Lung Cancer Yield Among Those Undergoing Lung Cancer Screening in Community-based Healthcare Systems

Abstract

Purpose: Lung cancer screening (LCS) via low-dose computed tomography (LDCT) for those with a high risk of lung cancer based on age and smoking history has been recommended in the United States for almost a decade, but performance of LCS in community-based settings is unclear. We aimed to estimate the proportion of those screened who were diagnosed with lung cancer across five healthcare systems in the United States. Methods: Study participants were LCS-eligible individuals who received care and a baseline LCS LDCT within the five healthcare systems in the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR-Lung). We collected data on LDCT utilization and results, as well as patient characteristics and smoking history, via electronic health records. LCS LDCT findings were categorized using Lung-RADS [negative (1), benign (2), probably benign (3), or suspicious (4)]. Lung cancer diagnoses occurring within 12 months of a baseline LDCT were ascertained via cancer registry data. Our preliminary analyses, presented here, includes estimates of lung cancer yield, overall, and by Lung-RADS category, among those receiving a baseline LDCT 2014–2018. Data collection through 2021 is underway and final analyses will include data through 2021. Results: There were 8,682 patients with a baseline scan included in analyses. Of these, 47% were female, 52% were ages 65+, and the ethnic and racial distribution was: 4% Hispanic, 2% Hawaiian/Pacific Islander, 4% Asian, 14% Black, and 74% White. There were 142 (1.6%) patients diagnosed with lung cancer within 12-months of their baseline LDCT. Among those with negative LCS LDCT findings, Lung-RADS 1 (n = 1,987) or Lung-RADS 2 (n = 5,232), there were 1 and 8 lung cancer diagnoses, respectively. Among those with positive LCS LDCT findings, Lung-RADS 3 (n = 906), Lung-RADS 4/4A (n = 363), or Lung-RADS 4B/4X (n = 194), 10 (1%), 35 (10%), and 88 (45%) were diagnosed with lung cancer, respectively. Conclusions: The proportion of those diagnosed with lung cancer within 12 months of a baseline LDCT within community settings is similar to clinical trials settings, and use of Lung-RADS categorization in community settings appropriately stratifies patients into those with a low- vs. high-risk of prevalent lung cancer.