P41.06 As Seen from the Rearview Mirror: A Retrospective Analysis of Lung Cancer Screening in Patients with Lung Cancer

Abstract

Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. The U.S. Preventive Services Task Force (USPSTF) and National Comprehensive Cancer Network (NCCN) recommend LC screening with low dose CT (LDCT) in high-risk individuals who meet criteria, which primarily focus on age and smoking history. Despite this, screening rates remain low. We conducted a retrospective analysis of patients with LC to evaluate the screening practices and rates for screening prior to their LC diagnosis. Patients diagnosed with LC between 2016 and 2019 were included in the analysis. Charts were reviewed for demographics, detailed smoking history, as well as histology and stage of LC. Associations between categorical factors and screening and were examined using the chi-square test. Associations between continuous and ordinal factors and screening and were examined using the Mann-Whitney test. Of the 530 charts reviewed, 64.3% and 43.2% met NCCN and USPSTF criteria for screening, however, only 10.9% and 12.9%, respectively, were referred for screening. A total of 4% and 4.9% of the subjects who did not meet NCCN nor USPSTF criteria were referred for screening [Table 1]. Of the 30 eligible patients who underwent screening, only 36.7% had LDCT, while 20% had chest X-ray and 43.3% had other types of CT scans. Eligible patients that met NCCN and/or USPSTF criteria and underwent screening were diagnosed at earlier stages [graph 1].Table 1Screening tendencies for eligible and ineligible patientsReferred for screeningMet NCCN criteriaDid not meet NCCN criteriaMet USPSTF criteriaDid not meet USPSTF criteriaYes30 (10.9%)6 (4%)24 (12.9%)12 (4.9%)No246 (89.1%)145 (96%)162 (87.1%)233 (95.1%) Open table in a new tab Our study showed that despite established guidelines for LC screening and insurance coverage, a vast majority of screening-eligible LC patients have never had LDCT. Lack of patient referral and wrong patient selection for screening suggests that physicians are not comfortable or entirely aware of screening guidelines. In patients that were eligible for screening, there was an improvement in earlier staging even with suboptimal screening.