Decision analysis of the effectiveness of lung cancer screening using autofluorescence bronchoscopy and computed tomography

Background: Lung cancer (LC) is the leading cause of cancer death in the developed world. Most cancers are associated with tobacco smoking. A primary hope for reducing lung cancer has been prevention of smoking and successful smoking cessation programs. To date, these programs have not been as successful as anticipated. Objective: The aim of the current study was to evaluate whether lung cancer screening combining low dose computed tomography with autofluorescence bronchoscopy (combined CT & AFB) is superior to CT or AFB screening alone in improving lung cancer specific survival. In addition, the extent of improvement and ideal conditions for combined CT & AFB screening were evaluated. Methods: We applied decision analysis and Monte Carlo simulation modeling using TreeAge Software to evaluate our study aims. Histology- and stage specific probabilities of lung cancer 5-year survival proportions were taken from Surveillance and Epidemiologic End Results (SEER) Registry data. Screeningassociated data was taken from the US NCI Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), National Lung Screening Trial (NLST), and US NCI Lung Screening Study (LSS), other relevant published data and expert opinion. Results: Decision Analysis - Combined CT and AFB was the best approach at Improving 5-year survival (Overall Expected Survival (OES) in the entire screened population was 0.9863) and in lung cancer patients only (Lung Cancer Specific Expected Survival (LOSES) was 0.3256). Combined screening was slightly better than CT screening alone (OES = 0.9859; LCSES = 0.2966), and substantially better than AFB screening alone (OES = 0.9842; LCSES = 0.2124), which was considerably better than no screening (OES = 0.9829; LCSES = 0.1445). Monte Carlo simulation modeling revealed that expected survival in the screened population and lung cancer patients is highest when screened using CT and combined CT and AFB. CT alone and combined screening was substantially better than AFB screening alone or no screening. For LCSES, combined CT and AFB screening is significantly better than CT alone (0.3126 vs. 0.2938, p< 0.0001). Conclusions: Overall, these analyses suggest that combined CT and AFB is slightly better than CT alone at improving lung cancer survival, and both approaches are substantially better than AFB screening alone or no screening.

James J. Campbell and Dr. Arthur Flint outside Hashinger Hall

James J. Campbell [right], director of the Chapman College Residence Education Center at the El Toro Marine Corps Air Station, discusses the college's new science scholarship program with Dr. Arthur Flint, chairman of the Chapman Division of Natural Sciences, in front of the new science center, Hashinger Hall, Chapman College, 346 N. Center Street, Orange, California. The late Dr. Edward H. Hashinger, former trustee and past chairman of the board is the man whose name has graced the walls of this building since 1969. The Hashinger Science Center (3 floors, 65,364 sq.ft.) houses all science departments including biology, natural and applied sciences, environmental and chemical sciences, food science and nutrition, kinesiology and physical therapy.

Newly repainted signage, Student Union [old], Chapman College, Orange, California

Newly repainted signage on the Old Student Union, Chapman College, Orange, California; part of a campus renewal project in 1973. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Lounge area of the old Student Union, Chapman College, Orange, California

Lounge area of the old Student Union, Chapman College, Orange, California. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Lounge area of the old Student Union, Chapman College, Orange, California

Lounge area of the old Student Union, Chapman College, Orange, California. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Outside the old student union, Chapman College, Orange, California

Old Student Union, Chapman College, Orange, California. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Old Student Union patio, Chapman College, Orange, California

Old Student Union patio, Chapman College, Orange, California. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Snack bar inside the old Student Union, Chapman College, Orange, California

Snack bar inside the old Student Union, Chapman College, Orange, California in the 1970s. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Patio area of old Student Union, Chapman College, Orange, California

Patio area of old Student Union, Chapman College, Orange, California. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Patio area of the old Student Union, Chapman College, Orange, California

Patio area of the old Student Union, Chapman College, Orange, California. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Hungrey Panther entrance at the old Student Union, Chapman College, Orange, California

Hungrey Panther entrance at the old Student Union, Chapman College, Orange, California. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Old Student Union patio remodel, Chapman College, Orange, California

Old Student Union patio remodel in progress, Chapman College, Orange, California. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Old Student Union patio remodel, Chapman College, Orange, California

Old Student Union patio remodel in progress, Chapman College, Orange, California, 1973. Signage on building also part of the campus renewal. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Renovating the old Student Union patio, Chapman College, Orange, California

Renovating the old Student Union patio, Chapman College, Orange, California, 1973. The Australian tea trees were moved from the music building site. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.

Renovating the old Student Union patio, Chapman College, Orange, California, 1973

Renovating the old Student Union patio, Chapman College, Orange, California, 1973. The Australian tea trees were moved from the music building site. Originally the manual arts building and bus repair garage for Orange Union High School. Building annex additions through 1975 increased the size to 19,680 sq. ft. Used as a student union by Chapman College. In 1996 the building became the Cecil B. DeMille Hall, housing the Film and TV department.