P2.13-008 Lung Cancer Screening Improves Mortality: Examining Screening Patterns in an Urban Underserved Community

Abstract

The landmark Lung Cancer Screening (LCS) Trial demonstrated a significant reduction in mortality. However, European LCS trials have not confirmed such benefit. We examined the impact of LCS-led diagnosis on the mortality of newly diagnosed lung cancer patients at an urban medical center. Medical records of patients diagnosed with primary lung cancer for the period 2013-2015 (n=638) were reviewed to identify those who had an established primary care provider (PCP), were LCS-eligible/ non LCS-diagnosed, and LCS-eligible/LCS-diagnosed as per the United States Preventative Services Task Force (USPSTF) guidelines. Baseline characteristics between LCS-eligible/non-diagnosed patients and LCS-eligible/diagnosed patients were analyzed using chi-squared and Wilcoxon-Mann-Whitney tests. Kaplan-Meier curves were generated, and predictors of overall survival were evaluated using Cox proportional hazards modeling. 134 primary lung cancer patients had an established PCP and were LCS-eligible; 19/134 (14%) were LCS-diagnosed. LCS-eligible/LCS-diagnosed patients were of younger age (p=0.03), English-speaking (p=0.03), of higher socioeconomic status (p=0.02), active smokers (p<0.01), and had earlier disease stages (p=0.02) than LCS-eligible/non-diagnosed patients. All-cause mortality was significantly lower in LCS-eligible/diagnosed patients compared to LCS-eligible/non-diagnosed patients (p=0.03). Disease stage was found to be the main factor associated with higher mortality by multivariate regression analysis (HR: 6.13, stage 4 vs. stage 1-2, p<0.01). To our knowledge, this is the first report of lung cancer mortality differences in LCS eligible patients as a function of them undergoing or not LCS in a single-center setting since the inception of the USPSTF guidelines. Patients with an LCS-led diagnosis had a reduced mortality, probably as a result of having an earlier disease stage, which echoes the findings of large prospective LCS trials. LCS-led diagnosis rates remain low among lung cancer patients. Fully implementing the USPSTF guidelines constitutes a great unrealized opportunity to decrease lung cancer mortality.