Lung Cancer Screening With Low-Dose CT in the United States

6567 Background: The National Lung Screening Trial (NLST) demonstrated that screening high-risk patients with low-dose CT (LDCT) of the chest reduces lung cancer mortality compared to screening with chest x-ray. Uninsured and Medicaid patients lack access to this hospital-based screening test due to geographic isolation/socio-economic factors. We hypothesized that a mobile screening unit would improve access and confer benefits demonstrated by the NLST to this under-served group, which is most at risk of lung cancer deaths. Methods: In collaboration with Samsung Inc, we inserted a BodyTom portable 32 slide low-dose CT scanner into a 35-foot coach, reinforced to avoid equipment damage, to function as a mobile lung scanning unit. The unit includes a waiting area, high speed wireless internet connection for rapid image transfer, and electronic tablets to deliver smoking cessation and health education programs and shared decision-making video aids. It has been certified as a lung cancer screening Center of Excellence by Lung Cancer Alliance. We employed the LUNG RADS approach to lesion classification, yielding high sensitivity and specificity in assessment. All films were reviewed by a central panel of oncologists, pulmonologists and radiologists. The protocol was approved by Chesapeake IRB, which oversees all LCI cancer trials. Interim analysis at this time was approved by the Oversight Committee. Results: We screened 470 under-served smokers between 4/2017-1/2019; M:F 1.1:1, mean age 61 years (range 55-64), with average pack year history of 45.7 (30-150) (25% African-American; 3% Hispanic; 65% rural; 100% uninsured, under-insured or Medicaid - NC Medicaid does not cover lung cancer screening). Patients over the age of 64 years were excluded as they are covered by Medicare for lung cancer screening. We found at initial screen 35 subjects with LUNG RADS 4 lesions, 49 subjects with LUNG RADS 3 lesions, 10 lung cancers (2.1%), including 4 at stage I-II. 4 non-lung cancers were identified and treated. Other incidental non-oncologic findings are the subject of another presentation. Conclusions: In this small sample using the first mobile low dose CT lung screening unit in the United States, the initial cancer detection rate is comparable to that reported in the NLST but with marked improvement of screening rates in underserved groups and with better anticipated outcomes at lower cost than if they had first presented with metastatic disease.

Download Full-text

Projected Clinical, Resource, and Budget Impact of Implementing Low-Dose Computed Tomography Lung Cancer Screening in the United States

Value in Health ◽

10.1016/j.jval.2014.03.442 ◽

2014 ◽

Vol 17 (3) ◽

pp. A75-A76 ◽

Cited By ~ 1

Author(s):

J.A. Roth ◽

S.D. Sullivan ◽

A. Ravelo ◽

J.C. Sanderson ◽

S. Ramsey

Keyword(s):

United States ◽

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Low Dose ◽

Budget Impact ◽

Lung Cancer Screening ◽

The United States ◽

Clinical Resource ◽

Low Dose Computed Tomography

Download Full-text

State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa170 ◽

2020 ◽

Author(s):

Stacey A Fedewa ◽

Ella A Kazerooni ◽

Jamie L Studts ◽

Robert A Smith ◽

Priti Bandi ◽

...

Keyword(s):

United States ◽

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Cancer Mortality ◽

Low Dose ◽

Lung Cancer Screening ◽

Lung Cancer Mortality ◽

The United States ◽

Cancer Burden

Abstract Background Annual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018. Methods The American College of Radiology’s Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year. Results Nationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation’s highest lung cancer mortality rate and one of the highest SRs (13.7%). Conclusions Fewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS.

Download Full-text

A Proactive Patient Identification Algorithm Increased Low-Dose CT Lung Cancer Screening Eligible Patients Per United States Preventative Services Task Force Criteria

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.07.238 ◽

2021 ◽

Vol 233 (5) ◽

pp. S123

Author(s):

Jared R. Hendren ◽

Sowmyanarayanan Thuppal ◽

Stephen Hazelrigg ◽

Rebecca Hoffman ◽

Amit Sapra ◽

...

Keyword(s):

United States ◽

Lung Cancer ◽

Cancer Screening ◽

Low Dose ◽

Task Force ◽

Lung Cancer Screening ◽

Identification Algorithm ◽

Patient Identification ◽

Low Dose Ct ◽

Preventative Services

Download Full-text

Using Twitter to Assess the Public Response to the United States Preventive Services Task Force Guidelines on Lung Cancer Screening with Low Dose Chest CT

Journal of Digital Imaging ◽

10.1007/s10278-016-9933-6 ◽

2017 ◽

Vol 30 (3) ◽

pp. 323-327 ◽

Cited By ~ 10

Author(s):

Siddharth Khasnavis ◽

Andrew B Rosenkrantz ◽

Vinay Prabhu

Keyword(s):

United States ◽

Lung Cancer ◽

Cancer Screening ◽

Low Dose ◽

Task Force ◽

Lung Cancer Screening ◽

The United States ◽

Chest Ct ◽

Public Response ◽

The Public

Download Full-text

Extent of implementation of low-dose CT in lung cancer screening.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19177 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19177-e19177

Author(s):

Merin Jose ◽

Rajesh Desai

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

High Risk ◽

Low Dose ◽

Lung Cancer Screening ◽

The United States ◽

Smoking History ◽

Community Clinic ◽

Low Dose Ct ◽

The Impact

e19177 Background: Lung cancer is the leading cause of cancer deaths in the United States with only 15% alive 5 years after diagnosis. In 2013, USPSTF recommended annual screening for LDCT in high risk individuals. Studies had shown a 20% lower mortality (NELSON trial showed significantly lower lung cancer mortality) with LDCT screening. We aimed to assess the extent to which the guideline for lung cancer screening is being adopted in a community clinic. Methods: A retrospective review of electronic medical record of patients aged 55-80 years with no history of lung cancer who visited a primary care provider in a community clinic in New Jersey from October 2014- December 2019 was done. All records with any form of documentation of smoking were identified electronically. The records of those meeting the criteria (30 pack-year smoking history and currently smoking or have quit within the past 15 years) were reviewed manually to check 1) whether they are eligible for screening, 2) if eligible whether low dose CT has been recommended by the provider and 3) once recommended has it been done and followed by the patients. Results: 359 individuals with documented smoking history were identified. Of those 38.8 % (139/359) had a proper documentation (includes both PPD and number of years of smoking) of smoking history based on which high risk individuals could be identified. Of those 37 individuals met the criteria for lung cancer screening. 62% (23/37) had CT chest ordered at some point of time (16.2% for a different indication and the rest for lung cancer screening). Only 52.2% (12/23) of the patients followed the recommendations and got a LDCT done. Among those 50% (6/12) had follow up CT, 50 % (3/6) of those did it on a regular annual basis while the rest 50% (3/6) did it irregularly. 3 patients followed the annual CT screening for lung cancer. Conclusions: Based on these we note that almost half a decade since the recommendation has been established only a small proportion received the care and a still smaller minority followed it. It reflects the dearth of information regarding the guideline among providers and the lack of awareness of the need to follow among patients. This puts forward need for further interventions for implementation of the guidelines at all levels of care for lung cancer prevention. Measures include analyzing the areas of deficiency through questionnaires for patients and providers. Creating awareness on the need for accurate documentation of smoking history and the impact it can have on care delivered. Educating patients about the benefits in health outcome by following the recommendations.

Download Full-text