Mobile Lung Cancer Screening in Limited Resource Regions: The ProPulmão Project (BRELT3) Study Protocol

Background Lung cancer is a highly aggressive disease that affected almost 2.2 million people worldwide and caused 1.8 million deaths in 2020. Smoking as well as being exposed to cancer-causing substances in the workplace are significant contributors to the chance of developing cancer. Developing countries encounter distinctive obstacles in the implementation of lung cancer screening because of extensive geographical and socioeconomic disparities. Objectives: our primary objective is to describe tomographic findings in a high-risk lung cancer population in limited resource Brazilian areas. The secondary objectives are to quantify the frequency of pulmonary nodules (especially those falling into Lung-RADS categories 3 and 4) as well as the occurrence of lung cancer; to describe and analyze the challenges related to lung cancer screening programs in the context of Brazilian public health system; to explain the pulmonary function pattern and clinical characteristics of individuals diagnosed with moderate or severe emphysema by low-dose computed tomography (LDCT); and to evaluate the commitment of Community Health Assistants in actively recruiting the high-risk population. Methods: This is a prospective cohort study. The study includes individuals in an age range of 50 to 80 years who are either current or former smokers and have a smoking history of at least 20 pack-years. They undergo LDCT with a planned follow up of 12 months. All adverse events are monitored and assisted. The classification of screening results is performed according to the Lung-RADS standards. Individuals classified in categories 3 and 4 receive additional diagnostic assessments and may have further testing. Expected results: we expect this study shows the feasibility and effectiveness of lung cancer screening in people in situation of social vulnerability within limited resource settings, providing vital knowledge to reduce mortality and improve health outcomes. The project will generate relevant knowledge to inform policies on lung cancer screening within the Brazilian public health system, emphasizing the necessity of timely identification and action in limited resource settings. Outcome: The study's dissemination plan includes a website, social media, and participation in scientific conferences. Approval from the ethics committee has been obtained, and rigorous mechanisms are in place to guarantee the privacy of the data.