M. Patricia Rivera, MD, professor of medicine, UNC-Chapel Hill, UNC Lineberger Comprehensive Cancer Center, discusses novel methods of detecting high-risk lung cancer.

There are investigational studies using molecular biomarkers for individuals who have nodules. If a CT scan locates a nodule, there are emerging molecular biomarkers that can help identify high-risk individuals, says Rivera.

The National Lung Screening Trial (NLST) accrued 53,453 individuals at high risk for lung cancer. Individuals were randomized to 3 annual screenings with either low-dose CT or single-view posteroanterior chest radiography.

Findings showed that 25% of individuals who were screened with a CT scan were found to have a nodule, but 96% percent of those nodules were benign. The overwhelming majority of nodules detected on screening CTs are not cancer, so a lot of these patients may undergo unnecessary procedures. Biomarkers and genomic sequencing may help identify those individuals who may be more at risk and are likely to benefit from screening, says Rivera.

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M. Patricia Rivera, MD, professor of medicine, UNC Chapel Hill, UNC Lineberger Comprehensive Cancer Center, discusses novel methods of detecting high-risk lung cancer.

Dr. Rivera on the National Lung Screening Trial

M. Patricia Rivera, MD, professor of medicine, UNC Chapel Hill, UNC Lineberger Comprehensive Cancer Center, discusses the recent adoption of lung cancer screening into clinical practice.

Screening came about following the publication of The National Lung Screening Trial. The randomized trial compared CT scan with chest X-ray in smokers over the age of 55 with a 30-year smoking history. The trial demonstrated the first reduction in mortality for patients who had been screened with CT scan.

In 2014, the United States Preventative Task Force gave this a B recommendation. In 2015, Medicare approved screening, and since then it has become more available. However, it is considerably underutilized, says Rivera. As of 2015, only 3.9% of eligible patients were being screened in the United States. This may be due, in part, to the difficulty of getting an accurate smoking history.

M. Patricia Rivera, MD

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Dr. Rivera on the National Lung Screening Trial

Dr. Rivera on Screening in Lung Cancer