Respiratory Cancers

LungScreen WA

An early lung cancer in an ex-smoker detected on ultra-low dose CT

LungScreen WA

When lung cancer is caught at an early stage it’s potentially curable. The aim of LungScreen WA is to improve and develop ways of finding lung cancer when it is in this early stage.

There is great promise in screening for early lung cancer using low dose CT scans, but before it will be adopted more widely, there are many questions that need to be answered.

These are just some of the questions and work that the LungScreen WA team are working on.

What is the best way to find out who is at high risk of lung cancer?
Screening for early lung cancer is only effective when we screen high-risk people.

How can we best describe and communicate about the risks and benefits of screening for early lung cancer?
There is a fine balance of potential risk and benefit and people need to be aware of the pros and cons of screening.

When something abnormal is found on a CT scan, what is the chance that it is cancer?
How can we best predict this? Abnormalities on CT scans are very common, but most are not cancer – we are testing a new way to help doctors decide what to do with the scan results.

Leaning about what doctors think and understand about screening for early lung cancer.
If lung cancer screening is going to work, we need to know what GPs and other doctors know and think so they can offer the best service for patients.

Can computer software automatically detect early lung cancer on CT scans?
It takes a long time for specialists to report CT scans and a reliable computer program might be very helpful.

How best to recruit people to a screening program for lung cancer?
Most screening programs are quite simple to get people involved, screening for early lung cancer is a lot more complicated because most people have a low risk of lung cancer and don’t need screening.

Asbestos exposure and the risk of lung cancer 
In WA, asbestos use has been widespread and we are running a project to screen people who have been exposed and learn more as to who is at raised risk for lung cancer.

After surgery for lung cancer – what is the best way to follow patients up?
Currently follow up is based in specialist hospitals with multiple CT scans – this may not be the best or most preferred way.

Optimising the lowest dose from a CT scan
While the dose of radiation from a modern CT scanner is now very small, we are constantly trying to find ways of lowering the dose, while, still being able to see any important changes on the CT scan.


Pilot Study

Between 2015-2017 we ran a small test project to better understand some of the challenges for screening for early lung cancer using LDCT. All the scans were performed in community radiology centres (i.e. not in busy hospitals). We also tested different ways of choosing who is at risk of lung cancer (and therefore should get a LDCT), and also a different way of following up repeat CT scans using a protocol to guide decisions.

From nearly 50 people taking part, we found that we can use a telephone-based risk questionnaire effectively, we found (and treated) several early lung cancers (meaning the risk-test worked well) and all participants were followed up very well using the protocol.

The results of this study will help inform policy making within WA and Australia. A similar approach is being further tested in the big international lung screen trial (ILST), that we are also part of.

LungScreen WA team     

A/Prof Fraser Brims, Co-Principle Investigator

Dr Annette McWilliams

Dr Annette McWilliams, Co-Principle Investigator

 

 

Dr Conor Murray

Dr Conor Murray, Research Fellow

 

Dr Dave Manners

Dr Dave Manners, Research Fellow

  • Jacqui Logan, ILST Study Manager for WA
  • Siobhan Dormer, Research Nurse
  • Dr Kuan P Lim, Research Fellow
  • Dr Ed Harris, Research Fellow


Recent Publications

  • Annette McWilliams, Fraser Brims, Nanda Horeweg, Harry de Koning, James Jet. Lung Cancer Screening (chapter 7). International Association for the Study of Lung Cancer, Thoracic Oncology Textbook, 2nd Edition, 2017.
  • Manners, D., Wong, P., Murray, C., Teh, J., Kwok, Y. J., de Klerk, N., . . . Brims, F. J. H. (2017). Correlation of ultra-low dose chest CT findings with physiologic measures of asbestosis. EUROPEAN RADIOLOGY, 27(8), 3485-3490. doi:10.1007/s00330-016-4722-7
  • Brims, F. J. H. (2017). Integrated care for resected early stage lung cancer: innovations and exploring patient needs. BMJ Open Respiratory Research, 4, e000175. doi:10.1136/bmjresp-2016-000175
  • Weber, M., Yap, S., Goldsbury, D., Manners, D., Tammemagi, M., Marshall, H., . . . Canfell, K. (2017). Identifying high risk individuals for targeted lung cancer screening: Independent validation of the PLCO m2012 risk prediction tool. International Journal of Cancer, 141(2), 242-253. doi:10.1002/ijc.30673
  • Murray, C. P., Wong, P. M., Teh, J., de Klerk, N., Rosenow, T., Alfonso, H., . . . Brims, F. J. H. (2016). Ultra low dose CT screen-detected non-malignant incidental findings in the Western Australian Asbestos Review Programme. Respirology, 21(8), 1419-1424. doi:10.1111/resp.12826
  • Manners, D., Hui, J., Hunter, M., James, A., Knuiman, M. W., McWilliams, A., . . . Brims, F. J. H. (2016). Estimating eligibility for lung cancer screening in an Australian cohort, including the effect of spirometry. Medical Journal of Australia, 204(11), 406.e1-406.e6. doi:10.5694/mja16.00043
  • Manners, D., Emery, J., Brims, F. J., & Pettigrew, S. (2016). Lung cancer screening – Practical challenges of confining participation to those who might benefit. Australian and New Zealand Journal of Public Health, 40(3), 205-206. doi:10.1111/1753-6405.12516
  • Brims, F., McWilliams, A., & Fong, K. (2016). Lung cancer screening in Australia: Progress or procrastination?: There is progress internationally with lung cancer screening but far slower headway in Australia. Medical Journal of Australia, 204(1), 4-4.e1. doi:10.5694/mja15.01109
  • Manners, D., Emery, J., Brims, F., & Pettigrew, S. F. (2016). Lung Cancer Screening – Policy challenges of confining participation to those that might benefit. Australian and New Zealand Journal of Public Health, 40(3), 205-206. doi:10.1111/1753-6405.12516
  • Brims, F. J. H., Murray, C. P., De Klerk, N., Alfonso, H., Reid, A., Manners, D., . . . Musk, A. W. (2015). Ultra-low-dose chest computer tomography screening of an asbestos-exposed population in Western Australia. American Journal of Respiratory and Critical Care Medicine, 191(1), 113-116.
  • Brims, F., Musk, B., Reid, A., Pang, S. C., Franklin, P., Peters, S., & De Klerk, N. (2015). Presence of pleural plaques and/or asbestosis and the risk of lung cancer in a Crocidolite asbestos exposed population from Western Australia. In Journal of Thoracic Oncology Vol. 10 (pp. S613).
  • McWilliams A, Tammemagi M, Mayo JR, Lam S, Roberts H, Liu G et al. Malignancy risk of pulmonary nodules detected on first screening CT. NEJM, 2013; 369:910-919.
  • Cressman S, Lam S, Tammemagi M, Evans W, Leighl N, Regier D, Bolbocean C, Shepherd F, Tsao MS, Manos D, Liu G, Atkar-Khattra S, Cromwell I, Johnson M, Mayo J, McWilliams A, Couture C, English J, Goffin J, Hwang D, Puksa S, Roberts H, Tremblay A, MacEachern P, Burrowes P, Bhatia R, Finley R, Goss G, Nicholas G, Seely J, Sekhon H, Yee J, Amjadi K, Cutz JC, Ionescu D, Yasufuku K, Martel S, Soghrati K, Sin D, Tan W, Urbanski S, Xu Z, Peacock S. On behalf of the Pan-Canadian Early Detection of Lung Cancer Study Team. Resource Utilisation and Costs during the Initial Years of Lung Cancer Screening with Computed Tomography In Canada. JTO, 2014;9(10):1449-1458.
  • McWilliams A, Beigi P, Srinidhi A, Lam S, MacAulay C. Sex and Smoking Status Effects on the Early Detection of Early Lung Cancer in High-Risk Smokers using an Electronic Nose. IEEE Transactions on Biomedical Engineering, 2015;62(8):2044-2054. DOI: 10.1109/TBME.2015.2409092
  • McWilliams A. Does AQuIRE challenge the role of navigational bronchoscopy for peripheral pulmonary lesions? Ann Tranl Med, 2016;4(20):406.

LungScreen WA was last modified: January 23rd, 2018 by Sarah Cermak

LungScreen WA was last modified: January 23rd, 2018 by Sarah Cermak