Initial results of a lung cancer screening demonstration project: a local program evaluation

Area of Science:

• Pulmonology
• Radiology
• Public Health

Background:

• Lung cancer screening (LCS) aims to reduce mortality through early detection using low-dose computed tomography (LDCT).
• Implementing LCS demonstration projects is crucial for understanding participation and optimizing screening protocols within healthcare systems like the Veterans Health Administration (VHA).

Purpose of the Study:

• To evaluate participation rates, clinical outcomes, and operational lessons learned from a VHA LCS demonstration project.
• To assess the effectiveness of different patient outreach strategies on LCS completion.
• To characterize findings, including lung nodules and incidental findings, detected by LDCT in a screening population.

Main Methods:

• A prospective observational study was conducted at one VHA center.
• An electronic health record (EHR) algorithm and tobacco pack-year (TPY) data identified potentially eligible patients.
• Patients received invitations; outreach methods included mailings and phone calls, with variations between study phases.

Main Results:

• Of 6,133 potentially eligible patients, 1,388 had eligible TPY data; 918 were invited, and 178 (19%) completed LCS.
• LCS completion was significantly higher with combined mail and call outreach (22%) compared to mail-only (9%).
• Among completers, 61% had nodules requiring follow-up, 2 lung malignancies were found, and 20% of incidental findings were clinically significant.

Conclusions:

• Accurate identification of eligible patients is critical for LCS implementation.
• Balancing patient outreach strategies with resource limitations is essential for maximizing screening participation.
• Standardized methods are needed for tracking lung nodules and incidental findings detected by LDCT in LCS programs.