Lung cancer screening: Should we be excluding people with previous malignancy?

Table 1 Index trials of lung cancer screening

Ref.	Participants	Exclusion criteria	Design	Results
Aberle et al[5]	53454 participants	Previous lung cancer diagnosis	Randomized Control Trial	Rate of positive screening was 24.2% in LDCT and 6.9% with CXR group
	Age 55 to 74
	At least 30 pack-year smoking history	CT scan within previous 18 mo	Participants randomized to three annual screenings with LDCT (26722) vs single view PA CXR (26732)	The majority of positive screening results were false positives, 96.4% in the LDCT group and 94.5% in the CXR group
	Former smokers must have quit within previous 15 yr			Lung cancer mortality decreased by 20% (P = 0.004) and all cause mortality decreased by 6.7% in LDCT group (P = 0.02)
van Iersel et al[14]	15822 participants	Hemoptysis or unexplained weight loss of 15 lbs or more in last year	Randomized Control Trial	Ongoing - 10 yr follow up planned
	Age 50-74	Current or past diagnosis of renal cancer, melanoma or breast cancer
	Determined to be high risk based on answers to heath questionnaire	Lung cancer diagnosis within last 5 yr or current treatment	Participants randomized to either LDCT screening (7915) or no screening (7907)
	Good overall health (able to climb 2 flights of stairs, weight less than 140 kg)	CT scan within past year
Infante et al[16]	2472 participants	History of previous malignancy treated within 10 yr (exceptions: Early laryngeal cancer and nonmelanoma skin cancer with a 5-yr disease-free interval)	Randomized Control Trial	Ongoing. 3 yr results: Lung cancer detected in 4.7% of patients in LDCT group and 2.8% in controls (P = 0.016)
	Males aged 60-74
	20 pack-year smoking history	Comorbid conditions with life expectancy less than 5 yr	Randomized to 5 yr of annual screening with LDCT (1276) or clinical follow up (1196)	There was a 1.6% lung cancer mortality in the LDCT group and 1.7% in the control group (P = 0.84). No difference in all cause mortality (P = 0.83) to this point in the study
Saghir et al[22]	4104 participants	Previous cancer diagnosis and treatment	Randomized control trial	There was a higher rate of invasive procedures performed in the LDCT group compared with controls (P < 0.0001)
	Age 50-70			Ongoing. 5 yr results:
	At least 20 pack-year smoking history	Comorbid illness that would shorten life expectancy to < 10 yr	Participants randomized to five annual LDCT screenings (2052) or no screening (2052)	Lung cancer was diagnosed in 69 patients in the LDCT group, compared with 24 in the control group (P < 0.001)
	Former smokers who quit after age 50 and quit less than 10 yr prior	CT scan within previous year		Stage I-IIB lung cancer was diagnosed more frequently in the LDCT group (P = 0.002), however there was no difference in frequency of Stage IIIA-IV lung cancer (P = 0.509)
	FEV1 of at least 30% predicted value			There was no difference in mortality from lung cancer (P = 0.428) or overall mortality (P = 0.059) to this point of follow up
	Good overall health (able to climb 2 flights of stairs, weight less than 130 kg)
Pastorino et al[23]	4099 participants	History of cancer within the previous 5 yr	Randomized Control Trial	The cumulative 5-yr lung cancer incidence rate was 0.0031% in the control group, 0.0046% in the biennial, and 0.0062% in the annual LDCT group (P = 0.036)
	Age 49 or older
	At least 20 pack-year smoking history - current smoker or had quit within 10 yr		Randomized participants to annual LDCT screening (1190), biennial LDCT screening (1186), or observation alone (1723)	Rates of mortality from lung cancer were 0.0011% in the control group, 0.0011% in the biennial group, and 0.0022% in the annual group (P = 0.21)
				There was also no difference in all cause mortality between the three groups (P = 0.13)

LDCT: Low dose CT; CXR: Chest radiography; CT: Computed tomography.