Barriers to Lung Cancer Screening in a Multi-Disciplinary Thoracic Oncology Program Cohort: Effects of an Incidental Pulmonary Nodule Program.

Abstract

Introduction: Lung cancer screening (LCS) reduces mortality, but adoption has been slow; some people who develop lung cancer are ineligible. Incidental pulmonary nodule (IPN) programs also detect lung cancer early. We quantified barriers to LCS and the impact of an IPN program.

Methods: We categorized patients with lung cancer in a Multidisciplinary Thoracic Oncology Program from 2015-2023 as: screened; unscreened eligible; ineligible for LCS. We further categorized the unscreened cohorts according to exposure to an IPN program. We compared lung cancer outcomes between the groups.

Results: Of 1,904 patients, 6.4%, 41.4% and 52.2% were screened, eligible unscreened, and ineligible; 42% of the eligible unscreened (17% of whole cohort) and 46% of the ineligible cohort (24% of the whole cohort) were diagnosed through the IPN program. Thirty-three percent of the eligible unscreened non-IPN cohort had clinical encounters 12 to 36 months before diagnosis. Among the ineligible, 28% were age-ineligible, 20% had never smoked, 20.5% had <20 pack-year history and 32.5% had excessive quit duration. 5-year overall survival (OS) was 77% (95% CI 73-89), 45% (41-49) and 50% (46-54), respectively (p<0.0001). With the eligible unscreened as reference, the aHR were: 0.36(0.23-0.54) and 0.87(0.75-1.01) for the screened and ineligible cohorts. 5-year OS was 61% (55-68) versus 35% (30-39) and 60% (55-67) versus 42% (37-47) among IPN versus non-IPN cohorts of eligible unscreened and ineligible cohorts, respectively.

Conclusion: Screening improved survival in this community-based cohort. Eligibility criteria excluded more patients than non-screening of eligible patients. An IPN program alleviated both barriers.