Abstract
Keywords
Introduction
Performed vs. expected US CT Volume: an analysis of DIR data from 2020 to current week 2021.
Possible Pitfalls in the Detection of Malignancy in Respiratory-Infected Individuals
Effects of the COVID-19 Pandemic on Lung Cancer Screening and Lung Cancer Management
Lung cancer screening registry annual reports.
Targeted Screening for lung cancer with low radiation dose computed tomography; standard protocol prepared for the targeted lung health checks programme.
COVID-19 UK Lung cancer Coalition 2020.
COVID-19 UK Lung cancer Coalition 2020.
Country | Province or Program | Official Governmental Restrictions | Date/Period | Effect/Consequences on Lung Cancer Screening |
---|---|---|---|---|
Brazil | Six institutional screening programs | Yes | April 2020–present | Stop or delay |
Canada | Ontario Lung Screening Program | Ontario Health recommendation to Regional Cancer Programs | March 2020–May 2020 May 2020–June 2020 June 2020– present | Delay Gradual restart in descending order for those with the highest PLCOm2012 risk Program resumed |
People's Republic of China | Zhongshan Hospital Fudan University, Shanghai, People's Republic of China | Yes | January 2020–February 2020 | Stop |
Colombia | Local private practice/special insurance | Yes | April 2020–December 2020 | Stop |
Germany | Research programs | Yes | March 2020–September 2020 | Stop |
Hungary | Multicenter pilot program sponsored by the Ministry of Human Resources | Yes | March 2020–May 2020 June 2020 | Delay Gradual restart |
Italy | Independent trials or local private practice | Yes | March 2020–June 2020 March 2020–May 2020 June 2020 | Interruption of enrolment Reduction of follow-ups Program resumed |
Serbia | Regional pilot screening program | Yes | March 2020–May 2020 June 2020 | Stop Gradual restart |
South Korea | National Health Insurance Service Screening Program | No | July 2019–December 2019 January 2020–December 2020 | Normal screening activity Continuation of screening activity with a decreased screening rate (23.7% in the second half of 2019 to 22.4% in entire 2020) |
Spain | Two I-ELCAP screening programs (Navarra, Valencia) | Yes | March 2020–May 2020 May 2020–present March 2020–April 2020 April 2020–May 2020 May 2020–present | Clinica Universidad de Navarra: reduced to just a few follow-ups Program resumed Instituto Valenciano de Oncologia: screening activity stopped Follow-ups resumed Program resumed |
United Kingdom | Liverpool Health Lung Project 31 Manchester Health Check 32 Yorkshire Lung cancer screening trial 34 NHS-Eng-National-Cancer-Programme. Targeted Screening for Lung Cancer. 35 NHS-Eng-National-Cancer-Programme Targeted Screening for lung cancer with low radiation dose computed tomography; standard protocol prepared for the targeted lung health checks programme. https://www.england.nhs.uk/wp-content/uploads/2019/02/targeted-lung-health-checks-standard-protocol-v1.pdf Date accessed: September 30, 2021 | Yes | March 2020 Autumn 2020 August 2020 July 2020 Summer 2021 | Stopped Liverpool Health Lung Project: only short-term follow-up scans and clinical investigations Manchester Health Check: restarted recruitment Yorkshire Lung cancer screening trial: restarted NHS-Eng-National-Cancer-Programme. Targeted Screening for Lung Cancer: planed start of recruitment |
United States | Mount Sinai Health Care System, New York, New York | Yes | March 15, 2020–June 1, 2020 March 15, 2020–May 1, 2020. June 1, 2020–present May 1, 2020–present | Short-term follow-up LDCT scans only Biopsy of nodules for lung cancer not performed Baseline and annual repeat screening: restarted Biopsies of nodules for lung cancer: restarted |
United States | CDC, ACR Guidance, and the ACR LCSR | Yes | March 2020–May 2020 April 2020 June 2020–present June 2020–September 2020 | Program delay (ACR LCSR screening examination volume is down 54.3% over the same period in 2019) Gradual restart according to CHEST Expert Panel Report on lung cancer screening during the COVID-19 pandemic, stratified by risk of cancer 44 Programs resumed according to CDC and ACR guidance 57 ;ACR LCSR screening examination volume is down 3.76% over the same period in 2019 29 Registry ANRD Lung cancer screening registry annual reports. https://nrdrsupport.acr.org/support/solutions/articles/11000093991 Date accessed: September 30, 2021 |
Safety Concerns in Periods of Increased Respiratory Infections
- 1.Invitation and eligibility assessment and counseling on the advantages and disadvantages, which are done by mail or by virtual health tools.
- 2.The tobacco cessation consultation can be started through videoconferences with telephone or text messaging follow-up.
- 3.If vaccination is available, the vaccination should be completed 6 weeks before the on-site lung cancer screening takes place.
- 4.If testing for acute infection is available and reliable and is indicted, this can be done before on-site visits.
- 5.Patients should attend the institution during the time slots in which patient volume is limited, and this can be guided by advanced scheduling.
- 6.Pulmonary function tests should be scheduled after online counseling with a pulmonologist, taking into account air exchanges in the room and the time to disinfect the room and equipment. Changing filters in the apparatus for each patient is usually done as standard procedure in lung function testing and should be mandatory in these situations.
- 7.Initial consultation with the pulmonologist can be carried out by telemedicine to reduce the need for in-person visits once the low-dose CT and lung function tests have been performed.
- 8.Invasive procedures have to be decided, taking into account the pretest malignancy probability and risk of infection according to the actual local infection risks.47
Management of Backlog of Screening Procedures During and After Temporary Reduction in Activity
Conclusions and Recommendations
Recommendations
- 1.Enquire about acute respiratory symptoms by telemedicine interviews before the scheduled visit and in-person before imaging procedures, and ask for recent vaccinations in the upper arm. Reschedule these procedures in case of the presence of symptoms or recent vaccination to approximately 6 to 8 weeks later (Oxford Centre for Evidence-Based Medicine (OCEBM) level of evidence level 456).
- Jeremy H.
- Iain C.
- Paul G.
- et al.
Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). OCEBM Levels of Evidence Working Group.https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidenceDate accessed: September 30, 2021 - 2.Before admission of individuals into screening facilities, interview individuals regarding recent exposures to potentially infected individuals and require, for example, SARS-CoV-2 testing, when appropriate. This is to reduce the likelihood of SARS-CoV-2 transmission in the screening center to staff and others (OCEBM level of evidence level 456).
- Jeremy H.
- Iain C.
- Paul G.
- et al.
Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). OCEBM Levels of Evidence Working Group.https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidenceDate accessed: September 30, 2021 - 3.When there is a high rate of respiratory infections in the region, adapt the screening program to the actual risk level of contracting infections, and switch parts of the screening program to a remote setting (OCEBM level of evidence level 456).
- Jeremy H.
- Iain C.
- Paul G.
- et al.
Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). OCEBM Levels of Evidence Working Group.https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidenceDate accessed: September 30, 2021 - 4.Consider testing for the acute infection and vaccination with a time difference of approximately 6 weeks for on-site procedures, when available (OCEBM level of evidence level 356).
- Jeremy H.
- Iain C.
- Paul G.
- et al.
Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). OCEBM Levels of Evidence Working Group.https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidenceDate accessed: September 30, 2021 - 5.If there is a backlog of screening procedures, prioritization of the highest risk groups using a quantitative lung cancer risk prediction model should be considered (OCEBM level of evidence level 356).
- Jeremy H.
- Iain C.
- Paul G.
- et al.
Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). OCEBM Levels of Evidence Working Group.https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidenceDate accessed: September 30, 2021 - 6.Invest in educating the medical staff involved in lung cancer screening programs on the specific steps necessary to adapt the procedures according to the situation at hand (OCEBM level of evidence level 456).
- Jeremy H.
- Iain C.
- Paul G.
- et al.
Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). OCEBM Levels of Evidence Working Group.https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidenceDate accessed: September 30, 2021
CRediT Authorship Contribution Statement
Acknowledgments
References
- Reduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409
- Reduced lung-cancer mortality with volume CT screening in a randomized trial.N Engl J Med. 2020; 382: 503-513
- CT volumes from 2,398 radiology practices in the United States: a real-time indicator of the effect of COVID-19 on routine care, January to September 2020.J Am Coll Rad. 2021; 18: 380-387
- Performed vs. expected US CT Volume: an analysis of DIR data from 2020 to current week 2021.https://www.acr.org/Practice-Management-Quality-Informatics/Registries/NRDR-Publications/HighlightsDate accessed: September 30, 2021
- Impact of the COVID-19 pandemic on lung cancer screening program and subsequent lung cancer.J Am Coll Surg. 2021; 232: 600-605
- Exploring the real-world effect of the SARS-CoV-2 pandemic on the molecular diagnostics for cancer patients and high-risk individuals.Expert Rev Mol Diagn. 2021; 21: 101-107
- The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.Lancet Oncol. 2020; 21: 1023-1034
- False positive and false negative FDG-PET scans in various thoracic diseases.Korean J Radiol. 2006; 7: 57-69
- Factors influencing the false positive rate in CT lung cancer screening [e-pub ahead of print]. Acad Rad.https://doi.org/10.1016/j.acra.2020.07.040Date accessed: September 30, 2021
- Feasibility of lung cancer screening in developing countries: challenges, opportunities and way forward.Transl Lung Cancer Res. 2019; 8: S106-S121
- Features of resolving and nonresolving indeterminate pulmonary nodules at follow-up CT: the Nelson study.Radiology. 2014; 270: 872-879
- CT screening for lung cancer: the value of short-term CT follow-up.Chest. 2006; 129: 1039-1042
- Management and outcomes of suspected infectious and inflammatory lung abnormalities identified on lung cancer screening CT.AJR Am J Roentgenol. 2021; 217: 1083-1092
- Clinical significance of a solitary ground-glass opacity (GGO) lesion of the lung detected by chest CT.Lung Cancer. 2007; 55: 67-73
- Sea H. Increased Downstream testing in lung cancer screening patients during flu season 2019. American Roentgen Ray Society, Virginia, USA2019
- Axillary lymph node accumulation on FDG-PET/CT after influenza vaccination.Ann Nucl Med. 2012; 26: 248
- COVID-19 Vaccination-Related Uptake on FDG PET/CT: An Emerging Dilemma and Suggestions for Management.AJR Am J Roentgenol. 2021; 217: 975-983
- Multidisciplinary recommendations regarding post-vaccine adenopathy and radiologic imaging: radiology scientific expert panel.Radiology. 2021; 300: E323-E327
- The diagnostic accuracy of integrated positron emission tomography/computed tomography in the evaluation of pulmonary mass lesions in a tuberculosis-endemic area.S Afr Med J. 2015; 105: 1049-1052
- Asymptomatic pulmonary tuberculosis mimicking lung cancer on imaging: A retrospective study.Exp Ther Med. 2017; 14: 2180-2188
- Lung cancer CT screening and lung-RADS in a tuberculosis-endemic country: the Korean lung cancer screening project (K-LUCAS).Radiology. 2020; 296: 181-188
- Prevalence and burden of bronchiectasis in a lung cancer screening program.PLoS One. 2020; 15e0231204
- Do current lung cancer screening guidelines apply for populations with high prevalence of granulomatous disease? Results from the first Brazilian lung cancer screening trial (BRELT1).Ann Thorac Surg. 2016; 101: 481-488
- Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands.Lancet Oncol. 2020; 21: 750-751
- Operational challenges of a low-dose CT Lung Cancer Screening Program during the coronavirus Disease 2019 pandemic.Chest. 2020; 159: 1288-1291
- Cancer screening tests and cancer diagnoses during the COVID-19 pandemic.JAMA Oncol. 2021; 7: 458-460
- Impact of the COVID-19 pandemic on volumes and disparities in lung cancer screening.Chest. 2021; 160: 379-382
- Cancer screening during the coronavirus Disease-2019 pandemic: a perspective from the National Cancer Institute’s PROSPR consortium.Gastroenterology. 2021; 160: 999-1002
- Lung cancer screening registry annual reports.https://nrdrsupport.acr.org/support/solutions/articles/11000093991Date accessed: September 30, 2021
- The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer.Health Technol Assess. 2016; 20: 1-146
- Evaluation of a health service adopting proactive approach to reduce high risk of lung cancer: the Liverpool Healthy Lung Programme.Lung Cancer. 2019; 134: 66-71
- Implementing lung cancer screening: baseline results from a community-based ‘Lung Health Check’ pilot in deprived areas of Manchester.Thorax. 2019; 74: 405-409
- Baseline Results of the West London lung cancer screening pilot study - Impact of mobile scanners and dual risk model utilisation.Lung Cancer. 2020; 148: 12-19
- Yorkshire Lung Screening Trial (YLST): protocol for a randomised controlled trial to evaluate invitation to community-based low-dose CT screening for lung cancer versus usual care in a targeted population at risk.BMJ Open. 2020; 10e037075
- Targeted Screening for lung cancer with low radiation dose computed tomography; standard protocol prepared for the targeted lung health checks programme.https://www.england.nhs.uk/wp-content/uploads/2019/02/targeted-lung-health-checks-standard-protocol-v1.pdfDate accessed: September 30, 2021
- Selection criteria for lung-cancer screening.N Engl J Med. 2013; 368: 728-736
- Family history and risk of lung cancer: age-at-diagnosis in cases and first-degree relatives.Br J Cancer. 2006; 95: 1288-1290
- Liverpool Lung Project Lung cancer risk stratification model: calibration and prospective validation.Thorax. 2021; 76: 161-168
- Clinical recommendations on lung cancer management during the COVID-19 pandemic.Thorac Cancer. 2020; 11: 2067-2074
- Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study.Lancet Oncol. 2020; 21: 904-913
- Lung cancer control in the UK hit badly by COVID-19 pandemic.Lancet Oncol. 2020; 21: 1559
- COVID-19 UK Lung cancer Coalition 2020.https://www.uklcc.org.uk/wp-content/uploads/2020/10/UKLCC-COVID-19-Matters-Report-Oct-2020.pdfDate accessed: September 30, 2021
- COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study.Lancet Oncol. 2020; 21: 914-922
- Management of lung nodules and lung cancer screening during the COVID-19 pandemic: CHEST expert panel report.Chest. 2020; 158: 406-415
- ESMO management and treatment adapted recommendations in the COVID-19 era: lung cancer.ESMO Open. 2020; 5e000820
- Bronchoscopy in the age of COVID-19.J Bronchol Interv Pulmonol. 2020; 27: 160-162
- Safe performance of diagnostic bronchoscopy/EBUS during the SARS-CoV-2 pandemic.Respirology. 2020; 25: 703-708
- The impact of diagnostic imaging wait times on the prognosis of lung cancer.Can Assoc Radiol J J Assoc Canadienne Radiol. 2015; 66: 53-57
- Effect of time interval from diagnosis to treatment for non-small cell lung cancer on survival: a national cohort study in Taiwan.BMJ Open. 2020; 10e034351
- Does delaying time in cancer treatment affect mortality? A retrospective cohort study of Korean lung and gastric cancer patients.Int J Environ Res Public Health. 2021; 18: 3462
- Feasibility and safety of lung cancer screening and prevention program during the COVID-19 pandemic.Chest. 2021; 160: e5-e7
- Analysis of lung cancer risk model (PLCOM2012 and LLPv2) performance in a community-based lung cancer screening programme.Thorax. 2020; 75: 661-668
- Outcomes of long-term interval rescreening with low-dose computed tomography for lung cancer in different risk cohorts.J Thorac Oncol. 2019; 14: 1003-1011
- Importance of long-term low-dose CT follow-up after negative findings at previous lung cancer screening.Radiology. 2018; 289: 218-224
- Protocol and rationale for the international lung screening trial.Ann Am Thorac Soc. 2020; 17: 503-512
- Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). OCEBM Levels of Evidence Working Group.https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidenceDate accessed: September 30, 2021
- ACR statement on safe resumption of routine radiology care during the coronavirus Disease 2019 (COVID-19) pandemic.J Am Coll Radiol. 2020; 17: 839-844
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Footnotes
Disclosure: Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest, which are owned by Cornell Research Foundation. Since 2009, Dr. Henschke does not accept any financial benefit from these patents including royalties and any other proceeds related to the patents or patent applications owned by Cornell Research Foundation. Furthermore, Dr. Henschke serves as the president and board member of the Early Diagnosis and Treatment Research Foundation but receives no compensation for her roles. The Foundation is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases, whose funding comes from a variety of sources including philanthropic donations, grants, and contracts with agencies (federal and nonfederal), imaging, and pharmaceutical companies relating to image processing assessments and exclude any funding from tobacco companies or tobacco-related sources. Recipients of the Foundation include the International Early Lung Cancer Action Program, among others. The remaining authors declare no conflict of interest.
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