6540 Background: Studies such as the National Lung Screening Trial (NLST; N Engl J Med 2011;365:395-409) have shown a survival benefit to low-dose Lung CT screening in high-risk smokers. Levine Cancer Institute (LCI) initiated the first mobile low dose computerized tomographic (LDCT) lung screening program for underserved populations in 2017. In addition to being able to intervene early in the natural history of lung cancer, the project has also shown a previously unreported high incidence of incidental diseases in this population. We characterize these findings in 1198 patients. Methods: From May 2017, subjects with criteria eligible for NLST screening were identified and underwent LDCT for lung cancer detection. Patients screened in the program were all uninsured or underinsured, mean age 60.8 years, 18% were African American, 3% Latin-x and 78% were rural with an overall 47.1 mean pack-year smoking history. These patients were screened using a novel mobile LDCT (J Clin Oncol 37, 2019 suppl; abstr 6567) created for this program. By December 2020, 1198 patients completed their first screening. All CT scans were reviewed by two separate radiologists and were reviewed for quality assurance by a separate expert multidisciplinary team. Results: Of the 1198 subjects, 84% (1006 subjects) were found by LDCT to have a least one incidental disease. More than half of the subjects (645, 53.8%) had coronary atherosclerosis. Of those, 25% (183) were described to have at least moderate disease with 8% (96) described as severe. Overall, 42% (504) were found to have emphysema and 25% (299) had vascular atherosclerotic disease; 1.8% (22) of those screened had a detected aortic aneurysm. In total, thirty separate disease findings were found (listed from fourth to tenth most common finding: degenerative spine changes [205], cholelithiasis [59], hiatal hernia [52], pericardial effusions [38], fatty liver [32], kidney stone [3]), and cardiomegaly [30]). 3.5% (42) were found to have an undiscovered breast, adrenal, liver or kidney mass that required further workup. Conclusions: The number of incidental findings in our mainly rural underserved subject group was very high (84%). 35.5% of patients in the National Lung Screening Trial died from heart disease or respiratory disease. These numbers have not been overtly discussed and our study confirms the number of concerning incidental diseases that can lead to morbidity or mortality. In this high-risk, underserved population of heavy smokers, the opportunity for positive impact on other disease states can be increased by a mobile lung cancer screening program by increasing access to care.
Lung cancer incidence and mortality with extended follow-up in the National Lung Screening Trial
