Evaluation of Current Data suggests current screening does not work -high mortality rate -x-rays, sputum ineffective

Physical exam Physical exam is useful for determining risk but is ineffective for screening in early stages due to lack in symptoms

CT scans For majority of patients, ct scan haven’t been proven effective

Bronchoscopy and biopsy Methods are very invasive and are used primarily for detection

PET & MRI

Screening procedures Basically no screening done Patients walks in and are assessed for risk Smoker (10 packs a year), occupation, family history If patient is high risk, some will do x-rays, other will wait for symptoms CT scans are followed by x-rays, if anything found --> biopsy/treatment

Some do sputum Doctors are very negative about the process

Suggestions for current -Regular CT for high risk 55+ in age with 30/ packs a year (NLST)  mathematical modeling available soon Eliminate x-rays -Adding a PET to a CT when available -Cell block and smear when using sputum cytology -Low-dose spiral ct scan

For other high risk, biannual ct scan For all high risk eliminate x-rays completely Look up AFB/WBI*

Grading scale for the future (high risk) Sensitivity (1-2) Specificity (1-2) Invasiveness (1) Risk (1) Practicality (1) Implementation (1)

Biomarkers Breath – Sensitivity: % : 3 – Specificity: % : 4 – Invasiveness: 5 – Risk: 5 – Practicality: 3  26/30

Biomarkers continued….. Protein blood (aptamer) – Sensitivity 91% : 5 – Specificity 84%: 4 – Invasiveness: 4 – Risk: 5 – Practicality: 5 – Implementation: 5  28/30

…continued…. miRNA (serum based) main/validated – Sensitivity 82/92.5: – Specififcty 77/08: – Invasiveness : 4/ – Risk: 5/ – Practicality: 5/ – Implementation: 4/