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Multicenter Study
. 2022 Dec;17(12):1355-1364.
doi: 10.1016/j.jtho.2022.08.011. Epub 2022 Sep 7.

Stage Migration and Lung Cancer Incidence After Initiation of Low-Dose Computed Tomography Screening

Anil Vachani  1 , Nikki M Carroll  2 , Michael J Simoff  3 , Christine Neslund-Dudas  3 , Stacey Honda  4 , Robert T Greenlee  5 , Katharine A Rendle  6 , Andrea Burnett-Hartman  2 , Debra P Ritzwoller  2
Affiliations
Multicenter Study

Stage Migration and Lung Cancer Incidence After Initiation of Low-Dose Computed Tomography Screening

Anil Vachani et al. J Thorac Oncol. 2022 Dec.

Abstract

Introduction: Despite evidence from clinical trials of favorable shifts in cancer stage and improvements in lung cancer-specific mortality, the effectiveness of lung cancer screening (LCS) in clinical practice has not been clearly revealed.

Methods: We performed a multicenter cohort study of patients diagnosed with a primary lung cancer between January 1, 2014, and September 30, 2019, at one of four U.S. health care systems. The primary outcome variables were cancer stage distribution and annual age-adjusted lung cancer incidence. The primary exposure variable was receipt of at least one low-dose computed tomography for LCS before cancer diagnosis.

Results: A total of 3678 individuals were diagnosed with an incident lung cancer during the study period; 404 (11%) of these patients were diagnosed after initiation of LCS. As screening volume increased, the proportion of patients diagnosed with lung cancer after LCS initiation also rose from 0% in the first quartile of 2014 to 20% in the third quartile of 2019. LCS did not result in a significant change in the overall incidence of lung cancer (average annual percentage change [AAPC]: -0.8 [95% confidence interval (CI): -4.7 to 3.2]) between 2014 and 2018. Stage-specific incidence rates increased for stage I cancer (AAPC = 8.0 [95% CI: 0.8-15.7]) and declined for stage IV disease (AAPC = -6.0 [95% CI: -11.2 to -0.5]).

Conclusions: Implementation of LCS at four diverse health care systems has resulted in a favorable shift to a higher incidence of stage I cancer with an associated decline in stage IV disease. Overall lung cancer incidence did not increase, suggesting a limited impact of overdiagnosis.

Keywords: Cancer incidence; Lung cancer; Screening; Stage migration.

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Figures

Figure 1.
Figure 1.. Screening Volume and Lung Cancer Diagnoses, 2014–2019
Bars demonstrates the proportion of incident lung cancer diagnoses after at least one prior LCS-LDCT by quarter between 2014 and 2019. The gray line demonstrates the total volume of LCS-LDCT scans performed in that quarter.
FIGURE 2.
FIGURE 2.. Stage-Specific Trends in Lung Cancer Incidence for Overall Cohort, 2014–2018
a Stage 0 lung cancer excluded given the small number of in-situ lung cancer diagnoses (n=11)
FIGURE 3.
FIGURE 3.. Factors Associated with a Diagnosis of Early-Stage Lung Cancer
a early stage defined as Stage 0, I, and II
See this image and copyright information in PMC

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