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NSCLC Incidence Declining, Except in Stage I Disease

The overall incidence of non-small cell lung cancer (NSCLC) decreased from 2010 to 2017, with the incidence of stage IV disease falling, and stage I disease rising, researchers determined.

A cross-sectional epidemiological analysis showed that NSCLC incidence per 100,000 population declined from 46.4 to 40.9 during the study period. While the incidence of stage II, IIIA, and IIIB disease was stable, stage IV disease decreased from 21.7 to 19.6, and stage I disease increased from 10.8 to 13.2, reported Apar Kishor Ganti, MD, of the University of Nebraska Medical Center in Omaha, and colleagues.

NSCLC prevalence per 100,000 grew from 175.3 to 198.3 overall, increasing in younger patients (77.5 to 87.9) and falling in older patients (825.1 to 812.4), they noted in JAMA Oncology. The authors posited that the rising prevalence of the disease in the face of an overall decline in incidence suggests that people are generally living longer after diagnosis.

“One possible explanation for the increase in patients diagnosed with stage I NSCLC may be the increase in screening after publication of the National Lung Screening Trial (NLST) in 2011 and U.S. Preventive Services Task Force in 2013,” Ganti and team wrote.

“It is possible that awareness of the benefits of lung cancer screening after the publication of the NLST results in 2011 may have led to better follow-up of patients identified as having incidental pulmonary nodules and therefore diagnosed with lung cancer at an earlier stage,” they suggested.

“Now is the time for a concerted push for lung cancer screening implementation,” commented James L. Mulshine, MD, of Rush University Medical Center in Chicago, and Bruce Pyenson, FSA, MAAA, of Milliman, Inc. in New York City, in an accompanying editorial. “The numerous improvements in lung cancer screening since the NLST, ranging from underlying technologies to intervention management to patient support, mean the screening process will likely be even more beneficial than in the past trials.”

The 5-year period survival estimate for the NSCLC population was 26.4%, which was higher than previously published period estimates, which the authors said could be explained by “improvements in treatment and/or earlier treatment with earlier diagnosis.”

The overall incidence of NSCLC decreased from 15.5 to 13.5 per 100,000 in people younger than 65, and from 259.9 to 230.0 for those 65 and older. Incidence also decreased in both sexes — from 56 to 46.5 per 100,000 for men, and from 39.1 to 36.6 for women.

The absolute increase in stage I disease incidence was greater among patients ages 65 and older (60.3 to 64.2 per 100,000 vs 3.32 to 3.72 per 100,000 in patients <65), although the relative increases in stage I NSCLC incidence were higher among the younger patients (12% vs 6.6%). Greater absolute and relative reductions in the incidence of stage IV NSCLC were observed in older patients (108.6 to 85.5 per 100,000, a change of -27%) compared with the younger patients (8.7 to 7.4 per 100,000, a change of -17.6%).

In this study, Ganti and colleagues used the most recent published data from U.S. cancer registries (through 2017 in the case of incidence data, and 2016 for some other parameters), and found that there were 1.28 million new NSCLC cases recorded in the U.S. during the study period of 2010 to 2017 (53% men, 67% ≥65 years).

The authors noted that despite the increasing availability of better treatments for NSCLC, almost a quarter of NSCLC patients were categorized as receiving no treatment, most commonly patients 65 and older, and those with stage IV disease.

“Although concerning, these findings are not surprising, as previous studies in early-stage disease have shown that older individuals are not offered adjuvant chemotherapy after surgical resection, even though the magnitude of benefit with such treatment was the same as in younger adults,” wrote Ganti and team. “The reasons for this should be studied further.”

They acknowledged that the retrospective nature of their study was a limitation, as was the fact that certain data were only available through 2016.

  • Mike Bassett is a staff writer focusing on oncology and hematology. He is based in Massachusetts.

Disclosures

This study was funded by AstraZeneca.

Ganti is a consultant for AstraZeneca, Genentech, and Flagship Biosciences, has served on advisory boards for AstraZeneca, Blueprint Medicines, Jazz Pharmaceuticals, Cardinal Health, Mirati Therapeutics, and G1 Therapeutics, and receives research support from Takeda and Oncoceutics.

The other co-authors have been employees of and shareholders in AstraZeneca.

Pyenson reported serving as a commissioner on the Medicare Payment Advisory Commission outside the submitted work. Mulshine reported no disclosures.

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Source: MedicalNewsToday.com