Factors associated with lung cancer-specific mortality in lung cancer screening programs

Two major clinical trials have proven lung cancer screening (LCS) to be effective in reducing lung cancer-specific mortality. However, mortality reduction in the trials was only 20%. Our objective is to identify the causes contributing to lung cancer-specific death in our screening population.

This retrospective study reviewed all patients who were enrolled in our healthcare system's lung cancer screening program between January 2015 and June 2023. Chart reviews were performed of all patients who died after lung cancer diagnosis to first determine whether the death was attributed to lung cancer. We then performed a chart review to identify contributing factors to death, including: advanced stage at initial diagnosis; non-compliance; missed nodules; aggressive cancers; recurrence; and treatment complications.

During study period, 15,762 patients were screened, 694 were diagnosed with lung cancer, and 112 deaths were attributed directly to lung cancer. Potentially modifiable factors contributing to lung cancer-specific death accounted for the majority of causes (66/112; 59%), with advanced stage at initial diagnosis being the leading factor (28/112; 25%) followed by non-compliance (26/112; 23%) and missed nodules on CT (12/112; 11%). Non-modifiable contributing factors included development of an aggressive lung cancer (16/112; 14%), cancer recurrence after early stage (14/112; 13%), development of a second lung cancer (10/112; 9%), and treatment complications (6/112; 5%).

Potentially modifiable factors contributed to the majority of lung cancer-related deaths in our screening program. Interventions to improve uptake of screening and follow-up may be able to improve the efficacy of lung cancer screening programs.