Pilot study of lung cancer screening for survivors of Hodgkin lymphoma

Hodgkin lymphoma (HL) treatment increases the risk of lung cancer. Most HL survivors are not eligible for lung cancer screening (LCS) programs developed for the general population, and the utility of these programs has not been tested in HL survivors. We ran a LCS pilot in HL survivors to describe screening uptake, participant characteristics, impact of a decision aid and screen findings. HL survivors treated ≥5 years ago with mustine/procarbazine and/or thoracic radiation, were identified from a follow-up database and invited to participate. Participants underwent a low-dose computed tomography (LDCT) reported using protocols validated for the general population. Two hundred and eighteen individuals were invited, 123 were eligible, 102 were screened (58% response rate): 58% female, median age 52 years, median 22 years since HL treatment; 91.4% were deemed to have made an informed decision; participation was not influenced by age, sex, years since treatment or deprivation. Only three of 35 ever-smokers met criteria for LCS through the program aimed at the general population. Baseline LDCT results were: 90 (88.2%) negative, ten (9.8%) indeterminate, two (2.0%) positive. Two 3-month surveillance scans were positive. Of four positive scans, two patients were diagnosed with small-cell lung cancer; one underwent curative surgery. Coronary artery calcification was detected in 36.3%, and clinically significant incidental findings in 2.9%. LDCT protocols validated in ever-smokers can detect asymptomatic early-stage lung cancers in HL survivors. This finding, together with screening uptake and low false positive rates, supports further research to implement LCS for HL survivors (clinicaltrials gov. Identifier: NCT04986189.).