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Research ArticleOriginal ResearchA

Results of Lung Cancer Screening in the Community

John R. Handy, Michael Skokan, Erika Rauch, Steven Zinck, Rachel E. Sanborn, Svetlana Kotova and Mansen Wang
The Annals of Family Medicine May 2020, 18 (3) 243-249; DOI: https://doi.org/10.1370/afm.2519
John R. Handy Jr
1Department of Thoracic Surgery, Providence Cancer Institute, Portland, Oregon
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  • For correspondence: john.handy@providence.org
Michael Skokan
2Pulmonology East, The Oregon Clinic, Portland, Oregon
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Erika Rauch
3Lung Cancer Screening, Providence Cancer Institute, Portland, Oregon
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Steven Zinck
4The Radiology Group, Portland, Oregon
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Rachel E. Sanborn
5Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, Oregon
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Svetlana Kotova
1Department of Thoracic Surgery, Providence Cancer Institute, Portland, Oregon
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Mansen Wang
6Medical Data Research Center, Portland, Oregon
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Abstract

PURPOSE To address doubts regarding National Lung Screening Trial (NLST) generalizability, we analyzed over 6,000 lung cancer screenings (LCSs) within a community health system.

METHODS Our LCS program included 10 sites, 7 hospitals (2 non-university tertiary care, 5 community) and 3 free-standing imaging centers. Primary care clinicians referred patients. Standard criteria determined eligibility. Dedicated radiologists interpreted all LCSs, assigning Lung Imaging Reporting and Data System (Lung-RADS) categories. All category 4 Lung-RADS scans underwent multidisciplinary review and management recommendations. Data was prospectively collected from November 2013 through December 2018 and retrospectively analyzed.

RESULTS Of 4,666 referrals, 1,264 individuals were excluded or declined, and 3,402 individuals underwent initial LCS. Second through eighth LCSs were performed on 2,758 patients, for a total of 6,161 LCSs. Intervention rate after LCS was 14.6% (500 individuals) and was most often additional imaging. Invasive interventions (n = 226) were performed, including 141 diagnostic procedures and 85 surgeries in 176 individuals (procedure rate 6.6%). Ninety-five lung cancers were diagnosed: 84 non-small cell (stage 1: 60; stage 2: 7; stage 3: 9; stage 4: 8), and 11 small cell lung cancers. The procedural adverse event rate was 23/226 (10.1%) in 21 patients (0.6% of all screened individuals). Pneumothorax (n = 10) was the most frequent, 6 requiring pleural drainage. There were 2 deaths among 85 surgeries or 2.3% surgical mortality.

CONCLUSIONS Our LCS experience in a community setting demonstrated lung cancer diagnosis, stage shift, intervention frequency, and adverse event rate similar to the NLST. This study confirms that LCS can be performed successfully, safely, and with equivalence to the NLST in a community health care setting.

Key words
  • early cancer detection
  • lung cancer screening
  • Received for publication October 11, 2019.
  • Accepted for publication November 11, 2019.
  • © 2020 Annals of Family Medicine, Inc.
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Results of Lung Cancer Screening in the Community
John R. Handy, Michael Skokan, Erika Rauch, Steven Zinck, Rachel E. Sanborn, Svetlana Kotova, Mansen Wang
The Annals of Family Medicine May 2020, 18 (3) 243-249; DOI: 10.1370/afm.2519

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Results of Lung Cancer Screening in the Community
John R. Handy, Michael Skokan, Erika Rauch, Steven Zinck, Rachel E. Sanborn, Svetlana Kotova, Mansen Wang
The Annals of Family Medicine May 2020, 18 (3) 243-249; DOI: 10.1370/afm.2519
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