Population-based systematic enrolment of individuals ensures high lung cancer screening uptake

Lung cancer screening (LCS) is recommended by international societies, yet it is still debated how to efficiently enrol participants. The aim of this study was to evaluate systematic enrolment of patients through family physicians in a regional LCS pilot study in Estonia.

This study was conducted in one county (with approximately 10 % of the country's population), where all family physicians were approached. In each participating practice, all 55- to 74-year-old individuals were identified and evaluated by the family physician or nurse. Two LCS inclusion criteria were used in parallel - individuals with elevated lung cancer (LC) risk, according to either smoking status (≥20 pack-years; quit <15 years ago) and/or a PLCO_m2012noRace risk score (>1.5 %/6 years), underwent low-dose computed tomography (LDCT). The scans were evaluated and participants managed according to LungRADS 1.1 protocol.

Seventy-four participating family physician practices had 26 759 patients in the target age group. During the inclusion period 24 413 individuals were evaluated, of whom 17 215 were excluded. Of the remaining 7198 individuals, 3708 had higher LC risk and were referred for LDCT. Of the 3444 individuals who underwent LDCT, 30 were diagnosed with LC. Considering the total LCS target age group, an estimated participation rate of 79.3 % (95 %CI 78.1 %-80.5 %) was achieved.

Population-based systematic enrolment of participants for LCS by family physicians and nurses ensured very high uptake in the target group, providing a valuable reference for planning LCS programs in countries with family physicians on board.