There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by ...all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.
To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.
A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.
Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.
This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.
Immune checkpoint inhibitors (ICIs) have revolutionized cancer care but are associated with unique adverse events, including potentially life-threatening pneumonitis. The diagnosis of ICI-pneumonitis ...is increasing; however, the biological mechanisms, clinical and radiologic features, and the diagnosis and management have not been well defined.
To summarize evidence, identify knowledge and research gaps, and prioritize topics and propose methods for future research on ICI-pneumonitis.
A multidisciplinary group of international clinical researchers reviewed available data on ICI-pneumonitis to develop and refine research questions pertaining to ICI-pneumonitis.
This statement identifies gaps in knowledge and develops potential research questions to further expand knowledge regarding risk, biologic mechanisms, clinical and radiologic presentation, and management of ICI-pneumonitis.
Gaps in knowledge of the basic biological mechanisms of ICI-pneumonitis, coupled with a precipitous increase in the use of ICIs alone or combined with other therapies, highlight the importance in triaging research priorities for ICI-pneumonitis.
Lung cancer screening (LCS) has the potential to reduce the risk of lung cancer death in healthy individuals, but the impact of coexisting chronic illnesses on LCS outcomes has not been well defined. ...Consideration of the complex relationship between baseline risk of lung cancer, treatment-related harms, and risk of death from competing causes is crucial in determining the balance of benefits and harms of LCS.
To summarize evidence, identify knowledge and research gaps, prioritize topics, and propose methods for future research on how best to incorporate comorbidities in making decisions regarding LCS.
A multidisciplinary group of international clinicians and researchers reviewed available data on the effects of comorbidities on LCS outcomes, focusing on the juxtaposition of lung cancer risk and competing risks of death, consideration of benefits and risks in patients with chronic obstructive pulmonary disease, communication of risk, and treatment of screen-detected lung cancer.
This statement identifies gaps in knowledge regarding how comorbidities and competing causes of death impact outcomes in LCS, and we have developed questions to help guide future research efforts to better inform patient selection, education, and implementation of LCS.
There is an urgent need for further research that can help guide clinical decision-making with patients who may not benefit from LCS owing to coexisting chronic illness. This statement establishes a research framework to address essential questions regarding how to incorporate and communicate risks of comorbidities into patient selection and decisions regarding LCS.
Patients with a prior history of cancer (PHC) are at increased risk of second primary malignancy, of which lung cancer is the most common. We compared the performance metrics of positive screening ...rates and cancer detection rates (CDRs) among those with versus without PHC.
We conducted a secondary analysis of 26,366 National Lung Screening Trial participants screened with low dose computed tomography between August 2002 and September 2007. We evaluated absolute rates and age-adjusted relative risks (RRs) of positive screening rates on the basis of retrospective Lung CT Screening Reporting & Data System (Lung-RADS) application, invasive diagnostic procedure rate, complication rate, and CDR in those with versus without PHC using a binary logistic regression model using Firth’s penalized likelihood. We also compared cancer type, stage, and treatment in those with versus without PHC.
A total of 4.1% (n = 1071) of patients had PHC. Age-adjusted rates of positive findings were similar in those with versus without PHC (Baseline: PHC = 13.7% versus no PHC = 13.3%, RR 95% confidence interval (CI): 1.04 0.88–1.24; Subsequent: PHC = 5.6% versus no PHC = 5.5%, RR 95% CI: 1.02 0.84–1.23). Age-adjusted CDRs were higher in those with versus without PHC on baseline (PHC=1.9% versus no PHC = 0.8%, RR 95% CI: 2.51 1.67–3.81) but not on subsequent screenings (PHC = 0.6% versus no PHC = 0.4%, RR 95% CI: 1.37 0.99–1.93). There were no differences in cancer stage, type, or treatment by PHC status.
Patients with PHC may benefit from lung cancer screening, and with their providers, should be made aware of the possibility of higher cancer detection, invasive procedures, and complication rates on baseline lung cancer screening, but not on subsequent low dose computed tomography screening examinations.
The US Preventive Services Task Force (USPSTF) 2021 updated recommendations on lung cancer screening with chest computed tomography to apply to individuals 50-80 years of age (previously 55-80 ...years), with a ≥20 pack-year history (previously ≥30), whether currently smoking or quit ≤15 years ago. Despite being at higher risk for lung cancer, persons with HIV (PWH) were not well-represented in the National Lung Screening Trial, which informed the USPSTF 2013 recommendations. It is unknown or unclear how PWH are affected by the 2021 recommendations.
This study was a retrospective analysis of PWH with and without lung cancer in the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study.
We identified PWH, ages 40-80 years, who currently or previously smoked, with (cases) and without lung cancer (noncases). The sensitivity and specificity of the old, new, and alternative screening criteria were evaluated in each cohort.
We identified 52 women and 19 men with lung cancer and 1950 women and 1599 men without lung cancer. Only 11 women (22%) and 6 men (32%) with lung cancer met 2013 screening criteria; however, more women (22; 44%) and men (12; 63%) met 2021 criteria. Decreased age and tobacco exposure thresholds in women further increased sensitivity of the 2021 criteria.
The 2021 USPSTF lung cancer screening recommendations would have resulted in more PWH with lung cancer being eligible for screening at the time of their diagnosis. Further investigation is needed to determine optimal screening criteria for PWH, particularly in women.
Early detection using low-dose computed tomography scanning reduces lung cancer-specific mortality by 20% among high-risk individuals. Despite its efficacy, the uptake of lung cancer screening (LCS) ...remains low. This study aimed to identify factors associated with the uptake of LCS in high-risk individuals. Data for this study were obtained from the Behavioral Risk Factor Surveillance System (n=11,297). Multivariable logistic regression models were used. Individuals with no health insurance (OR: 0.33, 95% CI: 0.19-0.58), no primary health care provider (OR: 0.40, 95% CI: 0.25-0.64), no chronic obstructive pulmonary disease (OR: 0.37, 95% CI: 0.28- 0.49), and racial/ethnic minorities other than Black and Hispanic (OR: 0.49, 95% CI: 0.31-0.78) were less likely to participate in annual LCS. Low-dose computed tomography uptake varied widely across the 24 U.S. states. The findings from this study have important implications for designing more effective interventions to target specific U.S. states and subgroups for the uptake of annual LCS.
One of the principal etiological agents associated with losses in horticultural crops is the fungus Colletotrichum sp. This study aimed to evaluate the in vitro effectiveness of the essential oil ...(EO) from Cymbopogon citratus in chitosan supports for the control of Colletotrichum gloeosporioides isolated from sweet pepper plants. Methods: The extraction and phytochemical analysis of the EO of C. citratus were performed along with its encapsulation in chitosan-agar in order to compare it with other techniques and determine its effect on C. gloeosporioides. Results: The EO from the citral chemotype (58%) encapsulated in the chitosan-agar, with an 83% encapsulation efficiency in mass percentage, resulted in the total inhibition of mycelial growth at a minimum inhibitory concentration of 1370 ppm. This concentration was effective in controlling the disease under greenhouse conditions. The effectivity of the capsules containing EO was superior to that of other controls using EO evaluated in vitro. The capsules demonstrated an effective period of 51 days, with an additional 30 days of effectiveness after a reinfection cycle, thus providing similar results to the control with Trichoderma sp. Conclusions: Chitosan capsules present a promising strategy in the use of C. citratus EO on C. gloeosporioides, and they are highly effective and stable under in vitro and field conditions
World Lung Day provides an opportunity for the respiratory community to reflect on the devastating impact of chronic respiratory diseases (CRDs) such as asthma, tuberculosis, and lung cancer. These ...diseases continue to be the leading causes of disability and death worldwide. As a cancer pulmonologist, Rivera has witnessed the devastating consequences of lung cancer on patients and their families. It is the second most common and deadliest cancer in the US. Each year, lung cancer claims more lives than colon, breast, and prostate cancers combined. On this day, as a global respiratory community, they must take action to promote lung health as a fundamental human right. The American Thoracic Society (ATS), as a founding member of the Forum of International Respiratory Societies, is raising awareness and addressing the disproportionate burden of lung disease on low- and middle-income countries. Through advocacy, collaboration, and education, they strive to improve global health outcomes and address the social and environmental determinants of health, including tobacco use and climate change.
Halving the proportion of the people without sustainable access to safe drinking water and basic sanitation is among the Sustainable Development Goals (SDG). Lack of access to safe drinking water has ...been associated with the prevalence of waterborne diseases. Due to this reported association, the development of household water treatment devices has been an alternative to improve the quality supply of domestic water. In this study, we aimed to evaluate the performance of a ceramic silver-impregnated pot filter (CSF) system coupled with an adsorption process, composed of silver-impregnated granular activated carbon and zeolite (CSF + GAC-Z), to remove waterborne bacteria Escherichia coli and Salmonella spp. from spiked water. The performance of this system was compared with the conventional CSF system. In this respect, we evaluated six CSF and six CSF + GAC-Z using spiked water with 10
and 10
CFU/mL of E. coli and Salmonella spp. The mean percentage of removals ranged between 98% and 99.98%. The highest bacterial removal efficiency was recorded by the CSF + GAC-Z (99%) and CSF (99.98%) for E. coli and Salmonella spp., respectively, but no significant statistical differences were found between filtration systems. Our findings suggest that the CSF + GAC-Z system was effective in the removal of waterborne bacteria from spiked water.
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