First Actuarial Analysis Shows Significant Mortality Reduction When Lung Cancer Diagnosed Early
Washington, DC [February 16, 2010] --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
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. To
read the study, click here.
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
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.
Lung Cancer Alliance, www.lungcanceralliance.org,
is the only national non-profit dedicated exclusively to providing
patient support and advocacy for those living with or at risk for lung
cancer. Lung Cancer Alliance is committed to reversing decades of
stigma and neglect by empowering those with or at risk for the disease,
elevating awareness and changing health policy.
Milliman is among the world’s largest independent
actuarial and consulting firms with 52 offices in key locations
worldwide. Milliman employs over 2,400 people, with a professional
staff of more than 1,100 qualified consultants and actuaries, including
specialists ranging from clinicians to economists. The firm has
consulting practices in healthcare, employee benefits, property &
casualty insurance, life insurance and financial services. Milliman
serves the full spectrum of business, financial, government, union,
education and nonprofit organizations.