Patel, Alpa V;
Chang, Ellen T;
Hackshaw, Allan;
Janes, Sam M;
Buist, Diana SM;
Hubbell, Earl;
Clarke, Christina A;
(2024)
Overall and non-lung cancer incidence and mortality in the National Lung Screening Trial: Opportunities for multi-cancer early detection.
Cancer Medicine
, 13
(12)
, Article e7414. 10.1002/cam4.7414.
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Abstract
BACKGROUND: Currently recommended cancer screening programs address only part of the overall population cancer burden. Even populations deemed high-risk for certain individual cancers experience a considerable potential burden of other cancers. However, few published cancer screening trials report the incidence of untargeted cancers. METHODS: The National Lung Screening Trial (NLST), initiated in 2002–2004, was a randomized controlled trial of lung cancer screening in adults with ≥30 pack-years of smoking. Active follow-up for incident invasive cancers continued through 2009. RESULTS: Among 53,229 NLST subjects (median follow-up 6.5 years after randomization), the incidence of lung cancer was 615 per 100,000 person-years (32% of 6142 overall first primary incident invasive cancers), and that of non-lung cancer was 1327 per 100,000 (68%). Non-lung cancer incidence exceeded that for lung cancer in all 5-year age categories and all quintiles of smoking pack-years. Besides lung cancer, the most common cancers were prostate, breast, colon/rectum, bladder, and head/neck; 23% were smoking-related cancers, and 54% were cancer types lacking recommended population-based screening modalities (32% excluding prostate). Non-lung cancer comprised 48% of 1793 cancer deaths. CONCLUSIONS: In the NLST, only 32% of first primary cancer incidence after study entry was lung, compared with 68% non-lung. Even in a population at high risk for lung cancer, a single-cancer screening test misses most cancers. Thus, in combination with existing single-cancer screening modalities, multi-cancer screening tests—which address many of the incident non-lung cancers in this trial—have potential to address a currently inaccessible portion of cancer morbidity and mortality.
| Type: | Article |
|---|---|
| Title: | Overall and non-lung cancer incidence and mortality in the National Lung Screening Trial: Opportunities for multi-cancer early detection |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/cam4.7414 |
| Publisher version: | https://doi.org/10.1002/cam4.7414 |
| Language: | English |
| Additional information: | © 2024 GRAIL, LLC and The Author(s). Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/). |
| Keywords: | cancer risk, cancer screening, early detection of cancer, multi-cancer early detection, National Lung Screening Trial, population health |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > CRUK Cancer Trials Centre UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10205083 |
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