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Lung cancer diagnosis rates in clinical screening programs are higher than previously estimated from trial data. This study found approximately 4% of patients in lung cancer screening and incidental pulmonary nodule programs were diagnosed with cancer.

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Area of Science:

  • Pulmonology
  • Oncology
  • Radiology
  • Public Health

Background:

  • Estimates of lung cancer screening (LCS) impact often rely on the 3.97% lung cancer diagnosis rate (LCDR) from the National Lung Screening Trial (NLST).
  • Real-world LCDR in clinical LCS and incidental pulmonary nodule (IPN) programs may differ from NLST estimates.
  • Accurate LCDR is crucial for evaluating the effectiveness and resource allocation of lung cancer screening initiatives.

Purpose of the Study:

  • To estimate the lung cancer diagnosis rate (LCDR) in contemporary clinical lung cancer screening (LCS) and incidental pulmonary nodule (IPN) programs.
  • To compare LCDR in real-world clinical settings with historical data from the National Lung Screening Trial (NLST).
  • To assess the association between Lung-RADS scores and nodule characteristics with LCDR.

Main Methods:

  • A prospective cohort study was conducted in a large regional healthcare system, including patients undergoing low-dose CT for LCS or any CT identifying IPNs (diameter ≤30 mm) without prior lung cancer history.
  • Data were collected between January 1, 2015, and June 30, 2024.
  • Primary outcome was aggregate LCDRs; secondary outcomes included relative LCDRs stratified by Lung-RADS score (LCS cohort) or nodule size (IPN cohort). Cox proportional hazards models were used for adjusted hazard ratio (AHR) estimation.

Main Results:

  • The study included 40,612 patients (15,754 in LCS cohort, 24,858 in IPN cohort).
  • Cumulative LCDR at 36 months was 3.8% (95% CI, 3.4%-4.1%) in the LCS cohort and 4.3% (95% CI, 4.1%-4.6%) in the IPN cohort.
  • Higher Lung-RADS scores and larger nodule sizes were significantly associated with increased LCDR (e.g., AHR for Lung-RADS 4X was 107.22; AHR for nodules >20-30 mm was 15.65).

Conclusions:

  • This cohort study suggests a higher population-level LCDR in current clinical LCS and IPN programs compared to estimates from the NLST.
  • The observed LCDR of approximately 4% was achieved over a shorter follow-up period than the NLST.
  • Findings highlight the importance of real-world data for accurately assessing lung cancer screening program effectiveness and informing public health strategies.