Benefits Of Lung Cancer Screening Research Articles

Risks associated with cancer screening programmes among multimorbid patients: a systematic review

Abstract Background Cancer screening programmes have been implemented to facilitate early detection of cancer. However, there are risks associated with cancer screening, such as overdiagnosis. This means identifying problems that were never going to cause harm1. This includes identification of abnormalities that do not progress, or that progress too slowly to cause symptoms or harm during a person’s remaining lifetime in the context of multi-morbidity1,2. Aim We conducted a systematic review of the literature to explore the harms associated with overdiagnosis in multimorbid patients when they undergo three different types of cancer screening programmes. Methods The search was conducted on MEDLINE, EMBASE, PSYCHINFO and Scopus from 1960 (cancer screening programmes implementation) until November 2023. Inclusion criteria involved studies with multimorbid participants (having two or more chronic conditions), having one of three common types of cancers (i.e., breast, prostate and lung), and used a standardised method for screening (i.e., mammography, Prostate-specific antigen test, and Low Dose Computed tomography (LDCT) or Computed Tomography scans (CT)). Only peer-reviewed studies published in English were included. Four keyword sets were used, “Multimorbidity”, “Overdiagnosis “, “Patient harms” and “Cancer screening”. Two independent reviewers conducted the search and data extraction. Rayyan web application was used to help with title, and abstract screening, and to compare the independent reviews. The Newcastle-Ottawa scale was used for quality assessment. This systematic review was registered with PROSPERO database (CRD42024475175) and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidance. Ethical approval was not required to undertake this review. Results A total of 200 studies resulted from all the databases search and duplicates (n=29) removed. Titles, abstracts and full-texts were screened, with seven studies meeting the inclusion criteria. Quality assessment of the included studies showed two studies of good quality and five studies of poor quality. All included studies were conducted in the United States. Breast cancer overdiagnosis increased with increasing the number of comorbidities. Rates of overdiagnosis with prostate cancer were higher compared to breast cancer, with multimorbid patients having a 15% higher risk of overdiagnosed malignancies, compared to non-multimorbid individuals. Harms of overdiagnosis were categorised into psychological (e.g. anxiety), physical (e.g. side effects of medications) and financial (e.g. costs to healthcare systems). Overdiagnosis with lung cancer was associated with increased anxiety, with more individuals dying from other causes than lung cancer in post-mortem studies, questioning the risk versus benefit of lung cancer screening result interpretation for non-progressive disease. Conclusion The emergence of sophisticated testing technologies and greater access to screening tests can contribute to overdiagnosis. We found many different types of harm related to overdiagnosis in common types of cancer. Further research is required to explore the risk of overdiagnosis with other types of cancer. Awareness of clinicians about the risks of overdiagnosis, particularly in high-risk population, such as multimorbid patients, could guide their decision-making regarding non-progressive cancer treatment.

Lung Cancer Screening Health Belief Model: Psychometric Properties of the Arabic Version and Factors Influencing Screening and Prevention Among Jordanians.

Several screening models have recently been applied to study awareness and help people make informed decisions regarding cancer screening. This study aimed to explore the knowledge, attitudes, and lung cancer screening health beliefs (LCSHBs) among Jordanians. Moreover, we intended to translate the LCSHBs scale into the Arabic language and test its validity and reliability. An online survey (Google Forms) was completed by 916 participants in Jordan via snowball sampling technique from February 10, 2024, to March 2, 2024, assessing lung cancer screening knowledge, lung cancer preventive attitudes, screening-related health beliefs, and stages of screening adoption. Linear regression analysis, correlations, and non-parametric statistics were utilized for statistical inference. Participants had high mean percentage scores of 86.56% and 85.75% for knowledge and preventive attitudes towards lung cancer screening, respectively. The Arabic version of the LCSHBs model was found to be a valid and reliable tool, as indicated by principal component analysis extraction and Cronbach's alpha values. Lung cancer screening knowledge was positively associated with perceived benefits and negatively associated with perceived barriers to screening. Knowledge, perceived barriers, perceived risk of lung cancer, self-efficacy (SE) to screen, and lung cancer preventive attitudes were significantly associated with the perceived benefits of lung cancer screening (p<0.05). We also found that the higher the SE, the higher the physical activity and the lower the perceived barriers. The Arabic version of the LCSHBs model is valid and reliable for assessing health beliefs toward lung cancer screening. We recommend enhancing targeted interventions, educational outreach, and improving health insurance access to reduce lung cancer incidence in Jordan and promote screening behaviors.

The American Cancer Society National Lung Cancer Roundtable strategic plan: Implementation of high-quality lung cancer screening.

More than a decade has passed since researchers in the Early Lung Cancer Action Project and the National Lung Screening Trial demonstrated the ability to save lives of high-risk individuals from lung cancer through regular screening by low dose computed tomography scan. The emergence of the most recent findings in the Dutch-Belgian lung-cancer screening trial (Nederlands-Leuvens Longkanker Screenings Onderzoek [NELSON]) further strengthens and expands on this evidence. These studies demonstrate the benefit of integrating lung cancer screening into clinical practice, yet lung cancer continues to lead cancer mortality rates in the United States. Fewer than 20% of screen eligible individuals are enrolled in lung cancer screening, leaving millions of qualified individuals without the standard of care and benefit they deserve. This article, part of the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) strategic plan, examines the impediments to successful adoption, dissemination, and implementation of lung cancer screening. Proposed solutions identified by the ACS NLCRT Implementation Strategies Task Group and work currently underway to address these challenges to improve uptake of lung cancer screening are discussed. PLAIN LANGUAGE SUMMARY: The evidence supporting the benefit of lung cancer screening in adults who previously or currently smoke has led to widespread endorsement and coverage by health plans. Lung cancer screening programs should be designed to promote high uptake rates of screening among eligible adults, and to deliver high-quality screening and follow-up care.

Community Awareness of Lung Cancer Screening: A Cross-sectional Survey

BackgroundLung cancer remains the leading cause of cancer mortality in the United States, but only 4.5% of eligible people undergo recommended screening. We hypothesize that low community awareness remains a barrier to lung cancer screening. MethodsA cross-sectional survey was conducted in a convenience sample of attendees at our institution’s community health fair. Survey topics included demographics, smoking history, cancer history, lung cancer screening knowledge, and perceptions of screening risks and benefits. ResultsOf 214 survey participants, 139 (65%) were women, and there were 98 (46%) Asian and 86 (40%) White participants. Almost a third of the sample had worked in health care, and just more than a half had completed some graduate school. There were only 6 (2.8%) current smokers and 28 (13%) former smokers. Most participants (71%) did not know there was a way to screen for lung cancer. Most participants (66%) knew that cigarette smoking was the risk factor considered for lung cancer screening, but very few knew the screening criteria. More than 75% of participants chose “strongly agree” or “agree” that several benefits of lung cancer screening are important to consider, but only 50.0% to 66.3% for several risks. Most participants (71%) responded that they are “very likely” or “likely” to undergo screening if eligible. ConclusionsIn a survey study at a community health fair, community awareness of lung cancer screening was very low, but most participants said they would be willing to be screened if eligible. Community education is critical in increasing our lung cancer screening rates.

The Use of a Tailored Decision Aid to Improve Understanding of Lung Cancer Screening in People With HIV

People with HIV are at increased risk for lung cancer and multimorbidity, complicating the balance of risks and benefits of lung cancer screening. We previously adapted Decision Precision (screenlc.com) to guide shared decision-making for lung cancer screening in people with HIV. Does an HIV-adapted and personally tailored decision aid improve shared decision-making regarding lung cancer screening in people with HIV as measured by knowledge, decisional conflict, and acceptability? This was a single-arm pilot trial of the decision aid in 40 participants with HIV eligible for lung cancer screening. The decision aid included personalized screening recommendations and HIV-specific, five-year risk estimates of lung cancer and all-cause mortality. Participants reviewed the decision aid at shared decision-making visits and completed pre- and post-visit surveys with measures of knowledge about lung cancer screening, acceptability, and decisional conflict. The 40 enrolled participants were a median 62 years old and 60% were currently smoking with median five-year risks of lung cancer and all-cause mortality of 2.0% (IQR 1.4-3.3%) and 4.1% (IQR 3.3-7.9%). Personalized recommendations included "Encourage Screening" for 53% of participants and "Preference Sensitive" recommendations for the remainder. Participants showed improvement in two validated knowledge measures with relative improvement of 60% (p<0.001) on the LCS-12 and 27% (p<0.001) on the LKS-7, with significant improvement on questions regarding false-positive and false-negative findings, incidental findings, lung cancer-specific mortality benefit, and the possible harms of screening. Participants reported low scores on the decisional conflict scale (median score 0, IQR 0-5) and high acceptability. Ninety percent ultimately underwent screening within one month of the visit. This HIV-adapted and personally tailored decision aid improved participants' knowledge of risks, benefits, and characteristics of screening with low decisional conflict and high acceptability. This decision aid can enable high-quality shared decision-making in this high-risk population.

Challenges Addressing Lung Cancer Screening for Patients With Multimorbidity in Primary Care: A Qualitative Study.

Many individuals who are eligible for lung cancer screening have comorbid conditions complicating their shared decision-making conversations with physicians. The goal of our study was to better understand how primary care physicians (PCPs) factor comorbidities into their evaluation of the risks and benefits of lung cancer screening and into their shared decision-making conversations with patients. We conducted semistructured interviews by videoconference with 15 PCPs to assess the extent of shared decision-making practices and explore their understanding of the intersection of comorbidities and lung cancer screening, and how that understanding informed their clinical approach to this population. We identified 3 themes. The first theme was whether to discuss or not to discuss lung cancer screening. PCPs described taking additional steps for individuals with complex comorbidities to decide whether to initiate this discussion and used subjective clinical judgment to decide whether the conversation would be productive and beneficial. PCPs made mental assessments that factored in the patient's health, life expectancy, quality of life, and access to support systems. The second theme was that shared decision making is not a simple discussion. When PCPs did initiate discussions about lung cancer screening, although some believed they could provide objective information, others struggled with personal biases. The third theme was that ultimately, the decision to be screened was up to the patient. Patients had the final say, even if their decision was discordant with the PCP's advice. Shared decision-making conversations about lung cancer screening differed substantially from the standard for patients with complex comorbidities. Future research should include efforts to characterize the risks and benefits of LCS in patients with comorbidities to inform guidelines and clinical application.

Acceptability of Personalized Lung Cancer Screening Program Among Primary Care Providers.

Personalized LCS facilitated by a risk model and/or a biomarker test is proposed as an alternative to existing programs. Acceptability of personalized approach among PCPs is unknown. The goal of this study is to assess the acceptability of personalized LCS among PCPs.

Proactively tailoring implementation: the case of shared decision-making for lung cancer screening across the VA New England Healthcare Network

BackgroundShared Decision-Making to discuss how the benefits and harms of lung cancer screening align with patient values is required by the US Centers for Medicare and Medicaid and recommended by multiple organizations. Barriers at organizational, clinician, clinical encounter, and patient levels prevent SDM from meeting quality standards in routine practice. We developed an implementation plan, using the socio-ecological model, for Shared Decision-Making for lung cancer screening for the Department of Veterans Affairs (VA) New England Healthcare System. Because understanding the local context is critical to implementation success, we sought to proactively tailor our original implementation plan, to address barriers to achieving guideline-concordant lung cancer screening.MethodsWe conducted a formative evaluation using an ethnographic approach to proactively identify barriers to Shared Decision-Making and tailor our implementation plan. Data consisted of qualitative interviews with leadership and clinicians from seven VA New England medical centers, regional meeting notes, and Shared Decision-Making scripts and documents used by providers. Tailoring was guided by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS).ResultsWe tailored the original implementation plan to address barriers we identified at the organizational, clinician, clinical encounter, and patient levels. Overall, we removed two implementation strategies, added five strategies, and modified the content of two strategies. For example, at the clinician level, we learned that past personal and clinical experiences predisposed clinicians to focus on the benefits of lung cancer screening. To address this barrier, we modified the content of our original implementation strategy Make Training Dynamic to prompt providers to self-reflect about their screening beliefs and values, encouraging them to discuss both the benefits and potential harms of lung cancer screening.ConclusionsFormative evaluations can be used to proactively tailor implementation strategies to fit local contexts. We tailored our implementation plan to address unique barriers we identified, with the goal of improving implementation success. The FRAME-IS aided our team in thoughtfully addressing and modifying our original implementation plan. Others seeking to maximize the effectiveness of complex interventions may consider using a similar approach.

Benefit-to-radiation-risk of low-dose computed tomography lung cancer screening.

The US National Lung Screening Trial (NLST) and Dutch-Belgian NELSON randomized controlled trials have shown significant mortality reductions from low-dose computed tomography (CT) lung cancer screening (LCS). NLST, ITALUNG, and COSMOS trials have provided detailed dosimetry data for LCS. LCS trial mortality benefit results, organ dose and effective dose data, and Biological Effects of Ionizing Radiation, Report VII (BEIR VII) organ dose-to-cancer-mortality risk data are used to estimate benefit-to-radiation-risk ratios of the NLST, ITALUNG, and COSMOS trials. Data from those trials also are used to estimate benefit-to-radiation-risk ratios for longer-term LCS corresponding to scenarios recommended by United States Preventive Services Task Force and the American Cancer Society. Including only screening doses, NLST benefit-to-radiation-risk ratios are 12:1 for males, 19:1 for females, and 16:1 overall. Including both screening and estimated follow-up doses, benefit-to-radiation-risk ratios for NLST are 9:1 for males, 13:1 for females, and 12:1 overall. For the ITALUNG trial, the benefit-to-radiation-risk ratio is 58-63:1. For the COSMOS trial, assuming sex-specific mortality benefits like those of the NELSON trial, the benefit-to-radiation-risk ratio is 23:1. Assuming a conservative 20% mortality benefit, annual screening in people 50-79 years old with a 20+ pack-year history of smoking has benefit-to-radiation-risk ratios of 23:1 (with follow-up doses adding 40% to screening doses) to 29:1 (with follow-up adding 10%) based on COSMOS dose data. Based on linear, no threshold BEIR VII dose-risk estimates, benefit-to-radiation-risk ratios for LCS are highly favorable. Results emphasize the importance of using modern CT technologies, maintaining low diagnostic follow-up rates, and minimizing both screening and diagnostic follow-up doses. The benefits of lung cancer screening significantly outweigh estimates of future harms associated with exposure to radiation during screening and diagnostic follow-up examinations. Our findings emphasize the importance of lung cancer screening practices using state-of-the-art computed tomography scanners and specialized low-dose lung screening and diagnostic follow-up techniques.

What Goes into Patient Selection for Lung Cancer Screening? Factors Associated with Clinician Judgments of Suitability for Screening.

Rationale: Achieving the net benefit of lung cancer screening (LCS) depends on optimizing patient selection. Objective: To identify factors associated with clinician assessments that a patient was unlikely to benefit from LCS ("LCS-inappropriate") because of comorbidities or limited life expectancy. Methods: Retrospective analysis of patients assessed for LCS at 30 Veterans Health Administration facilities from January 1, 2015 to February 1, 2021. We conducted hierarchical mixed-effects logistic regression analyses to determine factors associated with clinicians' designations of LCS inappropriateness (primary outcome), accounting for 3-year predicted probability (i.e., competing risk) of non-lung cancer death. Measurements and Main Results: Among 38,487 LCS-eligible patients, 1,671 (4.3%) were deemed LCS-inappropriate by clinicians, whereas 4,383 (11.4%) had an estimated 3-year competing risk of non-lung cancer death greater than 20%. Patients with higher competing risks of non-lung cancer death were more likely to be deemed LCS-inappropriate (odds ratio [OR], 2.66; 95% confidence interval [CI], 2.32-3.05). Older patients (ages 75-80; OR, 1.45; 95% CI, 1.18-1.78) and those with interstitial lung disease (OR, 1.98; 95% CI, 1.51-2.59) were more likely to be deemed LCS-inappropriate than would be explained by competing risk of non-lung cancer death, whereas patients currently smoking (OR, 0.65; 95% CI, 0.58-0.73) were less likely to be deemed LCS-inappropriate, suggesting that clinicians over- or underweighted these factors. The probability of being deemed LCS-inappropriate varied from 0.4% to 74%, depending on the clinician making the assessment (median OR, 3.07; 95% CI, 2.89-3.25). Conclusion: Concerningly, the likelihood that a patient is deemed LCS-inappropriate is more strongly associated with the clinician making the assessment than with patient characteristics. Patient selection may be optimized by providing decision support to help clinicians assess net LCS benefit.

Tobacco treatment specialists’ knowledge, attitudes and beliefs about lung cancer screening: Potential piece of the puzzle for increasing lung cancer screening awareness

ObjectivesLess than 5% of eligible U.S. individuals undergo lung cancer screening (LCS). A significant barrier is lack of awareness; more effective outreach and education strategies are needed to achieve greater population LCS uptake. Tobacco Treatment Specialists (TTSs) are an untapped resource to assist and understanding TTS knowledge and perspectives about LCS and readiness and capacity to assist is a critical first step. MethodsA sequential explanatory mixed-methods study design was conducted to understand LCS knowledge, attitudes, beliefs, and practices of TTSs. A cross-sectional survey (N = 147) was conducted supplemented with 3 focus groups (N = 12). ResultsTTSs lacked good working knowledge about LCS in general and screening guidelines, but think it is important for their patient population and open to routinely assessing and adding this educational component into their current workflow. ConclusionsTobacco treatment offers a unique venue for LCS awareness and is a setting where there are experienced specialists trained in tobacco use assessment and treatment. Results highlight the unmet training needs required to facilitate integration of tobacco treatment and LCS. Practice ImplicationsTTSs are an expanding healthcare workforce. There is a strong need for current TTSs to receive additional training in the benefits of LCS.

Lung cancer screening status and acceptability of a personalized approach in Texas.

e22516 Background: Current lung cancer screening (LCS) guidelines rely on age and smoking history. Despite its proven benefit, only 5-15% of eligible patients receive LCS, with Texas having one of the lowest rates among states in the US. Personalized screening strategies select people for LCS based on their personal lung cancer risk and may increase LCS’s effectiveness and efficiency. We assess current LCS practices and the acceptability of personalized LCS among primary care providers (PCP) in Texas. Methods: We surveyed 32,983 Texas-based PCPs including primary care physicians, physician assistants, and nurse practitioners on an existing network (Protocol 2019-1257; PI: Dr. Shete), and 400 attendees of the 2022 Texas Academy of Family Physicians (TAFP) conference. Deidentified demographics, current LCS practices, and acceptability of personalized LCS were obtained. We analyzed the responses by subgroups of interest using comparative statistics. Using nonparametric bootstrap, we derived an enriched dataset and utilized it to develop logistic regression models to further understand respondent tendencies related to current LCS practices and acceptability of personalized LCS. Results: Response rates were 0.3% (n=91) and 15% (n=60) for the 2019-1257 and TAFP surveys, respectively. Respondent demographics are provided in the table. Most (84%) respondents regularly assess LCS in their practice, with those in the following categories more likely to assess for LCS eligibility: 40-49 years old, female, non-Black, physicians, with &lt;10 years in practice, seeing &gt;50 patients per week, and work at a non-residency training site (all p-values &lt; 0.05). Half of the respondents were interested in adopting personalized LCS while an additional 40% wanted to learn more information. Respondents in the following categories were associated with increased interest in personalized LCS: younger than 60 years, non-White, non-physicians, seeing 100 or more patients per week, at a non-residency training site, and at a decentralized practice (all p values &lt; 0.05). Majority (66%) of respondents expressed concerns regarding time availability with the personalized LCS. Conclusions: There is a great need to enhance the awareness and engagement of Texas-based PCPs about LCS. Most of the respondents expressed interest in personalized LCS. Time availability was the main concern related to personalized LCS. Findings from this project highlight the need for better education of Texas-based PCPs on the benefits of LCS, and the development of efficient decision tools to facilitate shared decision-making sessions to ensure successful implementation of personalized LCS. [Table: see text]

U.S. Newspaper Coverage of Lung Cancer Screening From 2010 to 2022.

BACKGROUND. Newspapers are an important source of information for the public about low-dose CT (LDCT) lung cancer screening (LCS) and may influence public perception and knowledge of this important cancer screening service. OBJECTIVE. The purpose of this article was to evaluate the volume, content, and other characteristics of articles pertaining to LCS that have been published in U.S. newspapers. METHODS. The ProQuest U.S. Newsstream database was searched for U.S. newspaper articles referring to LCS published between January 1, 2010 (the year of publication of the National Lung Screening Trial results), and March 28, 2022. Search terms included "lung cancer screening(s)," "lung screening(s)," "low dose screening(s)," and "LDCT." Search results were reviewed to identify those articles mentioning LCS. Characteristics of included articles and originating newspapers were extracted. Articles were divided among nine readers, who independently assessed article sentiment regarding LCS and additional article content using a standardized form. RESULTS. The final analysis included 859 articles, comprising 816 nonsyndicated articles published in a single newspaper and 43 syndicated articles published in multiple newspapers. Sentiment regarding LCS was positive in 76% (651/859) of articles, neutral in 21% (184/859), and negative in 3% (24/859). Frequency of positive sentiment was lowest (61%) for articles published from 2010 to 2012; frequency of negative sentiment was highest (8%) for articles published in newspapers in the highest quartile for weekly circulation. LCS enrollment criteria were mentioned in 52% of articles, smoking cessation programs in 28%, need for annual CT in 27%, and shared decision-making in 4%. Cost or insurance coverage for LCS was mentioned in 33% in articles. A total of 64% of articles mentioned at least one benefit of LCS (most commonly early detection or possible cure of lung cancer), and 23% mentioned at least one harm (most commonly false-positives). A total of 9% of articles interviewed or mentioned a radiologist. CONCLUSION. The sentiment of U.S. newspaper articles covering LCS from 2010 to 2022 was overall positive. However, certain key elements of LCS were infrequently mentioned. CLINICAL IMPACT. The findings highlight areas for potential improvement of LCS media coverage; radiologists have an opportunity to take a more active role in this coverage.

Expanding the Reach and Grasp of Lung Cancer Screening.

Low-dose computer tomographic (LDCT) lung cancer screening reduces lung cancer-specific and all-cause mortality among high-risk individuals, but implementation has been challenging. Despite health insurance coverage for lung cancer screening in the United States since 2015, fewer than 10% of eligible persons have participated; striking geographic, racial, and socioeconomic disparities were already evident, especially in the populations at greatest risk of lung cancer and, therefore, most likely to benefit from screening; and adherence to subsequent testing is significantly lower than that reported in clinical trials, potentially reducing the realized benefit. Lung cancer screening is a covered health care benefit in very few countries. Obtaining the full population-level benefit of lung cancer screening will require improved participation of already eligible persons (the grasp of screening) and improved eligibility criteria that more closely match up with the full spectrum of persons at risk (the reach of screening), irrespective of smoking history. We used the socioecological framework of health care to systematically review implementation barriers to lung cancer screening and discuss multilevel solutions. We also discussed guideline-concordant management of incidentally detected lung nodules as a complementary approach to early lung cancer detection that can extend the reach and strengthen the grasp of screening. Furthermore, we discussed ongoing efforts in Asia to explore the possibility of LDCT screening in populations in whom lung cancer risk is relatively independent of smoking. Finally, we summarized innovative technological solutions, including biomarker selection and artificial intelligence strategies, to improve the safety, effectiveness, and cost-effectiveness of lung cancer screening in diverse populations.

Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination

Maximizing benefits of lung cancer screening requires timely follow-up after a positive screening test. The American College of Radiology (ACR) Lung CT Screening Reporting and Data System (Lung-RADS) recommends testing and follow-up timing based on the screening result. To determine rates of and factors associated with recommended follow-up after a positive lung cancer screening examination by Lung-RADS category. This prospective cohort study of lung cancer screening examinations performed from January 1, 2015, through July 31, 2020, with follow-up through July 31, 2021, was conducted at 5 academic and community lung cancer screening sites in North Carolina. Participants included 685 adults with a positive screening examination, Lung-RADS categories 3, 4A, 4B, or 4X. Statistical analysis was performed from December 2020 to March 2022. Individual age, race, sex, smoking exposure, year of lung cancer screening examination, chronic obstructive pulmonary disease, body mass index, referring clinician specialty, rural or urban residence. Adherence, defined as receipt of recommended follow-up test or procedure after the positive screen per ACR Lung-RADS timeframes: 6 months for Lung-RADS 3 and 3 months for Lung-RADS 4A. For Lung-RADS 4B or 4X, adherence was defined as follow-up care within 4 weeks, as ACR Lung-RADS does not specify a timeframe. Among the 685 individuals included in this study who underwent lung cancer screening with low-dose computed tomography, 416 (60.7%) were aged at least 65 years, 123 (18.0%) were Black, 562 (82.0%) were White, and 352 (51.4%) were male. Overall adherence to recommended follow-up was 42.6% (292 of 685) and varied by Lung-RADS category: Lung-RADS 3 = 30.0% (109 of 363), Lung-RADS 4A = 49.5% (96 of 194), Lung-RADS 4B or 4X = 68.0% (87 of 128). Extending the follow-up time increased adherence: Lung-RADS 3 = 68.6% (249 of 363) within 9 months, Lung-RADS 4A = 77.3% (150 of 194) within 5 months, and Lung-RADS 4B or 4X = 80.5% (103 of 128) within 62 days. For Lung-RADS 3, recommended follow-up was less likely among those currently smoking vs those who quit (adjusted odds ratio [aOR], 0.48; 95% CI, 0.29-0.78). In Lung-RADS 4A, recommended follow-up was less likely in Black individuals vs White individuals (aOR, 0.35; 95% CI, 0.15-0.86). For Lung-RADS 4B or 4X, recommended follow-up was more likely in female individuals vs male individuals (aOR, 2.82; 95% CI, 1.09-7.28) and less likely in those currently smoking vs those who quit (aOR, 0.31; 95% CI, 0.12-0.80). In this cohort study, adherence to recommended follow-up after a positive screening examination was low but improved among nodules with a higher suspicion of cancer and after extending the follow-up timeline. However, the association of extending the follow-up time of screen-detected nodules with outcomes at the population level, outside of a clinical trial, is unknown. These findings suggest that studies to understand why recommended follow-up is lower in Black individuals, male individuals, and individuals currently smoking are needed to develop strategies to improve adherence.

Review of the future of lung cancer screening

: Lung cancer screening has progressed greatly in the last two decades since the initial publication of Early Lung Cancer Action Project (ELCAP) in 1999. Since then, large randomized trials, the National Lung Screening Trial (NLST) and NELSON studies, have also shown the benefit of lung cancer screening with CT, and it is now widely available. There are many areas for improving the benefit of screening by refining the eligibility criteria, continued optimization of the screening regimen, identifying other related diseases, and improved treatment. As artificial intelligence (AI) techniques continue to improve, an automated report of all diseases can be produced from the low-dose CT scan. New screening tests are being developed for lung cancer including blood-based tests. There is growing recognition that use of risk factor-based criteria which dichotomize age and pack-years of smoking to select eligible individuals for screening may not be the most efficient and may also lead to increased lung cancer disparity. Continued research will focus on optimal approaches for selecting high risk individuals for lung cancer screening and thus hopefully expand eligibility criteria beyond the current criteria which include only 20% of lung cancer patients. With the increase in early stage lung cancers identified from lung cancer screening, a key focus of ongoing research is the treatment of these cancers.

Health beliefs toward lung cancer screening among Chinese American high-risk smokers: Interviews based on Health Belief Model

ObjectiveThis study aims to explore health beliefs toward lung cancer screening with low dose computed tomography among Chinese American high-risk smokers. MethodsGuided by the Health Belief Model, semi-structured individual interviews were conducted with Chinese American high-risk smokers via phone. Additional questionnaires on demographic information, history of smoking and lung cancer screening were collected via email or phone before the interview, depending on participants’ preference. Content analysis was used to extract meaningful and significant themes in the dataset. Constant comparison analysis and process coding were used to categorize and code data. ResultsData saturation was reached after interviewing 12 participants. Chinese American high-risk smokers perceived a low susceptibility to lung cancer, since they believed various protective factors of lung cancer (e.g., doing exercise, healthy diet, etc.) reduced their risk of getting lung cancer. All the participants perceived a high severity of lung cancer. They acknowledged lung cancer would have a huge impact on their life. Perceived benefits of lung cancer screening were accurate in most aspects although minor confusions were still noticed among this population. Perceived barriers varied on participants’, physicians’, and institutional levels. High-risk Chinese American smokers had little confidence to screening for lung cancer. Cues to action for them to screening for lung cancer included recommendations from health care providers, support from family members and friends, and information shared on Chinese-based social media. ConclusionsMisconceptions and barriers to screening for lung cancer existed widely among Chinese American high-risk smokers. Intervention programs and targeted health education should be implemented to promote lung cancer screening among this population.

Abstract 23: Will novel systemic treatments alter the benefit of lung cancer screening?: A microsimulation study

Abstract Background: The U.S. Preventive Services Task Force has recently updated its 2013 lung cancer screening guidelines with low-dose computed tomography. In the last decade, population level mortality for advanced non-small cell lung cancer fell significantly due to the novel targeted and immunotherapy-based treatments. Moreover, with detection of new molecular targets, these therapies are expected to become the ultimate curative options. However, how these treatments might impact the benefits of lung cancer screening is unknown. Methods: We utilize a computer microsimulation modeling framework to screen the U.S. population aged 50 to 80 who had a 20 pack-year smoking history and currently smoked or had quit within the past 15 years under both standard treatments (chemotherapy and radiotherapy) and novel treatments (immunotherapy and targeted therapy) settings. The corresponding mortality reductions associated with the stage shift via low-dose computed screening are projected for each setting. Results: Over 25 years, risk-targeted screening saves 243 lives per 20,000 under standard therapies (12% mortality reduction) and 99 per 20,000 under fully adopted novel therapies (6% mortality reduction). Under standard treatment, 1.28 cancers are over-diagnosed per life saved; under fully adopted novel therapies, this increases to 3.46. Over 25 years the number needed to screen to avert one death is 82 under standard treatment and 202 under fully adopted novel therapies. Conclusions: Ongoing transition from chemotherapy and radiotherapy to novel immunotherapies and targeted therapies may reduce the expected lives saved by low-dose computed tomography screening. Screening recommendations might need to be reconsidered as novel treatments become widespread. Citation Format: Kemal Caglar Gogebakan, Jane Lange, Christopher Slatore, Ruth Etzioni. Will novel systemic treatments alter the benefit of lung cancer screening?: A microsimulation study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 23.

Comorbidity and life expectancy in shared decision making for lung cancer screening

Shared decision making (SDM) is an important part of lung cancer screening (LCS) that includes discussing the risks and benefits of screening, potential outcomes, patient eligibility and willingness to participate, tobacco cessation, and tailoring a strategy to an individual patient. More than other cancer screening tests, eligibility for LCS is nuanced, incorporating the patient's age as well as tobacco use history and overall health status. Since comorbidities and multimorbidity (ie, 2 or more comorbidities) impact the risks and benefits of LCS, these topics are a fundamental part of decision-making. However, there is currently little evidence available to guide clinicians in addressing comorbidities and an individual's "appropriateness" for LCS during SDM visits. Therefore, this literature review investigates the impact of comorbidities and multimorbidity among patients undergoing LCS. Based on available evidence and guideline recommendations, we identify comorbidities that should be considered during SDM conversations and review best practices for navigating SDM conversations in the context of LCS. Three conditions are highlighted since they concomitantly portend higher risk of developing lung cancer, potentially increase risk of screening-related evaluation and treatment complications and can be associated with limited life expectancy: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and human immunodeficiency virus infection.

Impact of Comorbidities on Lung Cancer Screening Evaluation

Objectives: We used data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial to examine the impact of self-reported chronic obstructive pulmonary disease, coronary artery disease, stroke, and diabetes mellitus on diagnostic complications in lung cancer screening evaluation. Methods: In our analysis, we included individuals from the usual care and intervention (annual chest x-ray) of the lung cancer screening trial with equal or greater than 55 years of age with a 20 pack-year smoking history who had undergone an invasive procedure. We performed multivariate logistic regression analysis to estimate the association of comorbidity on procedure complication. Our primary outcome was the incidence of major or moderate complications. Results: Features associated with high-risk complication included older age (OR = 1.03 per year, P = .001), history of coronary artery disease (OR = 1.40, P = .03), history of diabetes mellitus (OR = 0.41, P < .001, current smoking status (OR = 1.46, P ≤ .001), surgical biopsy (OR = 7.39, P < .001), needle biopsy (OR = 1.94, P < .001), and other invasive procedure (OR = 1.58, P < .001). We did not find an associated with complication and history of stroke (OR = 0.84, P = .53) or chronic obstructive pulmonary disease (OR = 1.27, P = .06). Conclusion: Patient and procedure-level factors may alter the benefits of lung cancer screening. Data concerning individual risk factors and high-risk complications should therefore be incorporated into diagnostic algorithms to optimize clinical benefit and minimize harm. Further study and validation of the risk factors identified herein are warranted.