Abstract 3679: Preliminary results from a patient group, excluded from the National Lung Cancer Screening Trial, who are at high risk for lung cancer- heavy smokers with HIV

Abstract

Abstract Purpose: Within the HIV population, the incidence of lung cancer is estimated to be 2-4 times that of the general population. Of the non AIDS associated malignancies, lung cancer is the leading cause of death among HIV patients who develop malignancy because of its advanced stage of presentation. The National Lung Cancer Screening Trial recently reported a 20% reduction in mortality for patients undergoing low dose computed tomography (CT) screening, but individuals with HIV diagnosis were excluded. To report the results of an observational pilot study of lung cancer CT screening in a cohort of HIV heavy smokers. Materials and Methods: A prospective cohort study was performed with 185 asymptomatic individuals with confirmed HIV diagnosis who had smoked 20 pack-years or more. All participants had baseline (prevalence) chest CT scanning and 107 patients (58.2%) also received at least one subsequent annual (incidence) examination of the chest and upper abdomen. All patients underwent hand held spirometry testing, cytologic analysis of sputa, and detailed health status questioning. Results: Of the 185 individuals, there were 31.4% females, 68.6% males, 90.3% African-Americans, 8.7% Caucasian, and 1.1% Hispanic. The median age at enrolment was 48 years, and the median number of smoking pack-years was 34. Non-calcified nodules were detected in 4 participants (2.1%) by low-dose prevalent CT compared to no nodules on incident CT scans. Only one patient with malignancy was detected (0.54%) on prevalent scanning and none on incident scanning. Stage of malignancy was advanced. No biopsies were undertaken for benign disease. CT evidence of COPD and coronary artery disease were present in 24% and 27% of patients, respectively. Additional CT findings of clinical importance were noted in the chest in 132 (71.7%) patients and extrathoracically in 30 (16.3%) of patients, respectively. Conclusion: The prevalence results of this pilot study are in line with other observational studies of greater sample size for HIV indeterminate patients. Although the sample size is small, it suggests no elevated incidence of lung cancer in HIV heavy smokers. Although the rate of incident scanning is low, CT screening of HIV patients is feasible. This justifies accruing a larger sample of HIV patients perhaps from an already well defined, large, prospective cohort of HIV heavy smokers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3679. doi:10.1158/1538-7445.AM2011-3679