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

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

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

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

5. PET & MRI

6. 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

7. Some do sputum Doctors are very negative about the process

8. 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

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

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

11. Biomarkers Breath – Sensitivity: 67-100% : 3 – Specificity: 83-100% : 4 – Invasiveness: 5 – Risk: 5 – Practicality: 3  26/30

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

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