Impact of Low-dose Chest CT Screening on the Association Between Rurality and Lung Cancer Outcomes

Area of Science:

• Oncology
• Public Health
• Radiology

Background:

• Lung cancer mortality rates are disproportionately higher in rural United States populations.
• Limited data exists on the effectiveness and outcomes of low-dose chest computed tomography (LDCT) screening in these rural settings.

Purpose of the Study:

• To evaluate the outcomes of LDCT screening for lung cancer in a predominantly rural healthcare system.
• To compare the rates of early-stage lung cancer diagnosis and survival between rural and nonrural populations.

Main Methods:

• Retrospective cohort study of 1805 patients undergoing screening LDCT between March 2015 and December 2019.
• Analysis of early-stage lung cancer diagnosis (AJCC stage I-II) and overall survival based on residency (rural vs. nonrural).

Main Results:

• The cohort (62.4% rural) had a median age of 63 and 40-pack-year smoking history.
• Lung cancer was diagnosed in 2.1% of patients, with 65.8% being early-stage.
• No significant difference in lung cancer diagnosis rates (aHR 1.59, P=0.24) or early-stage lung cancer survival (rural 88.2% vs. nonrural 87.5%, P=0.93) was observed between rural and nonrural residents.

Conclusions:

• LDCT screening in a rural population effectively identifies early-stage lung cancers.
• Survival outcomes for screen-detected early-stage lung cancer are similar for rural and nonrural patients.
• Wider LDCT implementation may mitigate the disparity in lung cancer outcomes for rural populations.