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James P Smith - One of the best experts on this subject based on the ideXlab platform.
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CT Screening for Lung Cancer: Alternative Definitions of Positive Test Result Based on the National Lung Screening Trial and International Early Lung Cancer Action Program Databases
Radiology, 2014Co-Authors: Rowena Yip, Claudia I Henschke, David F Yankelevitz, James P SmithAbstract:To determine the usefulness of alternative nodule size thresholds in a population undergoing computed tomographic (CT) screening for lung cancer and to compare the reported International Early Lung Cancer Action Program ( I-ELCAP International Early Lung Cancer Action Program ) Results with the National Lung Screening Trial ( NLST National Lung Screening Trial ) Results. The institutional review board approved this retrospective analysis. Informed consent was obtained according to HIPAA compliance. Findings in the CT cohort in the NLST National Lung Screening Trial of 25 813 participants who underwent baseline CT in 2002-2004 were reviewed. The frequency of solid and part-solid pulmonary nodules and the lung cancer diagnoses using an alternative nodule threshold of 5.0, 6.0, 7.0, 8.0, and 9.0 mm were determined. Proportional reduction in the frequency of Positive Results and their 95% confidence intervals using each of the alternative thresholds were calculated. The frequency of Positive Results in the baseline round in the CT arm of the NLST National Lung Screening Trial using the definition of a Positive Result of any parenchymal, solid or part-solid, noncalcified nodule of 5.0 mm or larger was 15.8% (4080 of 25 813). Using alternative thresholds of 6.0, 7.0, 8.0, and 9.0 mm, the frequencies of Positive Results were 10.5% (2700 of 25 813, 7.2% (1847 of 25 813), 5.3% (1362 of 25 813), and 4.1% (1007 of 25 813), respectively, and the corresponding proportional reduction in additional CT scans would have been 33.8% (1380 of 1480), 54.7% (2233 of 4080), 66.6% (2718 of 4080), and 73.8% (3013 of 4080), respectively. Concomitantly, the proportion of lung cancer diagnoses determined within the first 12 months would be delayed up to 9 months for 0.9% (two of 232), 2.6% (six of 232), 6.0% (14 of 232), and 9.9% (23 of 232) of the patients, respectively. The NLST National Lung Screening Trial Results are similar to those previously reported for the I-ELCAP International Early Lung Cancer Action Program and suggest that, even for high-risk participants in the NLST National Lung Screening Trial , higher thresholds of nodule size should be considered and prospectively evaluated.
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ct screening for lung cancer alternative definitions of Positive Test Result based on the national lung screening trial and international early lung cancer action program databases
Radiology, 2014Co-Authors: Rowena Yip, Claudia I Henschke, David F Yankelevitz, James P SmithAbstract:In a high-risk population, such as that of the National Lung Screening Trial (NLST), an increase in the average nodule-diameter threshold from 5.0 mm to 6.0, 7.0, 8.0, and 9.0 mm would decrease the obtaining of an additional CT scan of the chest by 33.8%, 54.7%, 66.6%, and 73.8%, respectively, and Result in a delay in the diagnosis of lung cancer of 0.9%, 2.6%, 6.0%, and 9.9% of patients who actually received a diagnosis of lung cancer during the baseline round of the NLST CT arm.
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definition of a Positive Test Result in computed tomography screening for lung cancer
Annals of Internal Medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:The threshold to define a Positive Result on chest computed tomography (CT) screening for lung cancer will affect the number of patients who undergo subsequent evaluation. This retrospective analys...
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Definition of a Positive Test Result in Computed Tomography Screening for Lung Cancer: A Cohort Study
Annals of internal medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-Positive" findings may Result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a Positive Result on the rates of Positive Results and cancer diagnoses is unknown. To assess the frequency of Positive Results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Prospective cohort study. Multi-institutional International Early Lung Cancer Action Program. 21 136 participants with baseline computed tomography performed between 2006 and 2010. The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. The frequency of Positive Results in the baseline round by using the current definition of Positive Result (any parenchymal, solid or part-solid, noncalcified nodule ≥5.0 mm) was 16% (3396/21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of Positive Results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. These findings suggest that using a threshold of 7 or 8 mm to define Positive Results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients.
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definition of a Positive Test Result in computed tomography screening for lung cancer a cohort study
Annals of Internal Medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:Background Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-Positive" findings may Result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a Positive Result on the rates of Positive Results and cancer diagnoses is unknown. Objective To assess the frequency of Positive Results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Design Prospective cohort study. Setting Multi-institutional International Early Lung Cancer Action Program. Patients 21 136 participants with baseline computed tomography performed between 2006 and 2010. Measurements The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. Results The frequency of Positive Results in the baseline round by using the current definition of Positive Result (any parenchymal, solid or part-solid, noncalcified nodule ≥5.0 mm) was 16% (3396/21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of Positive Results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. Limitation This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. Conclusion These findings suggest that using a threshold of 7 or 8 mm to define Positive Results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients.
W.a.j. Van Daal - One of the best experts on this subject based on the ideXlab platform.
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Impact ofBRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with breast or ovarian cancer
American Journal of Medical Genetics, 2004Co-Authors: Mari�lle S. Van Roosmalen, P.f.m. Stalmeier, L.c.g. Verhoef, J.e.h.m. Hoekstra-weebers, J.c. Oosterwijk, N. Hoogerbrugge, U. Moog, W.a.j. Van DaalAbstract:To evaluate the impact of BRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with cancer. Longitudinal cohort study including women affected and unaffected with breast or ovarian cancer Testing for a BRCA1/2 mutation. Data on well-being (anxiety, depression, cancer related distress, general health), treatment choice, and decision making about cancer prevention were collected at baseline (1 week after blood sampling; affected n = 192, unaffected n = 176) and at follow-up (2 weeks after disclosure of a Positive Test Result; affected n = 23, unaffected, n = 66). Women affected and unaffected with breast or ovarian cancer were compared using univariate statistics. Change over time was examined using repeated measures analysis of variance. With respect to well-being, affected women scored worse at baseline. At follow-up, both affected and unaffected women experienced a decline in well-being, which tended to be stronger in affected women. Women diagnosed with cancer less than 1 year previously tended to report a worse well-being than those diagnosed longer ago. With respect to treatment choice, more affected women intended to obtain prophylactic surgery and valued it higher at both time points. With respect to decision making, affected women had a lower preference for participation in decision making at baseline; no differences were found at follow-up. At follow-up, both affected and unaffected women showed an increase in strength of treatment preference and a decrease in decision uncertainty. Disclosure of a Positive Test Result had a negative impact on well-being. Affected women, especially those who have been recently diagnosed with cancer, experienced the worst well-being and could benefit from psychosocial support. (C) 2003 Wiley-Liss, Inc
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Impact of BRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with breast or ovarian cancer.
American journal of medical genetics. Part A, 2004Co-Authors: Mari�lle S. Van Roosmalen, P.f.m. Stalmeier, L.c.g. Verhoef, J.e.h.m. Hoekstra-weebers, J.c. Oosterwijk, N. Hoogerbrugge, U. Moog, W.a.j. Van DaalAbstract:To evaluate the impact of BRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with cancer. Longitudinal cohort study including women affected and unaffected with breast or ovarian cancer Testing for a BRCA1/2 mutation. Data on well-being (anxiety, depression, cancer related distress, general health), treatment choice, and decision making about cancer prevention were collected at baseline (1 week after blood sampling; affected n = 192, unaffected n = 176) and at follow-up (2 weeks after disclosure of a Positive Test Result; affected n = 23, unaffected n = 66). Women affected and unaffected with breast or ovarian cancer were compared using univariate statistics. Change over time was examined using repeated measures analysis of variance. With respect to well-being, affected women scored worse at baseline. At follow-up, both affected and unaffected women experienced a decline in well-being, which tended to be stronger in affected women. Women diagnosed with cancer less than 1 year previously tended to report a worse well-being than those diagnosed longer ago. With respect to treatment choice, more affected women intended to obtain prophylactic surgery and valued it higher at both time points. With respect to decision making, affected women had a lower preference for participation in decision making at baseline; no differences were found at follow-up. At follow-up, both affected and unaffected women showed an increase in strength of treatment preference and a decrease in decision uncertainty. Disclosure of a Positive Test Result had a negative impact on well-being. Affected women, especially those who have been recently diagnosed with cancer, experienced the worst well-being and could benefit from psychosocial support.
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impact of brca1 2 Testing and disclosure of a Positive Test Result on women affected and unaffected with breast or ovarian cancer
American Journal of Medical Genetics Part A, 2004Co-Authors: Mari�lle S. Van Roosmalen, P.f.m. Stalmeier, L.c.g. Verhoef, J.c. Oosterwijk, N. Hoogerbrugge, U. Moog, Josette E H M Hoekstraweebers, W.a.j. Van DaalAbstract:To evaluate the impact of BRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with cancer. Longitudinal cohort study including women affected and unaffected with breast or ovarian cancer Testing for a BRCA1/2 mutation. Data on well-being (anxiety, depression, cancer related distress, general health), treatment choice, and decision making about cancer prevention were collected at baseline (1 week after blood sampling; affected n = 192, unaffected n = 176) and at follow-up (2 weeks after disclosure of a Positive Test Result; affected n = 23, unaffected n = 66). Women affected and unaffected with breast or ovarian cancer were compared using univariate statistics. Change over time was examined using repeated measures analysis of variance. With respect to well-being, affected women scored worse at baseline. At follow-up, both affected and unaffected women experienced a decline in well-being, which tended to be stronger in affected women. Women diagnosed with cancer less than 1 year previously tended to report a worse well-being than those diagnosed longer ago. With respect to treatment choice, more affected women intended to obtain prophylactic surgery and valued it higher at both time points. With respect to decision making, affected women had a lower preference for participation in decision making at baseline; no differences were found at follow-up. At follow-up, both affected and unaffected women showed an increase in strength of treatment preference and a decrease in decision uncertainty. Disclosure of a Positive Test Result had a negative impact on well-being. Affected women, especially those who have been recently diagnosed with cancer, experienced the worst well-being and could benefit from psychosocial support.
Claudia I Henschke - One of the best experts on this subject based on the ideXlab platform.
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CT Screening for Lung Cancer: Alternative Definitions of Positive Test Result Based on the National Lung Screening Trial and International Early Lung Cancer Action Program Databases
Radiology, 2014Co-Authors: Rowena Yip, Claudia I Henschke, David F Yankelevitz, James P SmithAbstract:To determine the usefulness of alternative nodule size thresholds in a population undergoing computed tomographic (CT) screening for lung cancer and to compare the reported International Early Lung Cancer Action Program ( I-ELCAP International Early Lung Cancer Action Program ) Results with the National Lung Screening Trial ( NLST National Lung Screening Trial ) Results. The institutional review board approved this retrospective analysis. Informed consent was obtained according to HIPAA compliance. Findings in the CT cohort in the NLST National Lung Screening Trial of 25 813 participants who underwent baseline CT in 2002-2004 were reviewed. The frequency of solid and part-solid pulmonary nodules and the lung cancer diagnoses using an alternative nodule threshold of 5.0, 6.0, 7.0, 8.0, and 9.0 mm were determined. Proportional reduction in the frequency of Positive Results and their 95% confidence intervals using each of the alternative thresholds were calculated. The frequency of Positive Results in the baseline round in the CT arm of the NLST National Lung Screening Trial using the definition of a Positive Result of any parenchymal, solid or part-solid, noncalcified nodule of 5.0 mm or larger was 15.8% (4080 of 25 813). Using alternative thresholds of 6.0, 7.0, 8.0, and 9.0 mm, the frequencies of Positive Results were 10.5% (2700 of 25 813, 7.2% (1847 of 25 813), 5.3% (1362 of 25 813), and 4.1% (1007 of 25 813), respectively, and the corresponding proportional reduction in additional CT scans would have been 33.8% (1380 of 1480), 54.7% (2233 of 4080), 66.6% (2718 of 4080), and 73.8% (3013 of 4080), respectively. Concomitantly, the proportion of lung cancer diagnoses determined within the first 12 months would be delayed up to 9 months for 0.9% (two of 232), 2.6% (six of 232), 6.0% (14 of 232), and 9.9% (23 of 232) of the patients, respectively. The NLST National Lung Screening Trial Results are similar to those previously reported for the I-ELCAP International Early Lung Cancer Action Program and suggest that, even for high-risk participants in the NLST National Lung Screening Trial , higher thresholds of nodule size should be considered and prospectively evaluated.
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ct screening for lung cancer alternative definitions of Positive Test Result based on the national lung screening trial and international early lung cancer action program databases
Radiology, 2014Co-Authors: Rowena Yip, Claudia I Henschke, David F Yankelevitz, James P SmithAbstract:In a high-risk population, such as that of the National Lung Screening Trial (NLST), an increase in the average nodule-diameter threshold from 5.0 mm to 6.0, 7.0, 8.0, and 9.0 mm would decrease the obtaining of an additional CT scan of the chest by 33.8%, 54.7%, 66.6%, and 73.8%, respectively, and Result in a delay in the diagnosis of lung cancer of 0.9%, 2.6%, 6.0%, and 9.9% of patients who actually received a diagnosis of lung cancer during the baseline round of the NLST CT arm.
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definition of a Positive Test Result in computed tomography screening for lung cancer
Annals of Internal Medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:The threshold to define a Positive Result on chest computed tomography (CT) screening for lung cancer will affect the number of patients who undergo subsequent evaluation. This retrospective analys...
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Definition of a Positive Test Result in Computed Tomography Screening for Lung Cancer: A Cohort Study
Annals of internal medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-Positive" findings may Result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a Positive Result on the rates of Positive Results and cancer diagnoses is unknown. To assess the frequency of Positive Results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Prospective cohort study. Multi-institutional International Early Lung Cancer Action Program. 21 136 participants with baseline computed tomography performed between 2006 and 2010. The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. The frequency of Positive Results in the baseline round by using the current definition of Positive Result (any parenchymal, solid or part-solid, noncalcified nodule ≥5.0 mm) was 16% (3396/21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of Positive Results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. These findings suggest that using a threshold of 7 or 8 mm to define Positive Results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients.
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definition of a Positive Test Result in computed tomography screening for lung cancer a cohort study
Annals of Internal Medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:Background Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-Positive" findings may Result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a Positive Result on the rates of Positive Results and cancer diagnoses is unknown. Objective To assess the frequency of Positive Results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Design Prospective cohort study. Setting Multi-institutional International Early Lung Cancer Action Program. Patients 21 136 participants with baseline computed tomography performed between 2006 and 2010. Measurements The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. Results The frequency of Positive Results in the baseline round by using the current definition of Positive Result (any parenchymal, solid or part-solid, noncalcified nodule ≥5.0 mm) was 16% (3396/21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of Positive Results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. Limitation This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. Conclusion These findings suggest that using a threshold of 7 or 8 mm to define Positive Results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients.
Rowena Yip - One of the best experts on this subject based on the ideXlab platform.
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CT Screening for Lung Cancer: Alternative Definitions of Positive Test Result Based on the National Lung Screening Trial and International Early Lung Cancer Action Program Databases
Radiology, 2014Co-Authors: Rowena Yip, Claudia I Henschke, David F Yankelevitz, James P SmithAbstract:To determine the usefulness of alternative nodule size thresholds in a population undergoing computed tomographic (CT) screening for lung cancer and to compare the reported International Early Lung Cancer Action Program ( I-ELCAP International Early Lung Cancer Action Program ) Results with the National Lung Screening Trial ( NLST National Lung Screening Trial ) Results. The institutional review board approved this retrospective analysis. Informed consent was obtained according to HIPAA compliance. Findings in the CT cohort in the NLST National Lung Screening Trial of 25 813 participants who underwent baseline CT in 2002-2004 were reviewed. The frequency of solid and part-solid pulmonary nodules and the lung cancer diagnoses using an alternative nodule threshold of 5.0, 6.0, 7.0, 8.0, and 9.0 mm were determined. Proportional reduction in the frequency of Positive Results and their 95% confidence intervals using each of the alternative thresholds were calculated. The frequency of Positive Results in the baseline round in the CT arm of the NLST National Lung Screening Trial using the definition of a Positive Result of any parenchymal, solid or part-solid, noncalcified nodule of 5.0 mm or larger was 15.8% (4080 of 25 813). Using alternative thresholds of 6.0, 7.0, 8.0, and 9.0 mm, the frequencies of Positive Results were 10.5% (2700 of 25 813, 7.2% (1847 of 25 813), 5.3% (1362 of 25 813), and 4.1% (1007 of 25 813), respectively, and the corresponding proportional reduction in additional CT scans would have been 33.8% (1380 of 1480), 54.7% (2233 of 4080), 66.6% (2718 of 4080), and 73.8% (3013 of 4080), respectively. Concomitantly, the proportion of lung cancer diagnoses determined within the first 12 months would be delayed up to 9 months for 0.9% (two of 232), 2.6% (six of 232), 6.0% (14 of 232), and 9.9% (23 of 232) of the patients, respectively. The NLST National Lung Screening Trial Results are similar to those previously reported for the I-ELCAP International Early Lung Cancer Action Program and suggest that, even for high-risk participants in the NLST National Lung Screening Trial , higher thresholds of nodule size should be considered and prospectively evaluated.
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ct screening for lung cancer alternative definitions of Positive Test Result based on the national lung screening trial and international early lung cancer action program databases
Radiology, 2014Co-Authors: Rowena Yip, Claudia I Henschke, David F Yankelevitz, James P SmithAbstract:In a high-risk population, such as that of the National Lung Screening Trial (NLST), an increase in the average nodule-diameter threshold from 5.0 mm to 6.0, 7.0, 8.0, and 9.0 mm would decrease the obtaining of an additional CT scan of the chest by 33.8%, 54.7%, 66.6%, and 73.8%, respectively, and Result in a delay in the diagnosis of lung cancer of 0.9%, 2.6%, 6.0%, and 9.9% of patients who actually received a diagnosis of lung cancer during the baseline round of the NLST CT arm.
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definition of a Positive Test Result in computed tomography screening for lung cancer
Annals of Internal Medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:The threshold to define a Positive Result on chest computed tomography (CT) screening for lung cancer will affect the number of patients who undergo subsequent evaluation. This retrospective analys...
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Definition of a Positive Test Result in Computed Tomography Screening for Lung Cancer: A Cohort Study
Annals of internal medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-Positive" findings may Result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a Positive Result on the rates of Positive Results and cancer diagnoses is unknown. To assess the frequency of Positive Results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Prospective cohort study. Multi-institutional International Early Lung Cancer Action Program. 21 136 participants with baseline computed tomography performed between 2006 and 2010. The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. The frequency of Positive Results in the baseline round by using the current definition of Positive Result (any parenchymal, solid or part-solid, noncalcified nodule ≥5.0 mm) was 16% (3396/21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of Positive Results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. These findings suggest that using a threshold of 7 or 8 mm to define Positive Results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients.
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definition of a Positive Test Result in computed tomography screening for lung cancer a cohort study
Annals of Internal Medicine, 2013Co-Authors: Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P SmithAbstract:Background Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-Positive" findings may Result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a Positive Result on the rates of Positive Results and cancer diagnoses is unknown. Objective To assess the frequency of Positive Results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Design Prospective cohort study. Setting Multi-institutional International Early Lung Cancer Action Program. Patients 21 136 participants with baseline computed tomography performed between 2006 and 2010. Measurements The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. Results The frequency of Positive Results in the baseline round by using the current definition of Positive Result (any parenchymal, solid or part-solid, noncalcified nodule ≥5.0 mm) was 16% (3396/21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of Positive Results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. Limitation This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. Conclusion These findings suggest that using a threshold of 7 or 8 mm to define Positive Results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients.
Mari�lle S. Van Roosmalen - One of the best experts on this subject based on the ideXlab platform.
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Impact ofBRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with breast or ovarian cancer
American Journal of Medical Genetics, 2004Co-Authors: Mari�lle S. Van Roosmalen, P.f.m. Stalmeier, L.c.g. Verhoef, J.e.h.m. Hoekstra-weebers, J.c. Oosterwijk, N. Hoogerbrugge, U. Moog, W.a.j. Van DaalAbstract:To evaluate the impact of BRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with cancer. Longitudinal cohort study including women affected and unaffected with breast or ovarian cancer Testing for a BRCA1/2 mutation. Data on well-being (anxiety, depression, cancer related distress, general health), treatment choice, and decision making about cancer prevention were collected at baseline (1 week after blood sampling; affected n = 192, unaffected n = 176) and at follow-up (2 weeks after disclosure of a Positive Test Result; affected n = 23, unaffected, n = 66). Women affected and unaffected with breast or ovarian cancer were compared using univariate statistics. Change over time was examined using repeated measures analysis of variance. With respect to well-being, affected women scored worse at baseline. At follow-up, both affected and unaffected women experienced a decline in well-being, which tended to be stronger in affected women. Women diagnosed with cancer less than 1 year previously tended to report a worse well-being than those diagnosed longer ago. With respect to treatment choice, more affected women intended to obtain prophylactic surgery and valued it higher at both time points. With respect to decision making, affected women had a lower preference for participation in decision making at baseline; no differences were found at follow-up. At follow-up, both affected and unaffected women showed an increase in strength of treatment preference and a decrease in decision uncertainty. Disclosure of a Positive Test Result had a negative impact on well-being. Affected women, especially those who have been recently diagnosed with cancer, experienced the worst well-being and could benefit from psychosocial support. (C) 2003 Wiley-Liss, Inc
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Impact of BRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with breast or ovarian cancer.
American journal of medical genetics. Part A, 2004Co-Authors: Mari�lle S. Van Roosmalen, P.f.m. Stalmeier, L.c.g. Verhoef, J.e.h.m. Hoekstra-weebers, J.c. Oosterwijk, N. Hoogerbrugge, U. Moog, W.a.j. Van DaalAbstract:To evaluate the impact of BRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with cancer. Longitudinal cohort study including women affected and unaffected with breast or ovarian cancer Testing for a BRCA1/2 mutation. Data on well-being (anxiety, depression, cancer related distress, general health), treatment choice, and decision making about cancer prevention were collected at baseline (1 week after blood sampling; affected n = 192, unaffected n = 176) and at follow-up (2 weeks after disclosure of a Positive Test Result; affected n = 23, unaffected n = 66). Women affected and unaffected with breast or ovarian cancer were compared using univariate statistics. Change over time was examined using repeated measures analysis of variance. With respect to well-being, affected women scored worse at baseline. At follow-up, both affected and unaffected women experienced a decline in well-being, which tended to be stronger in affected women. Women diagnosed with cancer less than 1 year previously tended to report a worse well-being than those diagnosed longer ago. With respect to treatment choice, more affected women intended to obtain prophylactic surgery and valued it higher at both time points. With respect to decision making, affected women had a lower preference for participation in decision making at baseline; no differences were found at follow-up. At follow-up, both affected and unaffected women showed an increase in strength of treatment preference and a decrease in decision uncertainty. Disclosure of a Positive Test Result had a negative impact on well-being. Affected women, especially those who have been recently diagnosed with cancer, experienced the worst well-being and could benefit from psychosocial support.
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impact of brca1 2 Testing and disclosure of a Positive Test Result on women affected and unaffected with breast or ovarian cancer
American Journal of Medical Genetics Part A, 2004Co-Authors: Mari�lle S. Van Roosmalen, P.f.m. Stalmeier, L.c.g. Verhoef, J.c. Oosterwijk, N. Hoogerbrugge, U. Moog, Josette E H M Hoekstraweebers, W.a.j. Van DaalAbstract:To evaluate the impact of BRCA1/2 Testing and disclosure of a Positive Test Result on women affected and unaffected with cancer. Longitudinal cohort study including women affected and unaffected with breast or ovarian cancer Testing for a BRCA1/2 mutation. Data on well-being (anxiety, depression, cancer related distress, general health), treatment choice, and decision making about cancer prevention were collected at baseline (1 week after blood sampling; affected n = 192, unaffected n = 176) and at follow-up (2 weeks after disclosure of a Positive Test Result; affected n = 23, unaffected n = 66). Women affected and unaffected with breast or ovarian cancer were compared using univariate statistics. Change over time was examined using repeated measures analysis of variance. With respect to well-being, affected women scored worse at baseline. At follow-up, both affected and unaffected women experienced a decline in well-being, which tended to be stronger in affected women. Women diagnosed with cancer less than 1 year previously tended to report a worse well-being than those diagnosed longer ago. With respect to treatment choice, more affected women intended to obtain prophylactic surgery and valued it higher at both time points. With respect to decision making, affected women had a lower preference for participation in decision making at baseline; no differences were found at follow-up. At follow-up, both affected and unaffected women showed an increase in strength of treatment preference and a decrease in decision uncertainty. Disclosure of a Positive Test Result had a negative impact on well-being. Affected women, especially those who have been recently diagnosed with cancer, experienced the worst well-being and could benefit from psychosocial support.