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

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

We categorized patients with lung cancer enrolled in a Multidisciplinary Thoracic Oncology Program from 2015 to 2023 as screened, unscreened, eligible, or ineligible for LCS. We further categorized the unscreened cohorts according to their exposure to IPN programs. We compared the lung cancer outcomes between the groups.

Of the 1904 patients, 6.4%, 41.4%, and 52.2% were screened, eligible unscreened, and ineligible, respectively; 42% of the eligible unscreened (17% of the 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 participants, 28% were age-ineligible, 20% had never smoked, 20.5% had a less than 20-pack-year history, and 32.5% had an excessive quitting duration. The five-year overall survival rates were 77% (95% confidence interval: 73-89), 45% (41-49), and 50% (46-54), respectively (p < 0.0001). With the eligible unscreened as a reference, the adjusted hazard ratios were 0.36 (0.23-0.54) and 0.87 (0.75-1.01) for the screened and ineligible cohorts. Five-year overall survival 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.

Screening improved the survival in this community-based cohort. The eligibility criteria excluded more patients than the failure to screen eligible patients. The IPN program alleviated both barriers.