LDCT & Lung Nodule Screening Combine to Detect More Cancer

lung cancer screening: lung cancer screeningNew research finds that low-dose computed tomography (LDCT) lung cancer screening and lung nodule detection and reporting programs are complementary. Combining the two could expand access to early lung cancer detection and curative treatment to different-risk populations, as well as alleviate emerging disparities in access to early lung cancer detection. In a study recently published in the Journal of Clinical Oncology, researchers evaluated two approaches to early lung cancer detection—LDCT and program-based management of incidentally detected lung nodules (2022; doi: 10.1200/JCO.21.02496). “Although lung cancer screening saves lives, implementing low-dose CT lung cancer screenings has been very challenging,” noted Raymond Osarogiagbon, MD, Chief Scientist and Director of the Multidisciplinary Thoracic Oncology Program at Baptist Memorial Health Care, and lead author of the study. Osarogiagbon and his colleagues hypothesized that program-based establishment of guideline-concordant management of incidental lung nodules provides an alternative pathway to early diagnosis of lung cancer. They also noted that the characteristics of lung cancer diagnosed through such programs would be similar to LDCT-detected lung cancer, but “there would be synergy between programs by providing access to different-risk populations.” The authors also hypothesized that lung cancer diagnosed through the two early detection programs—LDCT and incidental lung nodule—would have earlier stage and better outcomes than lung cancer diagnosed outside them, according to Osarogiagbon. He noted that the researchers used Baptist Memorial's multidisciplinary thoracic oncology program to provide lung cancer patients with diagnosis outside these early-detection programs. Study Details The authors conducted a prospective observational study that enrolled patients in the early detection programs. For context, the researchers compared them with patients managed in a multidisciplinary care program, comparing clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer. From 2015 to May 2021, 22,886 patients were enrolled in the study, with nearly 5,700 in LDCT, more than 15,000 in lung nodule, and close to 1,800 in multidisciplinary care. Overall, the researchers found that less than half of patients diagnosed with lung cancer (46%) would have been eligible to receive LDCT based on the U.S. Preventive Services Task Force (USPSTF) 2013 criteria. Fifty-four percent would have been eligible using the 2021 criteria. Still, the team found that the lung nodule program would have been able to identify 20 percent of Stage I and Stage II lung cancer cases among all participating patients diagnosed with the disease, even if all patients deemed eligible for LDCT according to the USPSTF's 2021 recommendation had received the exam. In comparison to those undergoing LDCT, patients diagnosed with lung cancer who participated in the lung nodule program were more likely to be Black, uninsured, and have given up smoking. And, eligibility for lung cancer screening increased across all three programs with the 2021 USPSTF recommendations. There has been a steep rise in the CT scans for diagnostics across North America and Europe since the 1970s, noted Osarogiagbon, adding that these scans often reveal lesions, some of which turn out to be lung cancer. By starting from the point of lesion detection, incidental lung nodule programs avoid several barriers that impair access to LDCT, including limitations of the eligibility criteria, recruitment of eligible patients, and insurance barriers, he noted. “A lot of the patients enrolled into the lung nodule program, for example, had their lesion-detecting CT scan performed in the ED for other reasons. A high proportion of such patients may never otherwise have presented for preventive care services,” Osarogiagbon stated. Ultimately, these results help illustrate the way in which LDCT screening and lung nodule programs can work together to increase patient access to early lung cancer detection and treatment, as well as impact how radiology teams provide care for these patients, he noted. “In terms of sheer volume of diagnosis, for every one lung cancer diagnosed through the LDCT program, five were diagnosed through the lung nodule program; 60 percent of patients in both programs had Stage I/II lung cancer,” Osarogiagbon said. Noting that fewer than 50 percent of the patients diagnosed with lung cancer in the nodule program would have been eligible for LDCT even by the new 2021 USPSTF criteria, “the key intervention with the incidental lung nodule program was to develop an automated means of using the electronic health record system to capture the radiology reports in which the radiologist expressed concern about the presence of a potentially malignant or premalignant lesion,” he explained. “This digital health approach improved the probability of guideline-concordant care, overcoming human errors in the hand off from radiologist to subsequent care delivery teams.” Mark McGraw is a contributing writer.