Assessing information available for health professionals and potential participants on lung cancer screening program websites: a cross-sectional study (Preprint)

BACKGROUND Lung cancer is the number one cause of cancer death worldwide. The US Preventive Services Task Force (USPSTF) updated recommendations for lung cancer screening in 2021, adjusting the age of screening to 50 years (from 55 years), and reducing the number of pack-years total firsthand cigarette smoke exposure to 20 (down from 30). With many individuals using the internet for healthcare information, it is important to understand what information is available for individuals contemplating lung cancer screening. OBJECTIVE To assess the eligibility criteria and information available on lung cancer screening program websites for both health professionals and potential screeners. METHODS A descriptive cross-sectional analysis in March 2021 of 151 lung cancer screening program websites of academic (n=76) and community medical centers (n=75) in the United States for data related to information for health professionals and potential screeners was conducted. Presentation of eligibility criteria for potential participants and presence of information available specific to the health professionals about lung cancer screening, were the primary outcomes. Secondary outcomes included presentation of information about cost, smoking cessation, and inclusion of an online risk assessment tool, any clinical guidelines and multimedia used to present information. RESULTS Eligibility criteria is included in nearly all websites, with age range (92.1%) and smoking history (93.4%) included. Age was only consistent with the latest recommendations in 14.5% of the websites and no websites had updated smoking history. Half the websites mention screening costs as related to the type of insurance held. About one in six (15%) featured an online assessment tool to determine eligibility. A similar proportion (15%) hosted information specifically for health professionals. About a third (29%) of websites referred to smoking cessation. Almost a third of websites (30.5%) used multimedia to present information, such as short videos or podcasts. CONCLUSIONS Most US websites of lung cancer screening programs provide information about eligibility criteria, but this is not consistent and has not been updated across all websites following the latest USPSTF recommendations. Online resources require updating to present standardized information that is accessible for all.

The Additional Value of Lung Cancer Screening Program in Identifying Unrecognized Diseases

Background: A systematic examination of low-dose CT (LDCT) scan, beside lung nodules, may disclose the presence of undiagnosed diseases, improving the efficacy and the cost/efficacy of these programs. The study was aimed at evaluating the association between LDCT scan findings and non-oncologic and oncologic diseases.Methods: The LDCT scan of participants to the “Un Respiro per la vita”® lung cancer screening program were checked and abnormal findings, beside lung nodules, recorded. First admission to the acute care because of cardiovascular (CD), respiratory (RD) and oncological diseases (OD) in the following three years were retrieved. The association of LDCT scan abnormal findings with CD, RD and OD was assessed through univariable and multivariable logistic regression models.Results: Mean age of 746 participants was 62 years (SD:5), 62% were male. 11 (1.5%) received a diagnosis of lung cancer. 16.1% participants were admitted to the acute care in the following three years: 8.6% for CD, 4.3% for RD and 5.2% for OD. Valve calcification (OR 2.02, p:0.02) and mucus plugs (OR 3.37, p:0.04) were positively associated with CD, while sub-pleural fibrosis had a protective role (OR 0.47, p:0.01). Lung nodules >8 mm (OR 5.54, p:<0.01), tracheal deviation (OR 6.04, p:0.01) and mucus plugs (OR 4.00, p:0.04) were positively associated with OD admissions. Centrilobular emphysema OR for RD admissions was 1.97 (p:0.06).Conclusions: Selected LDCT scan findings are harbingers of undiagnosed CD, RD and OD, even different from lung cancer, whom knowledge might improve the efficacy and cost/efficacy of lung cancer screening programs.

Early impact of lung cancer screening program.

e18677 Background: Lung cancer has the highest mortality among the leading cancers in the U.S. Its detection in the early stages is one of the strategies to increase survival. This study aims to identify whether the implementation of a structured Lung Cancer Screening Program impacted the percentage of Early Stage Lung Cancer Diagnosis (ESLCD). Methods: Retrospective cohort study aiming to identify changes over time considering the following indicators: a) percentage of ESLCD; b) the percentage of lung resections for ESLCD. In October 2019, there was a restructuring of our institutional Lung Cancer Screening Program (LCSP). We analyzed quarterly incident lung cancer cases at our institution between October 2017 and December 2019. Descriptive, bivariate, and multivariate analyses were performed. Results: Our cohort comprised 736 patients. The age average was 69.3 years, 54.6% female, 96.5% white. Clinical Stage 1A to 2B corresponded to 43.3% of patients. 71.9% had their diagnosis and treatment in the institution. Factors associated with ESLCD were being in the LCSP (OR 4.4 [95%CI 2.3-8.1]); diagnosis and treatment in the institution (OR 2.2 [95%CI 1.6-3.2]); having 3 or less comorbidities (OR 1.6 [95%CI 1.2-2.1]) and female (OR 1.4 [95%CI 1.1-1.9]). In the last Quarter of 2017, the percentage of ESLCD through LCSP was 2.6%, and in the last Quarter of 2019 (2019Q4), 28.8%, representing a 1025% growth. Also, in 2019Q4, 44.8 % of the ESLCD cases that had surgery came through the LCSP, which is a significant increase from prior quarters. Conclusions: The restructuring of our LCSP may have resulted in an increase in ESLCD and the number of curative surgeries for Lung Cancer. Identification of opportunities for improvement of health care delivery can help to increase ESLCD; a longer time for follow-up is needed to observe if the upward trend is sustained and its effects on patient survival. Selected indicators by quarter, 2017 to 2019.[Table: see text]