Lung Cancer Diagnosed Through Screening, Lung Nodule, and Neither Program: A Prospective Observational Study of the Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta Cohort

Abstract

Purpose: Lung cancer screening saves lives, but implementation is challenging. We evaluated two approaches to early lung cancer detection-low-dose computed tomography screening (LDCT) and program-based management of incidentally detected lung nodules.

Methods: A prospective observational study enrolled patients in the early detection programs. For context, we compared them with patients managed in a Multidisciplinary Care Program. We compared clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer.

Results: From 2015 to May 2021, 22,886 patients were enrolled: 5,659 in LDCT, 15,461 in Lung Nodule, and 1,766 in Multidisciplinary Care. Of 150, 698, and 1,010 patients diagnosed with lung cancer in the respective programs, 61%, 60%, and 44% were diagnosed at clinical stage I or II, whereas 19%, 20%, and 29% were stage IV (P = .0005); 47%, 42%, and 32% had curative-intent surgery (P < .0001); aggregate 3-year overall survival rates were 80% (95% CI, 73 to 88) versus 64% (60 to 68) versus 49% (46 to 53); 5-year overall survival rates were 76% (67 to 87) versus 60% (56 to 65) versus 44% (40 to 48), respectively. Only 46% of 1,858 patients with lung cancer would have been deemed eligible for LDCT by US Preventive Services Task Force (USPSTF) 2013 criteria, and 54% by 2021 criteria. Even if all eligible patients by USPSTF 2021 criteria had been enrolled into LDCT, the Nodule Program would have detected 20% of the stage I-II lung cancer in the entire cohort.

Conclusion: LDCT and Lung Nodule Programs are complementary, expanding access to early lung cancer detection and curative treatment to different-risk populations. Implementing Lung Nodule Programs may alleviate emerging disparities in access to early lung cancer detection.

FIG 1.

Cumulative enrollment of patients into LDCT, LNP, and MDC Programs: (A) patients enrolled, (B) patients diagnosed with lung cancer, and (C) patients diagnosed with clinical stage I or II lung cancer. (D) Proportions of the whole cohort of 1,858 patients diagnosed with lung cancer who had stage I/II, III, and IV lung cancer identified through each program (clinical stage distribution transcohort). LDCT, Low-Dose Computed Tomography Lung Cancer Screening Program; LNP, Lung Nodule Program; MDC, Multidisciplinary Care Program.

FIG 2.

Use of surgery only, surgery with or without other treatment modality (any surgery), and surgery or stereotactic radiosurgery (surgery or SBRT) to treat patients diagnosed with lung cancer through LDCT, LNP, and MDC Programs: (A) proportions within each program (denominator is patients diagnosed with lung cancer within each program) and (B) proportions of the whole cohort (denominator is all 1,858 patients diagnosed with lung cancer from all three programs combined). LDCT, Low-Dose Computed Tomography Lung Cancer Screening Program; LNP, Lung Nodule Program; MDC, Multidisciplinary Care Program; SBRT, stereotactic body radiotherapy.

FIG 3.

Kaplan-Meier survival plots of patients diagnosed with lung cancer who were enrolled into LDCT, LNP, and MDC Programs. LDCT, Low-Dose Computed Tomography Lung Cancer Screening Program; LNP, Lung Nodule Program; MDC, Multidisciplinary Care Program.

FIG A1.

Stage distribution of lung cancer patients diagnosed through three programs. LDCT, Low-Dose Computed Tomography Lung Cancer Screening Program; LNP, Lung Nodule Program; MDC, Multidisciplinary Care Program.