The first ever actuarial analysis of lung cancer mortality, published today in Population Health Management Journal, provides strong evidence that earlier detection could reduce the number of late stage lung cancer deaths by over 70,000 people each year in the US.
Calling the number "profound," Lung Cancer Alliance (LCA) President Laurie Fenton-Ambrose said, "This would be the equivalent of eliminating all deaths from breast and prostate cancer each year. It clearly demonstrates why we must make research and development of earlier detection tools for lung cancer a public health priority."
The study was carried out by Milliman Inc., an internationally renowned actuarial firm, and commissioned by Lung Cancer Alliance, the American Legacy Foundation, the Bonnie J. Addario Lung Cancer Foundation, Joan's Legacy Foundation, Lungevity Foundation, the Prevent Cancer Foundation and the Thomas G. LaBrecque Foundation.
Bruce S. Pyenson, FSA, one of the co-authors of the study said, "We found that higher stage at diagnosis was profoundly associated with higher all-cause mortality and lower stage at diagnosis had profoundly lower all-cause mortality."
"Our reporting all-cause mortality is perhaps more relevant to patients than the more common disease-specific survival or 5-year survival, as patients probably are more concerned about overall survival, not whether they face death from cancer, treatment side-effects, or something else," he noted.
The study analyzed detailed records of over 241,000 lung cancer patients diagnosed and treated between 1988 and 2003 from the Surveillance, Epidemiology and End Results (SEER) database of the National Cancer Institute.
Mortality rates from those records were compared to demographically- and year-adjusted standard national mortality rates to develop "load" mortality ratios. These show the added mortality burden that treated lung cancer brings to patients, and how that burden dramatically increases by stage.
Using actuarial techniques honed over the past 100 years to set insurance premium rates based on age, sex and other factors such as smoking, the ratios were then used to predict what would happen to the 160,000 people diagnosed with late stage lung cancer (Stages III A, IIIB and IV) in 2007.
According to the analysis, only 8600 will still be alive in 2012.
However, the analysis shows if those same people were to have their cancers detected and treated as early stage lung cancers a year or two before 2007, over 75,000 additional persons would be alive in 2012.
James L. Mulshine, MD, Vice President for Research at Rush University Medical Center and a co-author of the study said: "This robust finding reinforces the urgent need to support research directed at better diagnostic approaches to consistently find early lung cancer as a near-term strategy to improve lung cancer outcomes."
"Another really useful finding is that our methodology allows testing of various biases, such as lead-time bias and pseudo-disease that could explain the profoundly lower mortality. Those biases would need to be huge to account for the much better early stage survival," Pyenson said.
Even under sensitivity testing for slower rates of progression (lead time bias) or higher rates of benign disease (psuedo-disease), the predicted number of people who would still be alive in 2012 would be at least 44,689.
Actuarial techniques can help evaluate early detection methods and can tease out information on specific subsets of the population that would be impractical or take decades using traditional clinical trials methods.
According to Pyenson, this potential is beginning to be recognized in the FDA's post-release surveillance program to detect side-effects or advantages of various therapies, he added.
For example, the detailed analysis carried out by Milliman indicated that:
- For all types of lung cancer, early stage mortality is less than 15% of that for late stage;
- The extra mortality burden of lung cancer for women is higher than for men;
- There are race-related mortality differences, although "stage at diagnosis" is a much more important factor;
- Long-term survivors of all stages have similar mortality rates to their smoker counterparts of the same age, sex and race in the rest of the population, although there are very few long-term survivors of late stage lung cancer.
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