Effectiveness of low-dose CT scan for lung cancer screening in the community setting.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1543-1543
Author(s):  
Jason Aboudi Mouabbi ◽  
Tarik H. Hadid ◽  
Eugene Uh
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Task Force ◽  
Demographic Data ◽  
Community Setting ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
The United States

1543 Background: Lung cancer is the leading cause of cancer death in the United States (US) and worldwide. Chest X-ray (CXR) is ineffective in reducing lung cancer mortality. National Lung Cancer Screening Trail (NLST) reported 20% reduction in mortality with the use of low-dose computed tomography (LDCT) scan to screen high risk individuals. Therefore, major organizations including US Preventive Services Task Force has adopted LDCT for lung cancer screening in high risk populations. However, The generalizability of this approach in community setting is yet to be confirmed. Our objective is to assess the ability of LDCT in detection of lung nodules and lung cancer in the community setting and compare the results to those reported in the NLST. Methods: Charts of subjects who underwent LDCT screening between 2013 and 2016 at SJHMC were retrospectively reviewed. Demographic data, the results of the LDCT scans, interventions performed, complications of procedures and pathology findings were collected. All cancer cases found by LDCT and the stage of cancers were documented. The results of our study were statistically compared to the results of both arms of the NLST (CT and CXR arms). Since CXR is ineffective for lung cancer screening, CXR arm serves equivalently to no screening. Results: The baseline characteristics of the subjects are significantly different between this study and NLST. LDCT in our study detected significantly higher positive findings. There are more cancers detected in this study compared to NLST CT and CXR arms, which could reflect higher incidence of cancer in this community or higher proportion of current smokers in our study. In this study, LDCT detected cancers at higher stages compared to that of the NLST CT arm but similar stages to NLST CXR arm. This may indicate that LDCT when performed in the community is less effective in detecting cancer at early stages. Conclusions: The community population have different characteristics compared those enrolled in clinical trials. This may limit the generalizability of the results. Population-based studies are needed to confirm the results of the NLST. [Table: see text]

scholarly journals Effectiveness of Lung Cancer Screening Implementation in the Community Setting in the United States

2019 ◽  
Vol 15 (7) ◽  
pp. e607-e615 ◽  
Author(s):  
Amy Copeland ◽  
Angela Criswell ◽  
Andrew Ciupek ◽  
Jennifer C. King
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Community Setting ◽  
Lung Cancer Screening ◽  
The United States ◽  
Community Based ◽  
Lung Cancers ◽  
Low Dose Computed Tomography

PURPOSE: The National Lung Screening Trial demonstrated a 20% relative reduction in lung cancer mortality with low-dose computed tomography screening, leading to implementation of lung cancer screening across the United States. The Centers for Medicare and Medicaid Services approved coverage, but questions remained about effectiveness of community-based screening. To assess screening implementation during the first full year of CMS coverage, we surveyed a nationwide network of lung cancer screening centers, comparing results from academic and nonacademic centers. METHODS: One hundred sixty-five lung cancer screening centers that have been designated Screening Centers of Excellence responded to a survey about their 2016 program data and practices. The survey included 21 pretested, closed- and open-ended quantitative and qualitative questions covering implementation, workflow, numbers of screening tests completed, and cancers diagnosed. RESULTS: Centers were predominantly community based (62%), with broad geographic distribution. In both community and academic centers, more than half of lung cancers were diagnosed at stage I or limited stage, demonstrating a clear stage shift compared with historical data. Lung-RADS results were also comparable. There are wide variations in the ways centers address Centers for Medicare and Medicaid Services requirements. The most significant barriers to screening implementation were insurance and billing issues, lack of provider referral, lack of patient awareness, and internal workflow challenges. CONCLUSION: These data validate that responsible screening can take place in a community setting and that lung cancers detected by low-dose computed tomography screening are often diagnosed at an early, more treatable stage. Lung cancer screening programs have developed different ways to address requirements, but many implementation challenges remain.

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

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.

Lung cancer screening in high-risk individuals with annual low-dose chest CT in a community setting.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e12529-e12529
Author(s):  
Niraj K. Gupta ◽  
Richard K Freeman ◽  
Susan Storey ◽  
Dave Reeves ◽  
Anthony Ascioti ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Community Setting ◽  
Lung Cancer Screening ◽  
Chest Ct

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

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.

scholarly journals ELIGIBILITY FOR LOW-DOSE COMPUTED TOMOGRAPHY LUNG CANCER SCREENING IN OLDER ASIAN AMERICAN SMOKERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S189-S189
Author(s):  
Chien-Ching Li ◽  
Kelsey Choi ◽  
Alicia Matthews ◽  
Raj Shah
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Asian American ◽  
Low Dose ◽  
Task Force ◽  
Significant Proportion ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Eligibility Criteria ◽  
Low Dose Computed Tomography

Abstract Lung cancer is the leading cause of cancer-related deaths in Asian Americans. Low-dose computed tomography lung cancer (LDCT) screening is an effective way to decrease lung cancer mortality. This study aimed to examine the difference in LDCT screening eligibility among Asian American subgroups. The National Health Interview Survey data (2006-2016) was analyzed. The U.S. Preventive Services Task Force guideline was used to determine the LDCT eligibility. A higher and statistically significant proportion of current Filipino smokers (35.4%) met LDCT screening eligibility criteria compared to Chinese (26.5%) and other Asian smokers (22.7%) (p=0.02). Hierarchical logistic regression results further showed that Filipino were more likely to meet LDCT screening criteria than other Asian while adjusting demographics (OR=1.87; p=0.01). The differences in LDCT screening eligibility no longer existed after additionally adjusting socioeconomic factors as well as perceived health status. Future targeted outreach and intervention research is needed for Filipinos with lower socioeconomic status.

Effectiveness of mobile computerized tomographic (CT) lung scanning unit for early diagnosis of lung cancer in under-served populations.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6567-6567
Author(s):  
Derek Raghavan ◽  
Darcy L Doege ◽  
Mellisa S Wheeler ◽  
John D Doty ◽  
James Oliver ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
The United States ◽  
Lung Cancers ◽  
Low Dose Ct ◽  
Screening Unit ◽  
Lung Screening ◽  
Lung Scanning

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.

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