Coronary Calcium Screening and Incidental Lung Cancer Detection in Patients Ineligible for US Preventive Services...

Area of Science:

• Radiology
• Pulmonology
• Oncology

Background:

• Lung cancer screening criteria exclude many individuals who develop lung cancer.
• Coronary calcium screening CT captures thoracic anatomy, offering potential for early lung cancer detection outside current guidelines.

Purpose of the Study:

• To evaluate the utility of coronary calcium screening CT for detecting lung cancer in individuals not meeting current US Preventive Services Task Force (USPSTF) lung cancer screening criteria.
• To assess the outcomes, cost-effectiveness, and safety of integrating lung nodule assessment into coronary calcium screening CT workflows.

Main Methods:

• Retrospective cohort study of 9,702 adults undergoing coronary calcium screening CT (2019-2022), excluding USPSTF-eligible patients.
• Pulmonary findings classified using Fleischner Society guidelines with longitudinal follow-up.
• Outcomes included nodule detection, follow-up adherence, lung cancer diagnosis, stage, and modeled mortality and cost-effectiveness.

Main Results:

• Actionable pulmonary nodules found in 11.7% of patients; 42.8% completed follow-up.
• Lung cancer diagnosed in 18 patients (3.7% of those with follow-up), with 83.3% at stage I and 100% survival post-resection.
• Modeled implementation estimated averting 339 deaths per 100,000 screened at $5,856 per QALY, with a benefit-to-risk ratio >100:1.

Conclusions:

• Systematic thoracic assessment during coronary calcium screening CT can complement existing lung cancer screening.
• Guideline-concordant pulmonary nodule follow-up enables earlier lung cancer detection in non-eligible patients.
• This strategy shows potential for improved lung cancer outcomes and cost-effectiveness.