Vidit Munshi, PhD
Lecturer, Markets, Public Policy & Law Department, Questrom School of Business, Boston University
Dr. Munshi is currently a lecturer at the Boston University Questrom School of Business.
Dr. Munshi earned his PhD in Health Policy from Harvard University in 2020. He graduated from Boston University in 2008 with a BA in Economics and a minor in journalism. He worked in media relations with the Boston Red Sox for a year before returning to BU to receive an MA in Economics in 2010.
Dr. Munshi worked as a research assistant at the ITA before entering the Harvard PhD program. He also worked as a life sciences research intern at Deloitte and spent numerous summers doing research at a Harvard Medical School oncology lab. He is interested in working to effect change in healthcare using various facets of health economics, including mathematical modeling, cost-effectiveness analysis, and outcomes research.
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Selected Publications
2023
Toumazis, Iakovos; Cao, Pianpian; de Nijs, Koen; Bastani, Mehrad; Munshi, Vidit; Hemmati, Mehdi; Haaf, Kevin Ten; Jeon, Jihyoun; Tammemägi, Martin; Gazelle, G Scott; Feuer, Eric J; Kong, Chung Yin; Meza, Rafael; de Koning, Harry J; Plevritis, Sylvia K; Han, Summer S
Risk Model-Based Lung Cancer Screening : A Cost-Effectiveness Analysis Journal Article
In: Ann Intern Med, 2023, ISSN: 1539-3704.
@article{pmid36745885,
title = {Risk Model-Based Lung Cancer Screening : A Cost-Effectiveness Analysis},
author = {Iakovos Toumazis and Pianpian Cao and Koen de Nijs and Mehrad Bastani and Vidit Munshi and Mehdi Hemmati and Kevin Ten Haaf and Jihyoun Jeon and Martin Tammem\"{a}gi and G Scott Gazelle and Eric J Feuer and Chung Yin Kong and Rafael Meza and Harry J de Koning and Sylvia K Plevritis and Summer S Han},
doi = {10.7326/M22-2216},
issn = {1539-3704},
year = {2023},
date = {2023-02-01},
journal = {Ann Intern Med},
abstract = {BACKGROUND: In their 2021 lung cancer screening recommendation update, the U.S. Preventive Services Task Force (USPSTF) evaluated strategies that select people based on their personal lung cancer risk (risk model-based strategies), highlighting the need for further research on the benefits and harms of risk model-based screening.
OBJECTIVE: To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.
DESIGN: Comparative modeling analysis.
DATA SOURCES: National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator.
TARGET POPULATION: 1960 U.S. birth cohort.
TIME HORIZON: 45 years.
PERSPECTIVE: U.S. health care sector.
INTERVENTION: Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model.
OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost.
RESULTS OF BASE-CASE ANALYSIS: Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%).
RESULTS OF SENSITIVITY ANALYSES: Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions.
LIMITATION: Risk models were restricted to age, sex, and smoking-related risk predictors.
CONCLUSION: Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration.
PRIMARY FUNDING SOURCE: National Cancer Institute (NCI).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: In their 2021 lung cancer screening recommendation update, the U.S. Preventive Services Task Force (USPSTF) evaluated strategies that select people based on their personal lung cancer risk (risk model-based strategies), highlighting the need for further research on the benefits and harms of risk model-based screening.
OBJECTIVE: To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.
DESIGN: Comparative modeling analysis.
DATA SOURCES: National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator.
TARGET POPULATION: 1960 U.S. birth cohort.
TIME HORIZON: 45 years.
PERSPECTIVE: U.S. health care sector.
INTERVENTION: Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model.
OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost.
RESULTS OF BASE-CASE ANALYSIS: Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%).
RESULTS OF SENSITIVITY ANALYSES: Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions.
LIMITATION: Risk models were restricted to age, sex, and smoking-related risk predictors.
CONCLUSION: Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration.
PRIMARY FUNDING SOURCE: National Cancer Institute (NCI).
OBJECTIVE: To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.
DESIGN: Comparative modeling analysis.
DATA SOURCES: National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator.
TARGET POPULATION: 1960 U.S. birth cohort.
TIME HORIZON: 45 years.
PERSPECTIVE: U.S. health care sector.
INTERVENTION: Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model.
OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost.
RESULTS OF BASE-CASE ANALYSIS: Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%).
RESULTS OF SENSITIVITY ANALYSES: Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions.
LIMITATION: Risk models were restricted to age, sex, and smoking-related risk predictors.
CONCLUSION: Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration.
PRIMARY FUNDING SOURCE: National Cancer Institute (NCI).
2021
Toumazis, Iakovos; Nijs, Koen; Cao, Pianpian; Bastani, Mehrad; Munshi, Vidit; Haaf, Kevin Ten; Jeon, Jihyoun; Gazelle, G. Scott; Feuer, Eric J.; Koning, Harry J.; Meza, Rafael; Kong, Chung Yin; Han, Summer S.; Plevritis, Sylvia K.
Cost-effectiveness Evaluation of the 2021 US Preventive Services Task Force Recommendation for Lung Cancer Screening. Journal Article
In: JAMA oncology, 2021, ISSN: 2374-2445, ().
@article{Toumazis2021,
title = {Cost-effectiveness Evaluation of the 2021 US Preventive Services Task Force Recommendation for Lung Cancer Screening.},
author = {Iakovos Toumazis and Koen Nijs and Pianpian Cao and Mehrad Bastani and Vidit Munshi and Kevin Ten Haaf and Jihyoun Jeon and G. Scott Gazelle and Eric J. Feuer and Harry J. Koning and Rafael Meza and Chung Yin Kong and Summer S. Han and Sylvia K. Plevritis},
url = {https://pubmed.ncbi.nlm.nih.gov/34673885/},
doi = {10.1001/jamaoncol.2021.4942},
issn = {2374-2445},
year = {2021},
date = {2021-10-01},
journal = {JAMA oncology},
abstract = {The US Preventive Services Task Force (USPSTF) issued its 2021 recommendation on lung cancer screening, which lowered the starting age for screening from 55 to 50 years and the minimum cumulative smoking exposure from 30 to 20 pack-years relative to its 2013 recommendation. Although costs are expected to increase because of the expanded screening eligibility criteria, it is unknown whether the new guidelines for lung cancer screening are cost-effective. To evaluate the cost-effectiveness of the 2021 USPSTF recommendation for lung cancer screening compared with the 2013 recommendation and to explore the cost-effectiveness of 6 alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years and an ending age for screening of 80 years but varied the starting ages for screening (50 or 55 years) and the number of years since smoking cessation (≤15, ≤20, or ≤25). A comparative cost-effectiveness analysis using 4 independently developed microsimulation models that shared common inputs to assess the population-level health benefits and costs of the 2021 recommended screening strategy and 6 alternative screening strategies compared with the 2013 recommended screening strategy. The models simulated a 1960 US birth cohort. Simulated individuals entered the study at age 45 years and were followed up until death or age 90 years, corresponding to a study period from January 1, 2005, to December 31, 2050. Low-dose computed tomography in lung cancer screening programs with a minimum cumulative smoking exposure of 20 pack-years. Incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of the 2021 vs 2013 USPSTF lung cancer screening recommendations as well as 6 alternative screening strategies vs the 2013 USPSTF screening strategy. Strategies with a mean ICER lower than $100 000 per QALY were deemed cost-effective. The 2021 USPSTF recommendation was estimated to be cost-effective compared with the 2013 recommendation, with a mean ICER of $72 564 (range across 4 models, $59 493-$85 837) per QALY gained. The 2021 recommendation was not cost-effective compared with 6 alternative strategies that used the 20 pack-year criterion. Strategies associated with the most cost-effectiveness included those that expanded screening eligibility to include a greater number of former smokers who had not smoked for a longer duration (ie, ≤20 years and ≤25 years since smoking cessation vs ≤15 years since smoking cessation). In particular, the strategy that screened former smokers who quit within the past 25 years and began screening at age 55 years was associated with screening coverage closest to that of the 2021 USPSTF recommendation yet yielded greater cost-effectiveness, with a mean ICER of $66 533 (range across 4 models, $55 693-$80 539). This economic evaluation found that the 2021 USPSTF recommendation for lung cancer screening was cost-effective; however, alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years but included individuals who quit smoking within the past 25 years may be more cost-effective and warrant further evaluation.},
keywords = {},
pubstate = {aheadofprint},
tppubtype = {article}
}
The US Preventive Services Task Force (USPSTF) issued its 2021 recommendation on lung cancer screening, which lowered the starting age for screening from 55 to 50 years and the minimum cumulative smoking exposure from 30 to 20 pack-years relative to its 2013 recommendation. Although costs are expected to increase because of the expanded screening eligibility criteria, it is unknown whether the new guidelines for lung cancer screening are cost-effective. To evaluate the cost-effectiveness of the 2021 USPSTF recommendation for lung cancer screening compared with the 2013 recommendation and to explore the cost-effectiveness of 6 alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years and an ending age for screening of 80 years but varied the starting ages for screening (50 or 55 years) and the number of years since smoking cessation (≤15, ≤20, or ≤25). A comparative cost-effectiveness analysis using 4 independently developed microsimulation models that shared common inputs to assess the population-level health benefits and costs of the 2021 recommended screening strategy and 6 alternative screening strategies compared with the 2013 recommended screening strategy. The models simulated a 1960 US birth cohort. Simulated individuals entered the study at age 45 years and were followed up until death or age 90 years, corresponding to a study period from January 1, 2005, to December 31, 2050. Low-dose computed tomography in lung cancer screening programs with a minimum cumulative smoking exposure of 20 pack-years. Incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of the 2021 vs 2013 USPSTF lung cancer screening recommendations as well as 6 alternative screening strategies vs the 2013 USPSTF screening strategy. Strategies with a mean ICER lower than $100 000 per QALY were deemed cost-effective. The 2021 USPSTF recommendation was estimated to be cost-effective compared with the 2013 recommendation, with a mean ICER of $72 564 (range across 4 models, $59 493-$85 837) per QALY gained. The 2021 recommendation was not cost-effective compared with 6 alternative strategies that used the 20 pack-year criterion. Strategies associated with the most cost-effectiveness included those that expanded screening eligibility to include a greater number of former smokers who had not smoked for a longer duration (ie, ≤20 years and ≤25 years since smoking cessation vs ≤15 years since smoking cessation). In particular, the strategy that screened former smokers who quit within the past 25 years and began screening at age 55 years was associated with screening coverage closest to that of the 2021 USPSTF recommendation yet yielded greater cost-effectiveness, with a mean ICER of $66 533 (range across 4 models, $55 693-$80 539). This economic evaluation found that the 2021 USPSTF recommendation for lung cancer screening was cost-effective; however, alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years but included individuals who quit smoking within the past 25 years may be more cost-effective and warrant further evaluation.
2017
Han, Summer S; Haaf, Kevin Ten; Hazelton, William D; Munshi, Vidit; Jeon, Jihyoun; Erdogan, Saadet A; Johanson, Colden; McMahon, Pamela M.; Meza, Rafael; Kong, Chung Yin; Feuer, Eric J; Koning, Harry J; Plevritis, Sylvia K
The impact of overdiagnosis on the selection of efficient lung cancer screening strategies Journal Article
In: International journal of cancer, vol. 140, no. 11, pp. 2436-2443, 2017, ISSN: 1097-0215, ().
@article{Han2017,
title = {The impact of overdiagnosis on the selection of efficient lung cancer screening strategies},
author = {Summer S Han and Kevin Ten Haaf and William D Hazelton and Vidit Munshi and Jihyoun Jeon and Saadet A Erdogan and Colden Johanson and Pamela M. McMahon and Rafael Meza and Chung Yin Kong and Eric J Feuer and Harry J Koning and Sylvia K Plevritis},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28073150},
doi = {10.1002/ijc.30602},
issn = {1097-0215},
year = {2017},
date = {2017-06-01},
journal = {International journal of cancer},
volume = {140},
number = {11},
pages = {2436-2443},
abstract = {The U.S. Preventive Services Task Force (USPSTF) recently updated their national lung screening guidelines and recommended low-dose computed tomography (LDCT) for lung cancer (LC) screening through age 80. However, the risk of overdiagnosis among older populations is a concern. Using four comparative models from the Cancer Intervention and Surveillance Modeling Network, we evaluate the overdiagnosis of the screening program recommended by USPSTF in the U.S. 1950 birth cohort. We estimate the number of LC deaths averted by screening (D) per overdiagnosed case (O), yielding the ratio D/O, to quantify the trade-off between the harms and benefits of LDCT. We analyze 576 hypothetical screening strategies that vary by age, smoking, and screening frequency and evaluate efficient screening strategies that maximize the D/O ratio and other metrics including D and life-years gained (LYG) per overdiagnosed case. The estimated D/O ratio for the USPSTF screening program is 2.85 (model range: 1.5-4.5) in the 1950 birth cohort, implying LDCT can prevent ∼3 LC deaths per overdiagnosed case. This D/O ratio increases by 22% when the program stops screening at an earlier age 75 instead of 80. Efficiency frontier analysis shows that while the most efficient screening strategies that maximize the mortality reduction (D) irrespective of overdiagnosis screen through age 80, screening strategies that stop at age 75 versus 80 produce greater efficiency in increasing life-years gained per overdiagnosed case. Given the risk of overdiagnosis with lung cancer screening, the stopping age of screening merits further consideration when balancing benefits and harms. This article is protected by copyright. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The U.S. Preventive Services Task Force (USPSTF) recently updated their national lung screening guidelines and recommended low-dose computed tomography (LDCT) for lung cancer (LC) screening through age 80. However, the risk of overdiagnosis among older populations is a concern. Using four comparative models from the Cancer Intervention and Surveillance Modeling Network, we evaluate the overdiagnosis of the screening program recommended by USPSTF in the U.S. 1950 birth cohort. We estimate the number of LC deaths averted by screening (D) per overdiagnosed case (O), yielding the ratio D/O, to quantify the trade-off between the harms and benefits of LDCT. We analyze 576 hypothetical screening strategies that vary by age, smoking, and screening frequency and evaluate efficient screening strategies that maximize the D/O ratio and other metrics including D and life-years gained (LYG) per overdiagnosed case. The estimated D/O ratio for the USPSTF screening program is 2.85 (model range: 1.5-4.5) in the 1950 birth cohort, implying LDCT can prevent ∼3 LC deaths per overdiagnosed case. This D/O ratio increases by 22% when the program stops screening at an earlier age 75 instead of 80. Efficiency frontier analysis shows that while the most efficient screening strategies that maximize the mortality reduction (D) irrespective of overdiagnosis screen through age 80, screening strategies that stop at age 75 versus 80 produce greater efficiency in increasing life-years gained per overdiagnosed case. Given the risk of overdiagnosis with lung cancer screening, the stopping age of screening merits further consideration when balancing benefits and harms. This article is protected by copyright. All rights reserved.
2015
Lowry, Kathryn; Gazelle, G. Scott; Gilmore, Michael; Johanson, Colden; Munshi, Vidit; Choi, Sung Eun; Tramontano, Angela; Kong, Chung Yin; McMahon, Pamela M.
Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis Journal Article
In: Cancer, vol. 121, no. 10, pp. 1556-62, 2015, ().
@article{Lowry2015,
title = {Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis},
author = {Kathryn Lowry and G. Scott Gazelle and Michael Gilmore and Colden Johanson and Vidit Munshi and Sung Eun Choi and Angela Tramontano and Chung Yin Kong and Pamela M. McMahon},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25652107},
doi = {10.1002/cncr.29225},
year = {2015},
date = {2015-05-01},
journal = {Cancer},
volume = {121},
number = {10},
pages = {1556-62},
institution = {Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Institute for Technology Assessment, Boston, Massachusetts.},
abstract = {Lung cancer screening with annual chest computed tomography (CT) is recommended for current and former smokers with a ≥30-pack-year smoking history. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lung cancer and may benefit from screening at lower pack-year thresholds.We used a previously validated simulation model to compare the health benefits of lung cancer screening in current and former smokers ages 55-80 with ≥30 pack-years with hypothetical programs using lower pack-year thresholds for individuals with COPD (≥20, ≥10, and ≥1 pack-years). Calibration targets for COPD prevalence and associated lung cancer risk were derived using the Framingham Offspring Study limited data set. We performed sensitivity analyses to evaluate the stability of results across different rates of adherence to screening, increased competing mortality risk from COPD, and increased surgical ineligibility in individuals with COPD. The primary outcome was projected life expectancy.Programs using lower pack-year thresholds for individuals with COPD yielded the highest life expectancy gains for a given number of screens. Highest life expectancy was achieved when lowering the pack-year threshold to ≥1 pack-year for individuals with COPD, which dominated all other screening strategies. These results were stable across different adherence rates to screening and increases in competing mortality risk for COPD and surgical ineligibility.Current and former smokers with COPD may disproportionately benefit from lung cancer screening. A lower pack-year threshold for screening eligibility may benefit this high-risk patient population. Cancer 2015. © 2015 American Cancer Society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lung cancer screening with annual chest computed tomography (CT) is recommended for current and former smokers with a ≥30-pack-year smoking history. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lung cancer and may benefit from screening at lower pack-year thresholds.We used a previously validated simulation model to compare the health benefits of lung cancer screening in current and former smokers ages 55-80 with ≥30 pack-years with hypothetical programs using lower pack-year thresholds for individuals with COPD (≥20, ≥10, and ≥1 pack-years). Calibration targets for COPD prevalence and associated lung cancer risk were derived using the Framingham Offspring Study limited data set. We performed sensitivity analyses to evaluate the stability of results across different rates of adherence to screening, increased competing mortality risk from COPD, and increased surgical ineligibility in individuals with COPD. The primary outcome was projected life expectancy.Programs using lower pack-year thresholds for individuals with COPD yielded the highest life expectancy gains for a given number of screens. Highest life expectancy was achieved when lowering the pack-year threshold to ≥1 pack-year for individuals with COPD, which dominated all other screening strategies. These results were stable across different adherence rates to screening and increases in competing mortality risk for COPD and surgical ineligibility.Current and former smokers with COPD may disproportionately benefit from lung cancer screening. A lower pack-year threshold for screening eligibility may benefit this high-risk patient population. Cancer 2015. © 2015 American Cancer Society.
2014
Goehler, Alexander; McMahon, Pamela M.; Lumish, Heidi S.; Wu, Carol; Munshi, Vidit; Gilmore, Michael; Chung, Jonathan H.; Ghoshhajra, Brian B.; Mark, Daniel; Truong, Quynh A.; Gazelle, G. Scott; Hoffmann, Udo
In: Circulation, vol. 130, no. 8, pp. 668-75, 2014, ().
@article{Goehler2014,
title = {Cost-Effectiveness of Follow-Up of Pulmonary Nodules Incidentally Detected on Cardiac CT Angiography in Patients with Suspected Coronary Artery Disease},
author = {Alexander Goehler and Pamela M. McMahon and Heidi S. Lumish and Carol Wu and Vidit Munshi and Michael Gilmore and Jonathan H. Chung and Brian B. Ghoshhajra and Daniel Mark and Quynh A. Truong and G. Scott Gazelle and Udo Hoffmann},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25015342},
doi = {10.1161/CIRCULATIONAHA.113.007306},
year = {2014},
date = {2014-08-01},
urldate = {2014-08-01},
journal = {Circulation},
volume = {130},
number = {8},
pages = {668-75},
institution = {Massachusetts General Hospital; Harvard Medical School, Boston, MA.},
abstract = {-Pulmonary nodules (PN) are often incidentally detected during coronary
CT angiography (CCTA) which is increasingly used to evaluate patients
with chest pain symptoms. However, the efficiency of following up
on incidentally detected PN is unknown.-We determined demographic
and clinical characteristics of stable symptomatic patients referred
for CCTA in whom incidentally detected PN warranted follow-up. A
validated lung cancer simulation model was populated with data from
these patients and clinical and economic consequences of follow-up
per Fleischner guidelines versus no follow-up were simulated. Of
the 3,665 patients referred to CCTA, 591 (16%) had PN requiring
follow-up. Mean age of patients with PN was 59±10 years, 66% were
male, 67% had ever smoked, and 21% had obstructive CAD. The projected
overall lung cancer incidence was 5.8% in these patients, but the
majority died from CAD (38%) and other causes (57%). Follow-up
of PN was associated with a 4.6% relative reduction in cumulative
lung cancer mortality (absolute mortality:FU: 4.33% vs. non-FU:
4.54%), more downstream testing (FU: 2.34 CTs/patient vs. non-FU:
1.01 CTs/patient), and an average increase of quality-adjusted life
of seven days. Costs per quality adjusted life year (QALY) gained
were $154,700 to follow-up the entire cohort and $129,800/QALY when
only smokers were included.-Follow-up of PN incidentally detected
in patients undergoing CCTA for chest pain evaluation is associated
with a small reduction in lung cancer mortality. However, significant
downstream testing contributes to limited efficiency as demonstrated
by a high cost per QALY, especially in non-smokers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
-Pulmonary nodules (PN) are often incidentally detected during coronary
CT angiography (CCTA) which is increasingly used to evaluate patients
with chest pain symptoms. However, the efficiency of following up
on incidentally detected PN is unknown.-We determined demographic
and clinical characteristics of stable symptomatic patients referred
for CCTA in whom incidentally detected PN warranted follow-up. A
validated lung cancer simulation model was populated with data from
these patients and clinical and economic consequences of follow-up
per Fleischner guidelines versus no follow-up were simulated. Of
the 3,665 patients referred to CCTA, 591 (16%) had PN requiring
follow-up. Mean age of patients with PN was 59±10 years, 66% were
male, 67% had ever smoked, and 21% had obstructive CAD. The projected
overall lung cancer incidence was 5.8% in these patients, but the
majority died from CAD (38%) and other causes (57%). Follow-up
of PN was associated with a 4.6% relative reduction in cumulative
lung cancer mortality (absolute mortality:FU: 4.33% vs. non-FU:
4.54%), more downstream testing (FU: 2.34 CTs/patient vs. non-FU:
1.01 CTs/patient), and an average increase of quality-adjusted life
of seven days. Costs per quality adjusted life year (QALY) gained
were $154,700 to follow-up the entire cohort and $129,800/QALY when
only smokers were included.-Follow-up of PN incidentally detected
in patients undergoing CCTA for chest pain evaluation is associated
with a small reduction in lung cancer mortality. However, significant
downstream testing contributes to limited efficiency as demonstrated
by a high cost per QALY, especially in non-smokers.
CT angiography (CCTA) which is increasingly used to evaluate patients
with chest pain symptoms. However, the efficiency of following up
on incidentally detected PN is unknown.-We determined demographic
and clinical characteristics of stable symptomatic patients referred
for CCTA in whom incidentally detected PN warranted follow-up. A
validated lung cancer simulation model was populated with data from
these patients and clinical and economic consequences of follow-up
per Fleischner guidelines versus no follow-up were simulated. Of
the 3,665 patients referred to CCTA, 591 (16%) had PN requiring
follow-up. Mean age of patients with PN was 59±10 years, 66% were
male, 67% had ever smoked, and 21% had obstructive CAD. The projected
overall lung cancer incidence was 5.8% in these patients, but the
majority died from CAD (38%) and other causes (57%). Follow-up
of PN was associated with a 4.6% relative reduction in cumulative
lung cancer mortality (absolute mortality:FU: 4.33% vs. non-FU:
4.54%), more downstream testing (FU: 2.34 CTs/patient vs. non-FU:
1.01 CTs/patient), and an average increase of quality-adjusted life
of seven days. Costs per quality adjusted life year (QALY) gained
were $154,700 to follow-up the entire cohort and $129,800/QALY when
only smokers were included.-Follow-up of PN incidentally detected
in patients undergoing CCTA for chest pain evaluation is associated
with a small reduction in lung cancer mortality. However, significant
downstream testing contributes to limited efficiency as demonstrated
by a high cost per QALY, especially in non-smokers.
Meza, Rafael; Haaf, Kevin Ten; Kong, Chung Yin; Erdogan, Ayca; Black, William C.; Tammemagi, Martin C.; Choi, Sung Eun; Jeon, Jihyoun; Han, Summer S.; Munshi, Vidit; Rosmalen, Joost; Pinsky, Paul; McMahon, Pamela M.; Koning, Harry J.; Feuer, Eric J.; Hazelton, William D.; Plevritis, Sylvia K.
Comparative analysis of 5 lung cancer natural history and screening models that reproduce outcomes of the NLST and PLCO trials Journal Article
In: Cancer, vol. 120, no. 11, pp. 1713-24, 2014, ().
@article{Meza2014,
title = {Comparative analysis of 5 lung cancer natural history and screening models that reproduce outcomes of the NLST and PLCO trials},
author = {Rafael Meza and Kevin Ten Haaf and Chung Yin Kong and Ayca Erdogan and William C. Black and Martin C. Tammemagi and Sung Eun Choi and Jihyoun Jeon and Summer S. Han and Vidit Munshi and Joost Rosmalen and Paul Pinsky and Pamela M. McMahon and Harry J. Koning and Eric J. Feuer and William D. Hazelton and Sylvia K. Plevritis},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24577803},
doi = {10.1002/cncr.28623},
year = {2014},
date = {2014-06-01},
journal = {Cancer},
volume = {120},
number = {11},
pages = {1713-24},
institution = {Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.},
abstract = {The National Lung Screening Trial (NLST) demonstrated that low-dose
computed tomography screening is an effective way of reducing lung
cancer (LC) mortality. However, optimal screening strategies have
not been determined to date and it is uncertain whether lighter smokers
than those examined in the NLST may also benefit from screening.
To address these questions, it is necessary to first develop LC natural
history models that can reproduce NLST outcomes and simulate screening
programs at the population level.Five independent LC screening models
were developed using common inputs and calibration targets derived
from the NLST and the Prostate, Lung, Colorectal and Ovarian Cancer
Screening Trial (PLCO). Imputation of missing information regarding
smoking, histology, and stage of disease for a small percentage of
individuals and diagnosed LCs in both trials was performed. Models
were calibrated to LC incidence, mortality, or both outcomes simultaneously.Initially,
all models were calibrated to the NLST and validated against PLCO.
Models were found to validate well against individuals in PLCO who
would have been eligible for the NLST. However, all models required
further calibration to PLCO to adequately capture LC outcomes in
PLCO never-smokers and light smokers. Final versions of all models
produced incidence and mortality outcomes in the presence and absence
of screening that were consistent with both trials.The authors developed
5 distinct LC screening simulation models based on the evidence in
the NLST and PLCO. The results of their analyses demonstrated that
the NLST and PLCO have produced consistent results. The resulting
models can be important tools to generate additional evidence to
determine the effectiveness of lung cancer screening strategies using
low-dose computed tomography. Cancer 2014. © 2014 American Cancer
Society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The National Lung Screening Trial (NLST) demonstrated that low-dose
computed tomography screening is an effective way of reducing lung
cancer (LC) mortality. However, optimal screening strategies have
not been determined to date and it is uncertain whether lighter smokers
than those examined in the NLST may also benefit from screening.
To address these questions, it is necessary to first develop LC natural
history models that can reproduce NLST outcomes and simulate screening
programs at the population level.Five independent LC screening models
were developed using common inputs and calibration targets derived
from the NLST and the Prostate, Lung, Colorectal and Ovarian Cancer
Screening Trial (PLCO). Imputation of missing information regarding
smoking, histology, and stage of disease for a small percentage of
individuals and diagnosed LCs in both trials was performed. Models
were calibrated to LC incidence, mortality, or both outcomes simultaneously.Initially,
all models were calibrated to the NLST and validated against PLCO.
Models were found to validate well against individuals in PLCO who
would have been eligible for the NLST. However, all models required
further calibration to PLCO to adequately capture LC outcomes in
PLCO never-smokers and light smokers. Final versions of all models
produced incidence and mortality outcomes in the presence and absence
of screening that were consistent with both trials.The authors developed
5 distinct LC screening simulation models based on the evidence in
the NLST and PLCO. The results of their analyses demonstrated that
the NLST and PLCO have produced consistent results. The resulting
models can be important tools to generate additional evidence to
determine the effectiveness of lung cancer screening strategies using
low-dose computed tomography. Cancer 2014. © 2014 American Cancer
Society.
computed tomography screening is an effective way of reducing lung
cancer (LC) mortality. However, optimal screening strategies have
not been determined to date and it is uncertain whether lighter smokers
than those examined in the NLST may also benefit from screening.
To address these questions, it is necessary to first develop LC natural
history models that can reproduce NLST outcomes and simulate screening
programs at the population level.Five independent LC screening models
were developed using common inputs and calibration targets derived
from the NLST and the Prostate, Lung, Colorectal and Ovarian Cancer
Screening Trial (PLCO). Imputation of missing information regarding
smoking, histology, and stage of disease for a small percentage of
individuals and diagnosed LCs in both trials was performed. Models
were calibrated to LC incidence, mortality, or both outcomes simultaneously.Initially,
all models were calibrated to the NLST and validated against PLCO.
Models were found to validate well against individuals in PLCO who
would have been eligible for the NLST. However, all models required
further calibration to PLCO to adequately capture LC outcomes in
PLCO never-smokers and light smokers. Final versions of all models
produced incidence and mortality outcomes in the presence and absence
of screening that were consistent with both trials.The authors developed
5 distinct LC screening simulation models based on the evidence in
the NLST and PLCO. The results of their analyses demonstrated that
the NLST and PLCO have produced consistent results. The resulting
models can be important tools to generate additional evidence to
determine the effectiveness of lung cancer screening strategies using
low-dose computed tomography. Cancer 2014. © 2014 American Cancer
Society.
Koning, Harry J.; Meza, Rafael; Plevritis, Sylvia K.; Haaf, Kevin Ten; Munshi, Vidit; Jeon, Jihyoun; Erdogan, Saadet Ayca; Kong, Chung Yin; Han, Summer S.; Rosmalen, Joost; Choi, Sung Eun; Pinsky, Paul F.; Gonzalez, Amy Berrington; Berg, Christine D.; Black, William C.; Tammemägi, Martin C.; Hazelton, William D.; Feuer, Eric J.; McMahon, Pamela M.
In: Ann Intern Med, vol. 150, no. 5, pp. 311-320, 2014, ().
@article{Koning2013,
title = {Benefits and Harms of Computed Tomography Lung Cancer Screening Strategies: A Comparative Modeling Study for the U\.{S}. Preventive Services {T}ask Force},
author = {Harry J. Koning and Rafael Meza and Sylvia K. Plevritis and Kevin Ten Haaf and Vidit Munshi and Jihyoun Jeon and Saadet Ayca Erdogan and Chung Yin Kong and Summer S. Han and Joost Rosmalen and Sung Eun Choi and Paul F. Pinsky and Amy Berrington Gonzalez and Christine D. Berg and William C. Black and Martin C. Tammem\"{a}gi and William D. Hazelton and Eric J. Feuer and Pamela M. McMahon},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24379002},
year = {2014},
date = {2014-03-01},
urldate = {2014-03-01},
booktitle = {Ann Intern Med},
journal = {Ann Intern Med},
volume = {150},
number = {5},
pages = {311-320},
abstract = {The optimal screening policy for lung cancer is unknown.To identify
efficient computed tomography (CT) screening scenarios in which relatively
more lung cancer deaths are averted for fewer CT screening examinations.Comparative
modeling study using 5 independent models.The National Lung Screening
Trial; the Prostate, Lung, Colorectal, and Ovarian trial; the Surveillance,
Epidemiology, and End Results program; and the U.S. Smoking History
Generator.U.S. cohort born in 1950.Cohort followed from ages 45 to
90 years.Societal.576 scenarios with varying eligibility criteria
(age, pack-years of smoking, years since quitting) and screening
intervals.Benefits included lung cancer deaths averted or life-years
gained. Harms included CT examinations, false-positive results (including
those obtained from biopsy/surgery), overdiagnosed cases, and radiation-related
deaths.The most advantageous strategy was annual screening from ages
55 through 80 years for ever-smokers with a smoking history of at
least 30 pack-years and ex-smokers with less than 15 years since
quitting. It would lead to 50% (model ranges, 45% to 54) of cases
of cancer being detected at an early stage (stage I/II), 575 screenings
examinations per lung cancer death averted, a 14% (range, 8.2% to
23.5 reduction in lung cancer mortality, 497 lung cancer deaths averted,
and 5250 life-years gained per the 100 000-member cohort. Harms would
include 67 550 false-positive test results, 910 biopsies or surgeries
for benign lesions, and 190 overdiagnosed cases of cancer (3.7% of
all cases of lung cancer [model ranges, 1.4% to 8.3).The number of
cancer deaths averted for the scenario varied across models between
177 and 862; the number of overdiagnosed cases of cancer varied between
72 and 426.Scenarios assumed 100% screening adherence. Data derived
from trials with short duration were extrapolated to lifetime follow-up.Annual
CT screening for lung cancer has a favorable benefit-to-harm ratio
for individuals ages 55 through 80 years with 30 or more pack-years'
exposure to smoking.National Cancer Institute.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The optimal screening policy for lung cancer is unknown.To identify
efficient computed tomography (CT) screening scenarios in which relatively
more lung cancer deaths are averted for fewer CT screening examinations.Comparative
modeling study using 5 independent models.The National Lung Screening
Trial; the Prostate, Lung, Colorectal, and Ovarian trial; the Surveillance,
Epidemiology, and End Results program; and the U.S. Smoking History
Generator.U.S. cohort born in 1950.Cohort followed from ages 45 to
90 years.Societal.576 scenarios with varying eligibility criteria
(age, pack-years of smoking, years since quitting) and screening
intervals.Benefits included lung cancer deaths averted or life-years
gained. Harms included CT examinations, false-positive results (including
those obtained from biopsy/surgery), overdiagnosed cases, and radiation-related
deaths.The most advantageous strategy was annual screening from ages
55 through 80 years for ever-smokers with a smoking history of at
least 30 pack-years and ex-smokers with less than 15 years since
quitting. It would lead to 50% (model ranges, 45% to 54) of cases
of cancer being detected at an early stage (stage I/II), 575 screenings
examinations per lung cancer death averted, a 14% (range, 8.2% to
23.5 reduction in lung cancer mortality, 497 lung cancer deaths averted,
and 5250 life-years gained per the 100 000-member cohort. Harms would
include 67 550 false-positive test results, 910 biopsies or surgeries
for benign lesions, and 190 overdiagnosed cases of cancer (3.7% of
all cases of lung cancer [model ranges, 1.4% to 8.3).The number of
cancer deaths averted for the scenario varied across models between
177 and 862; the number of overdiagnosed cases of cancer varied between
72 and 426.Scenarios assumed 100% screening adherence. Data derived
from trials with short duration were extrapolated to lifetime follow-up.Annual
CT screening for lung cancer has a favorable benefit-to-harm ratio
for individuals ages 55 through 80 years with 30 or more pack-years'
exposure to smoking.National Cancer Institute.
efficient computed tomography (CT) screening scenarios in which relatively
more lung cancer deaths are averted for fewer CT screening examinations.Comparative
modeling study using 5 independent models.The National Lung Screening
Trial; the Prostate, Lung, Colorectal, and Ovarian trial; the Surveillance,
Epidemiology, and End Results program; and the U.S. Smoking History
Generator.U.S. cohort born in 1950.Cohort followed from ages 45 to
90 years.Societal.576 scenarios with varying eligibility criteria
(age, pack-years of smoking, years since quitting) and screening
intervals.Benefits included lung cancer deaths averted or life-years
gained. Harms included CT examinations, false-positive results (including
those obtained from biopsy/surgery), overdiagnosed cases, and radiation-related
deaths.The most advantageous strategy was annual screening from ages
55 through 80 years for ever-smokers with a smoking history of at
least 30 pack-years and ex-smokers with less than 15 years since
quitting. It would lead to 50% (model ranges, 45% to 54) of cases
of cancer being detected at an early stage (stage I/II), 575 screenings
examinations per lung cancer death averted, a 14% (range, 8.2% to
23.5 reduction in lung cancer mortality, 497 lung cancer deaths averted,
and 5250 life-years gained per the 100 000-member cohort. Harms would
include 67 550 false-positive test results, 910 biopsies or surgeries
for benign lesions, and 190 overdiagnosed cases of cancer (3.7% of
all cases of lung cancer [model ranges, 1.4% to 8.3).The number of
cancer deaths averted for the scenario varied across models between
177 and 862; the number of overdiagnosed cases of cancer varied between
72 and 426.Scenarios assumed 100% screening adherence. Data derived
from trials with short duration were extrapolated to lifetime follow-up.Annual
CT screening for lung cancer has a favorable benefit-to-harm ratio
for individuals ages 55 through 80 years with 30 or more pack-years'
exposure to smoking.National Cancer Institute.
McMahon, Pamela M.; Meza, Rafael; Plevritis, Sylvia K.; Black, William C.; Tammemagi, C Martin; Erdogan, Ayca; Haaf, Kevin; Hazelton, William; Holford, Theodore R.; Jeon, Jihyoun; Clarke, Lauren; Kong, Chung Yin; Choi, Sung Eun; Munshi, Vidit; Han, Summer S.; Rosmalen, Joost; Pinsky, Paul F.; Moolgavkar, Suresh; Koning, Harry J.; Feuer, Eric J.
In: PLoS One, vol. 9, no. 6, pp. e99978, 2014, ().
@article{McMahon2014,
title = {Comparing benefits from many possible computed tomography lung cancer screening programs: extrapolating from the National Lung Screening Trial using comparative modeling},
author = {Pamela M. McMahon and Rafael Meza and Sylvia K. Plevritis and William C. Black and C Martin Tammemagi and Ayca Erdogan and Kevin Haaf and William Hazelton and Theodore R. Holford and Jihyoun Jeon and Lauren Clarke and Chung Yin Kong and Sung Eun Choi and Vidit Munshi and Summer S. Han and Joost Rosmalen and Paul F. Pinsky and Suresh Moolgavkar and Harry J. Koning and Eric J. Feuer},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24979231},
doi = {10.1371/journal.pone.0099978},
year = {2014},
date = {2014-01-01},
urldate = {2014-01-01},
journal = {PLoS One},
volume = {9},
number = {6},
pages = {e99978},
institution = {Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States of America.},
abstract = {The National Lung Screening Trial (NLST) demonstrated that in current and former smokers aged 55 to 74 years, with at least 30 pack-years of cigarette smoking history and who had quit smoking no more than 15 years ago, 3 annual computed tomography (CT) screens reduced lung cancer-specific mortality by 20% relative to 3 annual chest X-ray screens. We compared the benefits achievable with 576 lung cancer screening programs that varied CT screen number and frequency, ages of screening, and eligibility based on smoking.We used five independent microsimulation models with lung cancer natural history parameters previously calibrated to the NLST to simulate life histories of the US cohort born in 1950 under all 576 programs. 'Efficient' (within model) programs prevented the greatest number of lung cancer deaths, compared to no screening, for a given number of CT screens. Among 120 'consensus efficient' (identified as efficient across models) programs, the average starting age was 55 years, the stopping age was 80 or 85 years, the average minimum pack-years was 27, and the maximum years since quitting was 20. Among consensus efficient programs, 11% to 40% of the cohort was screened, and 153 to 846 lung cancer deaths were averted per 100,000 people. In all models, annual screening based on age and smoking eligibility in NLST was not efficient; continuing screening to age 80 or 85 years was more efficient.Consensus results from five models identified a set of efficient screening programs that include annual CT lung cancer screening using criteria like NLST eligibility but extended to older ages. Guidelines for screening should also consider harms of screening and individual patient characteristics.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The National Lung Screening Trial (NLST) demonstrated that in current and former smokers aged 55 to 74 years, with at least 30 pack-years of cigarette smoking history and who had quit smoking no more than 15 years ago, 3 annual computed tomography (CT) screens reduced lung cancer-specific mortality by 20% relative to 3 annual chest X-ray screens. We compared the benefits achievable with 576 lung cancer screening programs that varied CT screen number and frequency, ages of screening, and eligibility based on smoking.We used five independent microsimulation models with lung cancer natural history parameters previously calibrated to the NLST to simulate life histories of the US cohort born in 1950 under all 576 programs. 'Efficient' (within model) programs prevented the greatest number of lung cancer deaths, compared to no screening, for a given number of CT screens. Among 120 'consensus efficient' (identified as efficient across models) programs, the average starting age was 55 years, the stopping age was 80 or 85 years, the average minimum pack-years was 27, and the maximum years since quitting was 20. Among consensus efficient programs, 11% to 40% of the cohort was screened, and 153 to 846 lung cancer deaths were averted per 100,000 people. In all models, annual screening based on age and smoking eligibility in NLST was not efficient; continuing screening to age 80 or 85 years was more efficient.Consensus results from five models identified a set of efficient screening programs that include annual CT lung cancer screening using criteria like NLST eligibility but extended to older ages. Guidelines for screening should also consider harms of screening and individual patient characteristics.
2013
Munshi, Vidit; McMahon, Pamela M.
Importance of Smoking Cessation in a Lung Cancer Screening Program Journal Article
In: Curr Surg Rep, vol. 1, no. 4, 2013, ().
@article{Munshi2013,
title = {Importance of Smoking Cessation in a Lung Cancer Screening Program},
author = {Vidit Munshi and Pamela M. McMahon},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24312745},
doi = {10.1007/s40137-013-0030-1},
year = {2013},
date = {2013-12-01},
urldate = {2013-12-01},
journal = {Curr Surg Rep},
volume = {1},
number = {4},
institution = {Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.},
abstract = {Early detection of lung cancer and smoking cessation interventions
can decrease lung cancer mortality, but information on the effectiveness
and interaction between smoking cessation and lung cancer screening
is sparse and inconsistent. This review aims to synthesize recent
studies in two major areas of interest. First, we explore the interactions
and potential for synergies between lung cancer screening programs
and smoking cessation by summarizing reported changes in smoking
behavior observed in major screening trials in the United States
and Europe, as well as attempts to use smoking cessation interventions
to augment the benefits from lung cancer screening programs. Second,
we review the interaction between smoking habits and pre/post-operative
pulmonary resection outcomes, including changes in smoking behavior
post-diagnosis and post-treatment. Information from these areas should
allow us to maximize benefits from smoking cessation interventions
through the entire lung cancer screening process, from the screen
itself through potential curative resection after diagnosis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Early detection of lung cancer and smoking cessation interventions
can decrease lung cancer mortality, but information on the effectiveness
and interaction between smoking cessation and lung cancer screening
is sparse and inconsistent. This review aims to synthesize recent
studies in two major areas of interest. First, we explore the interactions
and potential for synergies between lung cancer screening programs
and smoking cessation by summarizing reported changes in smoking
behavior observed in major screening trials in the United States
and Europe, as well as attempts to use smoking cessation interventions
to augment the benefits from lung cancer screening programs. Second,
we review the interaction between smoking habits and pre/post-operative
pulmonary resection outcomes, including changes in smoking behavior
post-diagnosis and post-treatment. Information from these areas should
allow us to maximize benefits from smoking cessation interventions
through the entire lung cancer screening process, from the screen
itself through potential curative resection after diagnosis.
can decrease lung cancer mortality, but information on the effectiveness
and interaction between smoking cessation and lung cancer screening
is sparse and inconsistent. This review aims to synthesize recent
studies in two major areas of interest. First, we explore the interactions
and potential for synergies between lung cancer screening programs
and smoking cessation by summarizing reported changes in smoking
behavior observed in major screening trials in the United States
and Europe, as well as attempts to use smoking cessation interventions
to augment the benefits from lung cancer screening programs. Second,
we review the interaction between smoking habits and pre/post-operative
pulmonary resection outcomes, including changes in smoking behavior
post-diagnosis and post-treatment. Information from these areas should
allow us to maximize benefits from smoking cessation interventions
through the entire lung cancer screening process, from the screen
itself through potential curative resection after diagnosis.