Patients with a Previous History of Malignancy Undergoing Lung Cancer Screening: Clinical Characteristics and Radiologic Findings

117 Background: Disease stage at the time of diagnosis is the most important determinant of prognosis for lung cancer. Despite demonstrated effectiveness of lung cancer screening (LCS) in reducing lung cancer mortality, early detection continues to elude populations with the highest risk for lung cancer death. Consistent with the national rate, current screening rate in Alabama is dismal at 4.2%. While public awareness of LCS may be a likely cause there are no studies that have thoroughly evaluated current knowledge of LCS within the Deep South. Therefore, we measured (LCS) knowledge before and after receiving education delivered by Community Health Advisors (CHAs) among high-risk individuals living in medically-underserved communities of Alabama and to determine impact of psychological, demographic, health status and cognitive factors on rate of lung cancer screening participation. Methods: Participants were recruited from one urban county and six rural Black Belt counties (characterized by poverty, rurality, unemployment, low educational attainment and disproportionate lack of access to health services).100 individuals (i) aged between 55 to 80 years (ii) Currently smoke or have quit within the past 15 years. (iii) Have at least a total of 30-pack-year smoking history were recruited. Knowledge scores to assess lung cancer knowledge were calculated. Paired t-test was used to assess pre and post knowledge score improvement. Screening for lung cancer was modeled as a function of predisposed factors (age, gender, insurance, education, fatalism, smoking status, and history of family lung cancer). Results: Average age was 62.94(SD = 6.28), mostly female (54%); mostly current smokers (53% ). Most participants (80.85%) reported no family history of cancer. Fatalism was low, with a majority of the participants disagreeing that a cancer diagnosis is pre-destined (67.7%) and that there are no treatments for lung cancer (88.66%). Overall, lung cancer knowledge increased significantly from baseline of 4.64(SD = 2.37) to 7.61(SD = 2.26). Of the 100 participants, only 23 underwent screening due to lack of access to primary care providers and reluctance of PCPs to provide referral to LCS. 65% of those who were screened reported family history of lung cancer. Regression analysis revealed no significant association between risk factors and the decision to get screened by participants. Conclusions: Our study demonstrates that while CHA delivered education initiatives increases lung cancer screening knowledge, there are significant structural barriers that prohibit effective utilization of LCS which needs to be addressed.

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Lung Cancer Screening—Why Do It? Tobacco, the History of Screening, and Future Challenges

Seminars in Roentgenology ◽

10.1053/j.ro.2014.10.010 ◽

2015 ◽

Vol 50 (2) ◽

pp. 72-81 ◽

Cited By ~ 2

Author(s):

Patricia M. de Groot ◽

Brett W. Carter ◽

Myrna C.B. Godoy ◽

Reginald F. Munden

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Future Challenges ◽

History Of

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Community-based lung cancer screening program: A five-year comprehensive review.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e13080 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e13080-e13080

Author(s):

Ari Hakimian ◽

Axel Joob ◽

Jennifer Aversano ◽

Michael Vercillo ◽

Michael Oconnor ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Screening Program ◽

Lung Cancer Screening ◽

Smoking History ◽

Community Based ◽

Cancer Screening Program ◽

History Of ◽

Lung Cancer Screening Program

e13080 Background: Low-dose chest CT for lung cancer screening has been shown to have a significant impact on the early diagnosis of lung cancer. Initial trials have shown an approximate 20% decrease in overall lung cancer mortality (NLST, 2011). This study incorporates all patients who were evaluated by the Center for Thoracic Disease in a community-based lung cancer screening program from 2013 to 2018. Over the course of the study, thoracic surgeons have evaluated these patients with subsequent interval-based scans to monitor the progression of suspicious nodules. Methods: Eligibility criteria for the program included patients within the age range of 55-80, with a > 30 pack year smoking history, and that were current smokers or quit tobacco less than 15 years ago. Individuals between 50-55 years old were also included if they had > 20 pack year smoking history and at least one additional lung cancer risk factor. All patients included in this analysis completed an initial lung cancer screening consultation and recommended follow-up evaluations with thoracic surgeons from March 2013 to December 2018. All patients with suggestive abnormalities were discussed at a multidisciplinary conference prior to embarking on any invasive procedures. Patient data was collected on REDCap. Descriptive statistics for all continuous (mean ± SD) and categorical [N (%)] variables were calculated on patients. Results: 470 patients were included in the final analysis. The majority of the patients were males (56.4%), mean age was 64 years old (range: 50-81), and 55.3% were current smokers. The average smoking history was 42.3 pack years. 223 (47.6%) patients had a family history of cancer and 70 (14.5%) patients had a personal history of cancer. 25 patients (5.3%) had a diagnosis of primary lung cancer, among whom, 16 patients (64%) had early stage lung cancer (stage 1 and stage 2), 5 patients (20%) had stage 3, and 4 patients (16%) had stage 4 lung cancer. The cancer distribution included 17 adenocarcinomas (68%), 3 squamous cell carcinomas (12%), 3 small cell cancers (12%), 1 large cell cancer (4%) and 1 carcinoid tumor (4%). Conclusions: This study has demonstrated the value of enrolling patients in a community-based lung cancer screening program. Our results have reiterated the prevalence of discovering early staged lung cancer in high risk patients. This comprehensive five-year review indicates the importance of physician coordinated follow-up and evaluation in lung cancer screening patients.

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Evaluation of cardiovascular risk in a lung cancer screening cohort

Thorax ◽

10.1136/thoraxjnl-2018-212812 ◽

2019 ◽

Vol 74 (12) ◽

pp. 1140-1146 ◽

Cited By ~ 6

Author(s):

Mamta Ruparel ◽

Samantha L Quaife ◽

Jennifer L Dickson ◽

Carolyn Horst ◽

Stephen Burke ◽

...

Keyword(s):

Lung Cancer ◽

Risk Assessment ◽

Multivariate Analysis ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Coronary Heart Disease Mortality ◽

Cvd Risk ◽

Cross Sectional ◽

History Of ◽

Statin Use

IntroductionLung cancer screening (LCS) by low-dose computed tomography (LDCT) offers an opportunity to impact both lung cancer and coronary heart disease mortality through detection of coronary artery calcification (CAC). Here, we explore the value of CAC and cardiovascular disease (CVD) risk assessment in LCS participants in the Lung Screen Uptake Trial (LSUT).MethodsIn this cross-sectional study, current and ex-smokers aged 60–75 were invited to a ‘lung health check’. Data collection included a CVD risk assessment enabling estimation of 10 year CVD risk using the QRISK2 score. Participants meeting the required lung cancer risk underwent an ungated, non-contrast LDCT. Descriptive data, bivariate associations and a multivariate analysis of predictors of statin use are presented.ResultsOf 1005 individuals enrolled, 680 were included in the final analysis. 421 (61.9%) had CAC present and in 49 (7.2%), this was heavy. 668 (98%) of participants had a QRISK2≥10% and QRISK2 was positively associated with increasing CAC grade (OR 4.29 (CI 0.93 to 19.88) for QRISK2=10%–20% and 12.29 (CI 2.68 to 56.1) for QRISK2≥20% respectively). Of those who qualified for statin primary prevention (QRISK2≥10%), 56.8% did not report a history of statin use. In the multivariate analysis statin use was associated with age, body mass index and history of hypertension and diabetes.ConclusionsLCS offers an important opportunity for instituting CVD risk assessment in all LCS participants irrespective of the presence of LDCT-detected CAC. Further studies are needed to determine whether CAC could enhance uptake and adherence to primary preventative strategies.

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Chest CT findings among adult survivors of childhood and young adult cancer with a history of chest radiation.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.103 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 103-103

Author(s):

Emily S. Tonorezos ◽

Dana Barnea ◽

Amber Khan ◽

Joanne F. Chou ◽

Chaya S. Moskowitz ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Young Adult ◽

Pulmonary Nodule ◽

Total Body Irradiation ◽

Lung Cancer Screening ◽

Chest Ct ◽

History Of ◽

Total Body ◽

Young Adult Cancer

103 Background: While survivors of childhood and young adult cancer with a history of radiation therapy (RT) to the chest are known to be at increased risk for lung cancer, whether a CT-based lung cancer screening program is appropriate for this population is unknown. We sought to describe CT findings in a clinic-based population of childhood and young adult cancer survivors. Methods: We performed a detailed review of all diagnostic chest CT scans performed among patients seen in the Adult Long-Term Follow-Up Program at Memorial Sloan Kettering between August 2005 and May 2016. Included survivors were at least 5 years from diagnosis and had a history of RT to the mediastinum, mantle, axilla, lung, thoracic spine, or total body irradiation fields. Results were reviewed by at least two authors (ET, DB, or AK) and discrepancies were resolved by consultation with a pulmonologist (RK). Results: We identified 620 survivors with a history of chest field RT who were at least 5 years from diagnosis. The population was 48% male, with a median age at diagnosis of 17.2 years. Approximately half were survivors of Hodgkin Lymphoma (N=306; 49.5%) and almost one-third had undergone hematopoietic cell transplant (N=188; 31%); other diagnoses included non-Hodgkin Lymphoma and sarcoma. The most frequently cited RT field was mantle (N=219; 36%), followed by total body irradiation (N=142; 24%) and whole lung (N=110;18%). Among 351 survivors with at least one chest CT, 206 (59%) had at least one pulmonary nodule, 174 (50%) had fibrosis, and 132 (38%) had a ground glass opacity. Among those with a pulmonary nodule, the large majority (91% of those with a nodule) were followed expectantly or underwent repeat imaging; these patients were spared biopsy or resection. Among 18 patients who underwent biopsy, wedge resection, fine needle aspiration, or bronchoscopy, 4 were diagnosed with lung adenocarcinoma, 3 with metastatic sarcoma, and one with marginal zone lymphoma (MALT). Conclusions: Benign pulmonary nodules among adults with a history of RT for childhood or young adult cancer are common. Any strategy for lung cancer screening in this population will need to account for a high likelihood of benign findings on chest CT.

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