The Future of Lung Cancer Screening

James L. Mulshine, MD, talks about what the future holds vis-a-vis advancements in lung cancer screening.

Transcript:

James L. Mulshine, MD: I'm James Mulshine. I'm a thoracic medical oncologist from Rush University in Chicago. I'm involved with a variety of activities associated with development of lung cancer screening.

I was asked to talk at this meeting about innovations in this space. We talked about where the field of lung cancer screening is going to continue to improve the efficiency of the diagnostic workup as well as to try to develop and introduce techniques for automated image analysis and automated image sizing of lesions so that appropriate clinical management can be done.

This is really important because we're talking about introducing screening to large segments of the population, and there's real workflow issues. If this can be offset with the introduction of effective software tools to facilitate radiological management of screening, it'd be a very good and exciting things.

People are looking into this. The Quantitative Imaging Biomarkers Alliance of the Radiological Society of North America has been working on this area for about last 10 years. They've published guidelines. Their guidelines have demonstrated that if you take a structured approach to this, you can reduce the amount of variance and measurement of nodules in a very significant way.

I shouldn't say significant because it hasn't been shown statistically but in a very marked way. These are simple measures that if adhered to, can reduce the sub-optimal characterization of the small nodules in a marked way.

The small nodules that are relevant in screening are on the order of 5 millimeters to 10 millimeters, 12 millimeters. That's a size that we've never routinely measured in clinical practice before. This involves a certain amount of validation and quality control that we're not used to.

It's a very parallel challenge as to what is being seen right now with molecular pathology. We've had a lot of presentations in this meeting about the importance of those characterization issues in molecular pathology and trying to get very tightly standardized results so that clinical management could be done responsibly. We have the same issues in quantitative imaging of CT results.

People are working on this in a responsible fashion. Like I said, the Radiological Society of North America is doing this. There's strong involvement from the NIH, NCI, FDA and moving forward with these approaches. It's something that's happening and it's something that will be a part of software analysis of these images going forward.

It's important, as medical oncologists, we understand these things because measuring the small changes in these early lung cancers is being used for detection right now. In the not too distant future, this will be an integral part of the efforts that we're hearing about today in terms of the development of new adjuvant chemotherapy approaches to enhance curability in this early disease setting.

It's going to be part of our lives moving forward.