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Lung Cancer Yield by Baseline Screening Lung CT Screening Reporting and Data System (Lung-RADS) Assignment and
Andrea N Burnett-Hartman1, Nikki M Carroll1, Kris F Wain1
1National Cancer Institute, National Institutes of Health (A. N. B-H.); Institute for Health Research, Kaiser Permanente Colorado (N. M. C., K. F. W., B. P. H., D. P. R.); Perelman School of Medicine, University of Pennsylvania (A. V., K. A. R., R. Y. K.); Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute (R. T. G.); Center for Integrated Health Care Research, Kaiser Permanente Hawaii (S. A. H., C. E. S. O.); Hawaii Permanente Medical Group (S. A. H.); Henry Ford Health and Henry Ford Cancer Institute (C. N-D., M. S.).
Background:
Lung cancer yield from lung cancer screening (LCS) via low-dose computed tomography (LDCT) may differ in community-based settings compared to clinical trials.
Research Question:
What proportion of those receiving a baseline LCS LDCT in five healthcare systems in the United States were diagnosed with lung cancer within 12-months, overall, and by LCS findings and patient characteristics?
Study Design And Methods:
Study participants were LCS-eligible and received care and a baseline LCS LDCT within healthcare systems in the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR-Lung) from 2014-2020. We collected data on LCS utilization, results, patient characteristics, and smoking history via electronic health records. Baseline LCS LDCT findings were categorized using Lung-RADS, and lung cancer diagnoses were ascertained via cancer registries. The primary outcome was 12-month lung cancer yield.
Results:
Of 13,448 patients, 47% were female, 48% ages <65 years, 74% White, 14% Black, 4% Hispanic, 3% Asian, and 1% Native Hawaiian/Pacific Islander. There were 304 (2.3%) patients diagnosed with lung cancer within 12 months of baseline LDCT. Among those with Lung-RADS 1 (n=3,047) or 2 (n=7,978), there were 1 and 16 lung cancers, respectively. Among those with positive LCS findings (n=2,408), 12-month lung cancer yield was as follows: Lung-RADS 3=1.7%, 4-NOS (not otherwise specified)=38.5%, 4A=10.8%, 4B=38.8%, or 4X=69.2%. Among those with missing Lung-RADS (n=15), 1 lung cancer was diagnosed. Those at older ages, who currently smoked, with higher pack-years, greater comorbidity, or lower body mass index had higher lung cancer yields (p-value < 0.05).
Interpretation:
Lung cancer yield within 12 months after a baseline LDCT within PROSPR-Lung healthcare systems was higher than in LCS clinical trials. Differences may be attributable to higher smoking intensity, increased comorbidities, and an average older age at baseline scan in community settings compared to clinical trial settings.
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