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. 2020 May;18(3):243-249.
doi: 10.1370/afm.2519.

Results of Lung Cancer Screening in the Community

John R Handy Jr  1 , Michael Skokan  2 , Erika Rauch  3 , Steven Zinck  4 , Rachel E Sanborn  5 , Svetlana Kotova  6 , Mansen Wang  7
Affiliations

Results of Lung Cancer Screening in the Community

John R Handy Jr et al. Ann Fam Med. 2020 May.

Abstract

Purpose: To address doubts regarding National Lung Screening Trial (NLST) generalizability, we analyzed over 6,000 lung cancer screenings (LCSs) within a community health system.

Methods: Our LCS program included 10 sites, 7 hospitals (2 non-university tertiary care, 5 community) and 3 free-standing imaging centers. Primary care clinicians referred patients. Standard criteria determined eligibility. Dedicated radiologists interpreted all LCSs, assigning Lung Imaging Reporting and Data System (Lung-RADS) categories. All category 4 Lung-RADS scans underwent multidisciplinary review and management recommendations. Data was prospectively collected from November 2013 through December 2018 and retrospectively analyzed.

Results: Of 4,666 referrals, 1,264 individuals were excluded or declined, and 3,402 individuals underwent initial LCS. Second through eighth LCSs were performed on 2,758 patients, for a total of 6,161 LCSs. Intervention rate after LCS was 14.6% (500 individuals) and was most often additional imaging. Invasive interventions (n = 226) were performed, including 141 diagnostic procedures and 85 surgeries in 176 individuals (procedure rate 6.6%). Ninety-five lung cancers were diagnosed: 84 non-small cell (stage 1: 60; stage 2: 7; stage 3: 9; stage 4: 8), and 11 small cell lung cancers. The procedural adverse event rate was 23/226 (10.1%) in 21 patients (0.6% of all screened individuals). Pneumothorax (n = 10) was the most frequent, 6 requiring pleural drainage. There were 2 deaths among 85 surgeries or 2.3% surgical mortality.

Conclusions: Our LCS experience in a community setting demonstrated lung cancer diagnosis, stage shift, intervention frequency, and adverse event rate similar to the NLST. This study confirms that LCS can be performed successfully, safely, and with equivalence to the NLST in a community health care setting.

Keywords: early cancer detection; lung cancer screening.

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Figures

Figure 1
Figure 1
Lung cancer screening process. CT = computed tomography; LCS = lung cancer screening; lung-RADS = Lung Imaging Reporting and Data System; PCC = primary care clinician; SDM = shared decision making.
Figure 2
Figure 2
Cumulative number of lung cancer screens, initial LCS only, and patients diagnosed with lung cancer. LCS = lung cancer screening.
See this image and copyright information in PMC

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