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

Table 2 Prior malignancy and lung cancer

Prior malignancy	Ref.	Method	Results
Lung	Lou et al[38]	1294 participants with early-stage NSCLC underwent resection and then were followed with surveillance CT screening	Recurrence was diagnosed in 20% of patients and second primary lung cancer was diagnosed 7% of patients. The risk of second primary lung cancer diagnosis did not decrease over time
			Of the second primary cancers that were diagnosed, 93% were identified by scheduled surveillance CT. Of the recurrences that were diagnosed, 61% were identified by surveillance CT. Twenty five percent of patients required additional invasive testing, but less than 1% experienced complications from these procedures
Head and Neck	Milano et al[50]	61883 patients with SCC of the head and neck were identified via the SEER database. Of those, 4522 developed a second primary lung cancer. A retrospective data analysis was performed	The risk of developing a primary lung cancer after HNSCC was 5.8%, 11.4%, and 16.4% at 5, 10, and 15 yr
			These rates are higher compared to the general population
Head and Neck	Baxi et al[51]	35958 three-year survivors of SCC of the head and neck were identified via SEER database. A competing-risks proportional hazards regression was used to estimate probabilities of death from different causes	Second primary malignancy was the second leading cause of death (second only to primary head and neck squamous cell carcinoma) in this population Of these, 53% of second primary malignancies were lung cancer
Head and Neck	Pagedar et al[54]	Data was collected and retrospectively analyzed. Survival estimates were generated for patients with lung cancer with and without a history of head and neck cancer	The median survival of patients with only primary lung cancer was 38 mo, compared to 22 mo in those with a history of head and neck cancer with lung cancer as a second primary malignancy. This statistically significant difference suggests that survival outcomes after lung cancer diagnosis are worse in patients who have a history of head and neck malignancy
Breast	Kitada et al[63]	Data was collected an analyzed on 1226 patients who underwent surgical resection of breast cancer, 49 of whom were found to have at lease one pulmonary lesion during or after workup	14 patients underwent surgical resection of the pulmonary lesion. Primary lung cancer was the diagnoses in 3 of these patients, metastases in 8 cases. Of those diagnosed with second primary lung cancer, the stage was IA in all
Breast	Kerendi et al[67]	35 patients with breast cancer and second primary lung cancer were identified and retrospective analysis of survival was performed	More than half of patients had their lung cancer diagnosed during workup or follow-up. 54% of these patients were successfully treated with surgery. There was a statistically significant survival benefit when the cancer was detected early (stage IA, asymptomatic)
Breast	Milano et al[68]	3529 women with NSCLC diagnosis after breast treatment were identified in the SEER database. Data on these patients was retrospectively analyzed and compared to data on 151628 women diagnosed with NSCLC alone	Patients with a history of breast cancer were diagnosed at significant earlier stage, although surgical resection was used more frequently in the NSCLC only group
			History of breast cancer history did not affect overall survival in localized NSCLC. Overall survival was significantly greater in patients with regional and distant NSCLC that had a history of breast cancer
Bladder	del Rey et al[72]	Data from 231 patients with non-muscle invasive bladder cancer were retrospectively analyzed	Lung cancer was the most common second primary malignancy in this population. The risk of lung cancer in patients with non-muscle invasive bladder cancer is 10 fold higher than the regional general population
Lymphoma	Das et al[75]	Authors used a decision-analytic model to estimate potential benefits of annual low-dose CT screening vs no screening in a hypothetical cohort of patients (early stage lymphoma diagnosed at age 25, lung cancer screening starting at age 30). Model parameters were generated from SEER	In this simulated model, annual CT screening increased survival by 0.64 yr for smokers and 0.16 yr for non-smokers. The difference in quality of life and cost effectiveness was also more pronounced in smokers
Lymphoma	Milano et al[77]	Survival data of 187 patient with history of Hodgkins lymphoma diagnosed with NSCLC was compated to data from 178431 patients diagnosed with NSCLC only	Hodgkins lymphoma survivors had significantly inferior overall survival across all lung cancer stages (estimated to be between 30% to 60% decrease in overall survival)
			Patients with younger age at lymphoma diagnosis, younger age at lung cancer diagnoses, and those with longer latency between cancer diagnoses were more likely to be diagnosed with late stage disease
Colorectal	Hattori et al[34]	A retrospective analysis of lung cancer patients with (123) or without (4431) a previous history of colorectal cancer treated with surgical resection	There is no statistically significant difference in overall survival comparing patients with lung cancer vs lung cancer with a history of surgery for colorectal cancer. Prior history of colorectal cancer was not a poor prognostic indicator on multivariate analysis
			Of those patients who had been diagnosed with both lung and colorectal cancer, those who are older and those who underwent treatment with adjuvant chemotherapy had poorer outcomes

CT: Computed tomography; NSCLC: Non-small-cell lung cancer; SEER: Surveillance, epidemiology and end results; SCC: Squamous cell cancer; HNSCC: Head and neck squamous cell cancer.