert approximately 12,000 lung cancer deaths per year in the United States. Further studies are needed to estimate the number of avertable lung cancer deaths and the cost-effectiveness of LDCT screening under different scenarios of risk, various screening frequencies, and various screening uptake rates.

Park ER, Gareen IF, Jain A, Ostroff JS, Duan F, Sicks JD, et al. Examining whether lung screening changes risk perceptions: National Lung Screening Trial participants at 1-year follow-up. Cancer 2013 Apr 1;119(7):1306-1313. DOI:10.1002/cncr.27925; 10.1002/cncr.27925. PMID:23280348. PMCID:PMC3604047.
CONCLUSIONS: Lung screening did not change participants' risk perceptions of lung cancer or smoking-related disease. A negative screening test, which was the most common screening result, did not appear to decrease risk perceptions nor provide false reassurance to smokers.

Henschke CI, Yip R, Yankelevitz DF, MD, Smith JP, MD. Definiton of a Positive Test Result in Computed Tomography Screening for Lung Cancer: A Cohort Study. Ann Intern Med 2013 Feb 19, 2013;158(4):246.

Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-positive" findings may result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a positive result on the rates of positive results and cancer diagnoses is unknown. Here, Henschke et al assess the frequency of positive results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Findings suggest that using a threshold of 7 or 8 mm to define positive results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients. 


Nota bibliográfica cribado c pulmón 2013-02

Aberle DR, Abtin F, Brown K. Computed Tomography Screening for Lung Cancer: Has It Finally Arrived? Implications of the National Lung Screening Trial. Journal of Clinical Oncology 2013 February 11 DOI:10.1200/JCO.2012.43.3110.

This review discusses the risks and benefits of LDCT screening as well as an approach to LDCT implementation that incorporates systematic screening practice with smoking cessation programs and offers opportunities for better determination of appropriate risk cohorts for screening and for better diagnostic prediction of lung cancer in the setting of screen-detected nodules. The challenges of implementation are considered for screening programs, for primary care clinicians, and across socioeconomic strata. Considerations for future research to complement imaging-based screening to reduce the burden of lung cancer are discussed.


Nota bibliográfica cribado c pulmón 2013-01

Peres J. Lung Cancer Screening Gets Risk-Specific. Journal of the National Cancer Institute 2013 January 02;105(1):1-2. DOI:10.1093/jnci/djs631.

Ruano-Ravina A, Perez Rios M, Fernandez-Villar A. Lung Cancer Screening With Low-Dose Computed Tomography After the National Lung Screening Trial. The Debate is Still Open. Arch Bronconeumol 2013 Jan 11 DOI:10.1016/j.arbres.2012.10.003; 10.1016/j.arbres.2012.10.003. PMID:23317766.

The aim of this article is to highlight some concerns regarding lung cancer screening with CT through a thorough analysis of scientific literature. The publication of the National Lung Screening Trial in 2011 has revealed that CT screening of smokers and ex-smokers in three annual rounds reduces lung cancer mortality a 20% when compared with thorax x-ray screening. The first limitation of this screening modality is its lack of downstaging in successive screening rounds compared with the initial round. Also, lung cancer screening with CT has a low positive predictive value, similar to the percentage of unnecessary surgeries performed in false positives. Another problem is that, at present, the burden of lung cancer overdiagnosis is not known. It is to be expected that if overdiagnosis occurs when thorax x-ray screening is used it will be greater when using CT. CT, even at low doses, exposes patients to high levels of radiation. Dealing with positive nodules entails an even higher radiation dose and the number of cancer cases induced by radiation in patients screened with CT is not known. Lastly, published studies on lung cancer CT screening are vastly heterogeneous. They include different age groups, different types of smokers and ex-smokers and different tomogram thickness, making the results hardly comparable. In this context we do not recommend lung cancer screening with CT for smokers or ex-smokers outside of the context of individual counseling.


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