Article Figures & Data
Figures
- Figure 1
Lung cancer screening process.
CT = computed tomography; LCS = lung cancer screening; lung-RADS = Lung Imaging Reporting and Data System; PCC = primary care clinician; SDM = shared decision making.
- Figure 2
Cumulative number of lung cancer screens, initial LCS only, and patients diagnosed with lung cancer.
LCS = lung cancer screening.
Tables
Demographic No. (%) Age, y 55-64 1,114 (44) 65-81 1,399 (56) Sex Female 1,265 (50) Male 1,248 (50) Race White 2,159 (86) Asian 55 (2) African American 33 (1) Other 72 (3) American Indian or Alaska native 15 (<1) Patient refused 64 (3) Unknown 115 (4) Smoking Former 999 (40) Current 1,514 (60) Activity Type No. (%) Enrolled or completed LCS program during study period 2,791 (82) Did not schedule or declined PCC-ordered LSC 258 (8) Had diagnostic CTs (from LCS & not from LCS) 79 (2) Subsequent LCS scans outside PSJH 61 (2) Initial LCS resulted in diagnosis of cancer, no other LCS 51 (2) Had repeat scans within PSJH but after end of study period 50 (1) Changed insurance, other insurance issue, changed PCC, or had no PCC 46 (1) PCC declined or did not send subsequent orders 43 (1) Moved 23 (1) CT = computed tomography; LCS = lung cancer screening; PCC = primary care clinician; PSJH = Providence St Joseph Health.
Imaging Type No. Chest CT 501 X-ray 317 PET 129 Ultrasound 115 Other CT 55 MRI 35 Vascular imaging 14 Bone scan 4 Echocardiography 3 Bone density 2 Esophagram 2 Mammography 2 CT = computed tomography; MRI = magnetic resonance imaging; PET = positron emitted tomography.
Procedure Type No. Invasive diagnostic procedures 141 Bronchoscopy 62 CT-guided biopsy 31 (lung/liver/spine/lymph node/abdomen) (27/1/1/1/1) US-guided thyroid biopsy 23 US-guided non-thyroid biopsy 8 Endoscopic ultrasound 4 Esophagogastroduodenoscopy 4 Thoracentesis 3 Coronary angiography 3 Flexible laryngoscopy 2 Bone marrow biopsy 1 Surgeries 85 Thoracoscopic lobectomy 37 Thoracoscopic anatomic segmentectomy 11 Thoracoscopic wedge resection 7 Endovascular abdominal aneurysm repair 6 Kidney resection 5 Mediastinoscopy 3 Thoracoscopic/robotic thymectomy 3 Laparoscopic adrenalectomy 3 Hernia repair 2 Thyroid resection 2 Thoracoscopic pneumonectomy 1 Repair ascending aortic aneurysm with 1 AVR/CAB Aortic valve replacement 1 Thoracoscopic pleural biopsy 1 Mediastinal mass resection 1 Hepatectomy/Cholecystectomy 1 AVR = aortic valve replacement; CAB = coronary artery bypass; CT = computed tomography; US = ultrasound.
↵a Total number of procedures greater than 176 as some patients underwent multiple procedures.
Lung Cancer No. (n = 95) Other Cancer No. (n = 16) NSCLC stage I 60 Renal 4 NSCLC stage II 7 Breast 2 NSCLC stage III 9 Thyroid 1 NSCLC stage IV 8 Colon 1 Limited SCLC 4 Bile duct 1 Extensive SCLC 7 Prostate 1 Multiple myeloma 1 Lymphoma 1 Mesothelioma 1 Thymoma 1 Tonsil 1 Cervical cancer metastasis 1 NSCLC = non-small–cell lung cancer; SCLC = small cell lung cancer.
Adverse Events No. Diagnostic procedure complicationsa 12 Pneumothorax 10 Unplanned ED admission post EBUS for hypoxemia 1 Post bronchoscopy pneumonia 1 Surgery complicationsb 11 Death 2 Reoperation for bleeding 2 Prolonged air leak 2 Postoperative respiratory failure 2 Chest wall hernia 1 Atrial fibrillation requiring intervention 1 Lung segment torsion requiring completion lobectomy 1 EBUS = endobronchial ultrasound; ED = emergency department.
↵a 11 patients.
b 10 patients.
The Article in Brief
Results of Lung Cancer Screening in the Community
John R. Handy, Jr and colleagues
Background The benefits of routine lung cancer screenings have been hotly debated in the medical community. After reviewing a national trial published in 2011, the US Preventive Services Task Force introduced a recommendation for systematic low-dose CT lung cancer screenings for people at high risk. At the time, some leaders in the primary care community were not convinced that there was strong enough evidence in the initial trial to support routine screening. The current cohort study evaluated a lung cancer screening program within a large metropolitan non-university, non-NLST, community, tertiary care system.
What This Study Found The new lung cancer screening cohort study (n=3,402) conducted at a large integrated health system suggests that lung cancer screening in primary care is feasible. The study demonstrated low adverse event rates, and 70 percent of diagnosed lung cancer cases were detected at early stages in their development. 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.
Implications
- 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.
The Article in Brief
Results of Lung Cancer Screening in the Community
John R. Handy, Jr, and colleagues
Background The benefits of routine lung cancer screenings have been hotly debated in the medical community. After reviewing a national trial published in 2011, the US Preventive Services Task Force introduced a recommendation for systematic low-dose CT lung cancer screenings for people at high risk. At the time, some leaders in the primary care community were not convinced that there was strong enough evidence in the initial trial to support routine screening. The current cohort study evaluated a lung cancer screening program within a large metropolitan non-university, non-NLST, community, tertiary care system.
What This Study Found The new lung cancer screening cohort study (n = 3,402) conducted at a large integrated health system suggests that lung cancer screening in primary care is feasible. The study demonstrated low adverse event rates, and 70 percent of diagnosed lung cancer cases were detected at early stages in their development. 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.
Implications
- 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.
