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Screening study finds high prevalence of early-stage lung cancer among smokers with HIV
Theo Smart, 2015-03-05 08:10:00
Using low-dose computed tomography to screen selected people living with HIV who smoke, led to early lung cancer diagnoses at younger ages than normally seen in the general population, according to findings from the ANRS EP48 HIV CHEST study reported last week at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI 2015), in Seattle, USA.
During follow-up of the screening, there were no serious adverse events due to diagnostic procedures and more than half of the lung cancers detected by screening were surgically curable (stage 1a) according to Alain Makinson of University Hospital Montpellier who presented the study results during a thematic discussion session on cancer.
Lung cancer has been one of the most common non-AIDS-defining cancers in people living with HIV and it is seen at higher frequencies than in the general population. As noted by other presentations at the conference, a high rate of smoking among people with HIV is responsible for most of the increased risk, but HIV-related immune deficiency also appears to contribute.
Lung cancer has a very high rate of mortality because it can develop without noticeable symptoms and usually remains undiagnosed until it has advanced to a stage where it can no longer be cured.
However, studies have shown that low-dose computed tomography (CT) scans can detect early-stage non-small cell lung cancer lesions that are more responsive to treatment or surgery. Clearly, it would not be cost effective to perform scans on everyone, but a large multicentre study in the US, the National Lung Screening Trial (NLST), showed that using low-dose CT to screen those at highest risk reduced lung cancer-related mortality by 15-20% and overall mortality by 7%.
The screening protocol followed in the NLST is now recommended by the American Cancer Society: low-dose CT three times per year for high-risk individuals, defined as adults aged 55 to 74 years old, in fairly good health (sicker patients may have more abnormalities in their scans and are more likely to be harmed by diagnostic procedures) who are either still smoking or smoked within the last 15 years, with a smoking history of at least 30 pack-years (number of packs smoked per day multiplied by the number of years of smoking – people who smoke one pack a day for 30 years, or two packs a day for 15 years, would have a smoking history of 30 pack-years).
However, Makinson pointed out that further studies are needed to evaluate low-dose CT screening in different populations – particularly among smokers with HIV who are at higher risk of developing lung cancer. He noted that other studies have suggested that people living with HIV might develop lung cancer at an earlier age and with less of a smoking history.
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