Lung cancer: New model may prevent overdiagnosis, overtreatment

• Lung cancer is the second most common cancer in the world.
• Although previous research shows early detection screening can improve mortality rates for lung cancer, there is the possibility of overdiagnosis and overtreatment for patients.
• Researchers from the Moffitt Cancer Center in Tampa, FL, developed a model based on radiomics to aid healthcare professionals in identifying high-risk versus low-risk tumors in patients.
• The findings “could potentially inform how aggressively a lung cancer should or should not be treated,” say the researchers.

Lung cancer is the second most common cancer in the world. More than 2.2 million people received a new lung cancer diagnosis in 2020. Lung cancer is the most common type of cancer in men and the second most common in women.

Early detection screening for lung cancer provides a way for healthcare professionals to check for signs of the disease in people who are at high risk but currently have no symptoms.

The most common screening test for lung cancer is a low-dose computed tomography (LDCT) scan. Previous research shows screening LDCT reduces the death rate from lung cancer.

According to researchers from the Moffitt Cancer Center, lung cancer early detection screening can sometimes lead to overdiagnosis and overtreatment.

So, the scientists have developed a model based on radiomics where data from various medical imaging processes, such as MRIs and CT scans, combine to help healthcare professionals better identify high-risk versus low-risk tumors in patients.

The study was recently published in the journal Cancer Biomarkers.

Not all cancer stages are the same

According to Dr. Matthew Schabath, associate member in the Cancer Epidemiology Department at Moffitt Cancer Center and senior and corresponding author of this study, the goal of cancer screening is to detect cancers at earlier stages where treatment with surgery can be curative. However, not all early stages are the same.

“Some early-stage cancers are low-risk indolent diseases that probably would not become symptomatic in a patient’s lifetime and would not contribute to death,” he explained to Medical News Today.

“Other early-stage cancers are very high-risk/aggressive that associated with very poor outcomes and likely require more aggressive treatment, such as adjuvant therapies. And there is a spectrum of intermediate-risk cancers as well.”

“As such, the goal of this research was to generate radiomic biomarkers among lung cancers diagnosed in the lung cancer screening setting to better differentiate between indolent/low-risk, intermediate-risk, and high-risk lung cancers,” he added.

Establishing a radiomic model

For the study, Dr. Schabath and his team used the data and images from 94 participants in the National Lung Screening Trial. Researchers utilized radiomic data of each patient’s tumor area, establishing 65 stable and reproducible features.

Additionally, scientists examined the volume doubling time (VDT) of lung pulmonary nodules, which are abnormal growths on the lung. The VDT measures how quickly the nodule doubles in volume. During cancer screening, more aggressive tumors associated with a shorter VDT.

Once researchers established the model, they were able to divide patients into groups based on their risk of a poor outcome. The research team found the low-risk patient group had a 83.3% 5-year outlook, while the high-risk group’s five-year outlook dropped to 25%.

Additionally, researchers identified a VDT cut-off point that they were able to use to contrast patients with low-risk versus aggressive tumors.

Research next steps

Because not all cancers detected in cancer screenings are the same, Dr. Schabath believes utilizing biomarkers such as our radiomics biomarkers can help physicians personalize cancer treatment with the objective of improving a patient’s long-term outcomes.

“Over-treating indolent disease is a major concern in early detection because cancer treatments are associated with certain risks and comorbidities. So the biomarkers identified in our study could potentially inform how aggressively a lung cancer should or should not be treated.”

– Dr. Schabath

Dr. Schabath said they are currently validating their radiomic biomarkers in additional cohorts. “If successful, we will conduct a prospective clinical utility trial,” he explained when asked about research next steps. “If that is successful, we would have enough evidence to consider these radiomic biomarkers in standard-of-care.”

MNT also spoke with Dr. Andrea McKee, radiation oncology, director of the Rescue Lung Rescue Life CT lung screening program at Lahey Hospital and Medical Center and national spokesperson for the American Lung Association, about this study.

She believes this could be a useful tool to help identify those individuals with early-stage screen-detected lung cancer who may require care escalation beyond surgical resection, particularly those who may be appropriate candidates for neoadjuvant chemoimmunotherapy.

However, Dr. McKee disagreed with researchers’ characterization of overdiagnosis in lung cancer screenings in their study. “The mischaracterization of overdiagnosis and false-positive rates in CT lung screening is one of the identified barriers to adoption of screening in the US and abroad,” she explained.

“Until we correct these important screening metric misconceptions, I fear we will continue to observe low screening uptake rates among high-risk individuals.”

For next steps in this research, Dr. McKee said she would like to see this analysis performed controlling for histology and in a current screening population where modern imaging and reporting techniques — those which exclude pulmonary ground glass opacity (GGOs) — are utilized.

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