Plenary Lecture
Low-Dose Computed Tomography for Lung Cancer Screening…. What would the next step be?
Dr. Carlos Rivas-Echeverria
University of Los Andes
Venezuela
Email: rivasecheverria@gmail.com
Abstract: Lung cancer (LC) is a public health problem and the leading cause of cancer-related death worldwide. Is the third most common cause of mortality in high income countries. In Spain, in 2011, cancer was the first cause of mortality; and the LC mortality rate was almost as high as colonic, breast and prostate cancers combined. Most symptomatic patients (i.e. persistent cough, sputum streaked with blood, chest pain, voice change, and recurrent pneumonia or bronchitis) are diagnosed when they already have metastasis or a disseminated disease; therefore, five-year survival, among these patients, is very low (less than 20%). Major improvements in diagnostic tools, staging methods and treatment procedures and guidelines (e.g. surgery, chemotherapy and radiotherapy) have been recently reached. Cigarette smoking is by far the most important risk factor for LC. Clinical diagnosis and treatment together with prevention programs, such as smoking cessation, have decreased the LC mortality rate, nevertheless LC continues to have very poor long-term survival rates despite the improvements in diagnosis, staging, and treatment. Screening programs have been proposed as a means improving the LC survival rate by early detection. Chest X-rays, among other methods, have shown to be ineffective screening methods, with a very low sensitivity and specificity. Thus low-dose computed tomography (LDCT) scan has been proposed to be best way to reduce LC mortality by screening high risk asymptomatic patients. Since 2001, many studies (cross-sectional, cohort, randomized clinical trials, meta-analysis) have been conducted in order to assess the use of LDCT as a recommended tool for screening for LC. Although multiple randomized clinical trials had been conducted, no screening test had been shown to reduce LC–specific mortality until the June 2011 release of data from the landmark National Lung Cancer Screening Trial (NLST). This study showed a 20% lung cancer mortality rate reduction; on the other hand, the number of false-positive detections is significant, costs are considerable and harm caused by invasive diagnostic procedures and treatment of indolent, non-malignant nodules, are important factors to consider. Radiation risks must be also taken into account.
Prior to the design, development and an eventual implementation of a screening program in Soria, Spain, we have done a systematic review of the literature. In this plenary session, we will present this review. Epidemiological, clinical, pathological and other facts regarding LC will be briefly presented. We are going to discuss the clinical evidence, technical and logistical aspects, sensitivity, specificity, reliability, safety, efficiency, feasibility, applicability and rationale behind a public health screening program for lung cancer with LDCT.
Brief Biography of the Speaker: Dr. Carlos Rivas-Echeverria, MD, PhD, FACP is Medical Doctor (1992) and Specialist in Internal Medicine (1998) and in Critical Care (2000) at the University of Los Andes, Venezuela; with a PhD degree from La Universidad del Zulia, Venezuela. He has a Master degree in Sleep Medicine (Universidad Pablo de Oladive, Spain) and a Diplomate on Franchising Systems Management (Universidad Cat?lica Andr?s Bello, Venezuela). Currently, he is a Family Medicine Resident in Soria, Spain, and Master Degree in Sexology Candidate (INEFOC, Spain). He is the Head of the SLEEPCARE Sleep Clinics in Venezuela since 2002. He became Professor at the University of Los Andes on 1993 (Full Professor on 2004), and has been Head of the Department of Pharmacology. He is cofounder and active Member of the Intelligent Systems Laboratory (University of Los Andes). He has over 70 publications in high level conferences, journals, and book chapters and has been a mentor to numerous MD, MSc and PhD thesis candidates. The main areas of focus of his papers and research are: hypertensive disorders of pregnancy, sleep disorders, traffic accidents, and artificial intelligence. He became an active reviewer in several journals and societies, such as World Scientific and Engineering Academy and Society (WSEAS), and has been editor of some “WSEAS” journals. He has been organizer and chair of many international conferences and is Fellow of the American College of Physicians since 2008.