This report describes and contextualizes the high prevalence of mental health conditions (MHC) among Minnesota 2019 EVALI patients by examining the prevalence of MHC and associations between MHC and e-cigarette or vaping product (EVP) use in Minnesota population surveys. Investigators reviewed medical records for 140 EVALI patients to determine history of MHC. History of MHC and EVP use in the general population was estimated using self-reported measures and screening tools from two population-based surveys, the 2019 Minnesota Student Survey (MSS) and the 2018 Minnesota Behavioral Risk Factor Surveillance Survey (MN-BRFSS). Some 64.3% of EVALI patients had an MHC. In both Minnesota population surveys, MHCs were common among people who used EVP. The odds of MHC among youth aged <18 were higher among those who reported current EVP use compared with those did not report EVP use. Similarly, the odds of depression were higher among adults who reported current EVP use compared with those who did not. Clinicians treating patients with EVALI should consider evaluating the need for, and providing indicated referrals to, post-discharge mental health services for their patients.
The National Lung Screening Trial (NLST) in the United States was the first adequately powered randomized lung cancer screening trial that showed a significant 20% reduction in lung cancer mortality using low dose computed tomography (LDCT) versus standard chest X-ray. The trial studied 53,454 individuals between the ages of 55 to 74 years who smoked 30 pack-years or more and smoked within the past 15 years and recently published the extended follow-up results after a median follow-up of 12.3 years. The study confirmed LDCT screening does not just prolong the time of death from cancer, it prevents lung cancer deaths in a substantial proportion of those screened. The over-diagnosis rate is estimated to be only 3%. The benefit of LDCT screening was greater for those between the ages of 55 to 64 years than those who were older. The mortality reduction benefits became diluted with time suggesting more than 2 rounds of annual surveillance screening is needed. The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4,099 participants to a screening arm or control arm without intervention. The benefit of LDCT screening was not observed until after the fifth year of screening, with a 58% reduced risk of lung cancer mortality (HR 0.42; 95% CI 0.22–0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49–0.94). In September of 2018, the results of the second largest randomized trial was presented at the World Conference on Lung Cancer (WCLC 2019). The Dutch-Belgian NELSON trial compared LDCT vs no screening in 15,822 people between the age of 50 to 74 years who smoked an average of at least 15 cigarettes per day for 25 years or at least 10 cigarettes per day for 30 years or more and have smoked within 10 years. The study found a 24% and 33% reduction in lung cancer deaths in men and in women respectively. The greater mortality reduction benefit of LDCT screening in women compared to men was also observed in the randomized German LUSI trial with a similar trend in NLST in univariate analysis. Other studies addressed the issues of implementation at the population level such as how to report large number of screening LDCT efficiently, consistently and accurately as well as personalizing the frequency of surveillance screening using deep learning (a form of artificial intelligence). The Google team reported an automated method to replicate the radiologist workflow to read screening LDCT without human input or assistance. The deep learning algorithm equaled or out-performed radiologist readings with a 94.4% area under the curve performance. When prior CT imaging was not available, the model outperformed all six radiologists in the study with absolute reductions of 11% in false positives and 5% in false negatives. Another deep learning prediction algorithm was reported by an AmericanCanadian team that can estimate an individual’s 3-year risk of lung cancer instead of 1-year risk in the Google study to guide the frequency of surveillance screening LDCT. Using universally available nodule and non-nodule features without computer-aided diagnostic tools, the algorithm identified 10% of the screening population who may benefit from prompt diagnostic workup for a biologically aggressive tumor and 55% of individuals with a very low 2-year risk for lung cancer who could safely undergo the next scheduled screening CT in 2 years instead of annually. The key messages of these publications are: Screening of high-risk smokers with LDCT significantly reduces lung cancer mortality. In contrast to research studies that are limited by the duration of the research grant, organized populationbased screening programs should have more than 2 or 3 rounds of surveillance screening to maintain the benefits of screening. Promising technological advances are available that can change how cancer screening is done. Unfortunately, despite solid scientific evidence that LDCT screening can improve the dismal outcome of lung cancer patients, no Canadian province/territory has implemented large scale lung cancer screening. Considerable advances have also been made in identification of new targetable driver pathways, better treatment options for known targets as well as immunotherapy for tumors without druggable targets in patients with advanced lung cancer to improve progression free survival (PFS) and overall survival (OS).
The National Lung Screening Trial (NLST) in the United States was the first adequately powered randomized lung cancer screening trial that showed a significant 20% reduction in lung cancer mortality using low dose computed tomography (LDCT) versus standard chest X-ray. The trial studied 53,454 individuals between the ages of 55 to 74 years who smoked 30 pack-years or more and smoked within the past 15 years and recently published the extended follow-up results after a median follow-up of 12.3 years. The study confirmed LDCT screening does not just prolong the time of death from cancer, it prevents lung cancer deaths in a substantial proportion of those screened. The over-diagnosis rate is estimated to be only 3%. The benefit of LDCT screening was greater for those between the ages of 55 to 64 years than those who were older. The mortality reduction benefits became diluted with time suggesting more than 2 rounds of annual surveillance screening is needed. The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4,099 participants to a screening arm or control arm without intervention. The benefit of LDCT screening was not observed until after the fifth year of screening, with a 58% reduced risk of lung cancer mortality (HR 0.42; 95% CI 0.22–0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49–0.94). In September of 2018, the results of the second largest randomized trial was presented at the World Conference on Lung Cancer (WCLC 2019). The Dutch-Belgian NELSON trial compared LDCT vs no screening in 15,822 people between the age of 50 to 74 years who smoked an average of at least 15 cigarettes per day for 25 years or at least 10 cigarettes per day for 30 years or more and have smoked within 10 years. The study found a 24% and 33% reduction in lung cancer deaths in men and in women respectively. The greater mortality reduction benefit of LDCT screening in women compared to men was also observed in the randomized German LUSI trial with a similar trend in NLST in univariate analysis. Other studies addressed the issues of implementation at the population level such as how to report large number of screening LDCT efficiently, consistently and accurately as well as personalizing the frequency of surveillance screening using deep learning (a form of artificial intelligence). The Google team reported an automated method to replicate the radiologist workflow to read screening LDCT without human input or assistance. The deep learning algorithm equaled or out-performed radiologist readings with a 94.4% area under the curve performance. When prior CT imaging was not available, the model outperformed all six radiologists in the study with absolute reductions of 11% in false positives and 5% in false negatives. Another deep learning prediction algorithm was reported by an AmericanCanadian team that can estimate an individual’s 3-year risk of lung cancer instead of 1-year risk in the Google study to guide the frequency of surveillance screening LDCT. Using universally available nodule and non-nodule features without computer-aided diagnostic tools, the algorithm identified 10% of the screening population who may benefit from prompt diagnostic workup for a biologically aggressive tumor and 55% of individuals with a very low 2-year risk for lung cancer who could safely undergo the next scheduled screening CT in 2 years instead of annually. The key messages of these publications are: Screening of high-risk smokers with LDCT significantly reduces lung cancer mortality. In contrast to research studies that are limited by the duration of the research grant, organized populationbased screening programs should have more than 2 or 3 rounds of surveillance screening to maintain the benefits of screening. Promising technological advances are available that can change how cancer screening is done. Unfortunately, despite solid scientific evidence that LDCT screening can improve the dismal outcome of lung cancer patients, no Canadian province/territory has implemented large scale lung cancer screening. Considerable advances have also been made in identification of new targetable driver pathways, better treatment options for known targets as well as immunotherapy for tumors without druggable targets in patients with advanced lung cancer to improve progression free survival (PFS) and overall survival (OS).
