Low-dose CT Lung Cancer Screening Research Articles

OA10.05 Integrating Smoking Cessation into LDCT Lung Cancer Screening. Results of the Ontario, Canada, Pilot

Screening for lung cancer (LC) using low-dose computed tomography (LDCT) in high-risk individuals reduces LC mortality. In June 2017, Ontario Health (Cancer Care Ontario) initiated a screening Pilot that included a smoking cessation (SC) intervention to inform the implementation of a provincial organized lung screening program.

Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality.

Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality.

Study of the occupational health risk of radon exposure in underground workers in a mine

PurposeTo understand the influence of radon on human health in underground microenvironment of iron mine, and find the sensitive detection index of the influence of radon cumulative exposure on human health. MethodsAccording to National Work Manual of Occupational Radiation disease Surveillance (Survey of Miners with High radon Exposure) and expert consensus on low-dose spiral CT lung cancer screening. Selected 51 underground workers in an iron mine as the observation objects, using chromosome aberration of peripheral blood lymphocytes, micronucleus of lymphocytes, tumor markers of serum and low-dose CT screening of lung cancer as observation indexes. Results6 cases with elevated lymphocyte count (11.8%), NSE (neuron specific enolase) elevation detected 20 (39.2%), abnormal detection of SCC (Squamous cell carcinoma associated antigen) 13 (22.5%), Cyfra21-1 (cytokeratin 19 fragment) was detected 3 (5.9%). Chromosomal abnormalities and micronucleus abnormalities were detected 1 (2.0%). Thyroid nodules were detected 10 (19.6%). Low-dose chest CT detection plaques and funicular shadow 21 (41.2%), nodules 16 (31.4%), bulla 9 (17.6%) frosted (2.0%). ConclusionIn this study, based on the survey and monitoring data of miners in a deep mine, there is a health risk with radon exposure in the occupational health of iron ore workers, in particular, radon exposure causes lung cancer risk, which is a public health problem to be solved.

Deep Learning to Optimize Candidate Selection for Lung Cancer CT Screening: Advancing the 2021 USPSTF Recommendations

Background A deep learning (DL) model to identify lung cancer screening candidates based on their chest radiographs requires external validation with a recent real-world non-U.S. sample. Purpose To validate the DL model and identify added benefits to the 2021 U.S. Preventive Services Task Force (USPSTF) recommendations in a health check-up sample. Materials and Methods This single-center retrospective study included consecutive current and former smokers aged 50-80 years who underwent chest radiography during a health check-up between January 2004 and June 2018. Discrimination performance, including receiver operating characteristic curve analysis and area under the receiver operating characteristic curve (AUC) calculation, of the model for incident lung cancers was evaluated. The added value of the model to the 2021 USPSTF recommendations was investigated for lung cancer inclusion rate, proportion of selected CT screening candidates, and positive predictive value (PPV). Results For model validation, a total of 19 488 individuals (mean age, 58 years ± 6 [SD]; 18 467 [95%] men) and the subset of USPSTF-eligible individuals (n = 7835; mean age, 57 years ± 6; 7699 [98%] men) were assessed, and the AUCs for incident lung cancers were 0.68 (95% CI: 0.62, 0.73) and 0.75 (95% CI: 0.68, 0.81), respectively. In individuals with pack-year information (n = 17 390), when excluding low- and indeterminate-risk categories from the USPSTF-eligible sample, the proportion of selected CT screening candidates was reduced to 35.8% (6233 of 17 390) from 45.1% (7835 of 17 390, P < .001), with three missed lung cancers (0.2%). The cancer inclusion rate (0.3% [53 of 17 390] vs 0.3% [56 of 17 390], P = .85) and PPV (0.9% [53 of 6233] vs 0.7% [56 of 7835], P = .42) remained unaffected. Conclusion An externally validated deep learning model showed the added value to the 2021 U.S. Preventive Services Task Force recommendations for low-dose CT lung cancer screening in reducing the number of screening candidates while maintaining the inclusion rate and positive predictive value for incident lung cancer. © RSNA, 2022 Online supplemental material is available for this article.

Expected Cost Savings From Low-Dose Computed Tomography Scan Screening for Lung Cancer in Alberta, Canada

IntroductionThe expensive modern therapeutic regimens for advanced lung cancer (LC) stages have been recently approved. We evaluated whether low-dose computed tomography (LDCT) LC screening of high-risk Albertans is cost saving. MethodsWe used a decision analytical modeling technique with a health system perspective and a time horizon of 3 years to compare benefits associated with reduced health service utilization (HSU) from earlier diagnosis to the costs of screening. Using patient-level data, HSU costs by stage of disease were estimated for patients with LC, including inpatient, outpatient, and physician services, and costs for prescription drugs and cancer treatments. ResultsOf 101,000 people aged 55 to 74 years eligible for screening, an estimated 88,476 scans would be performed in Alberta in 3 years. Given LDCT sensitivity and specificity of 90.5% and 93.1%, respectively, we estimated that a stage shift toward earlier diagnosis would be expected whereby 43% more patients would be identified at stage 1 or 2 as compared with without screening. The estimated cost of screening is $35.6 million (M), whereas the stage shift associated with screening would avoid $42M in HSU costs. The net cost avoidance associated with screening is therefore $6.65M. The probability for the screening to be cost saving is estimated at 72%. ConclusionsThis study has revealed that LDCT LC screening is likely to be cost saving in Alberta. Adoption of this program into the provincial health care system is worth considering provided constraints in the system related to surgical capacity and CT wait times could be addressed.

A Coordinated Approach to Implementing Low-Dose CT Lung Cancer Screening in a Rural Community Hospital.

The authors describe a rural community hospital's approach to lung cancer screening using low-dose CT (LDCT) to address the high incidence of lung cancer mortality. An implementation project was conducted, documenting planning, education, and restructuring processes to implement a lung cancer screening program using LDCT in a rural community hospital (population 64,917, Rural-Urban Continuum Code 5) located in a region with the highest lung cancer mortality in Oregon. The hospital and community partners organized the implementation project around five recommendations for an efficient and effective lung cancer screening program that accurately identifies high-risk patients, facilitates timely access to screening, provides appropriate follow-up care, and offers smoking cessation support. Over a 3-year period (2018-2020), 567 LDCT scans were performed among a high-risk population. The result was a 4.8-fold increase in the number of LDCT scans from 2018 to 2019 and 54% growth from 2019 to 2020. The annual adherence rate increased from 51% in 2019 to 59.6% in 2020. Cancer was detected in 2.11% of persons scanned. Among the patients in whom lung cancer was detected, the majority of cancers (66.6%) were categorized as stage I or II. This rural community hospital's approach involved uniting primary care, specialty care, and community stakeholders around a single goal of improving lung cancer outcomes through early detection. The implementation strategy was intentionally organized around five recommendations for an effective and efficient lung cancer screening program and involved planning, education, and restructuring processes. Significant stakeholder involvement on three separate committees ensured that the program's design was relevant to local community contexts and patient centered. As a result, the screening program's reach and adherence increased each year of the 3-year pilot program.

Incidental pulmonary nodules, lung cancer screening, and lung cancer in the Medicare population.

6536 Background: Low-dose CT lung cancer screening (LDCT) saves lives, but only 5%-10% of eligible persons in the US have participated. Management of indeterminate pulmonary nodules (IPNs) identified on CT scans may also reduce lung cancer mortality. We assessed the frequency of IPNs, estimated cumulative lung cancer rates following IPNs, and compared characteristics of lung cancers diagnosed following IPNs versus LDCT screens. Methods: We defined 2 cohorts in the SEER-Medicare database: persons with 12+ months of Medicare Part A&amp;B coverage during 2014-2019 comprised the 5% sample cohort; persons in SEER-Medicare diagnosed with lung cancer during 2015-2017 with Part A&amp;B coverage for the prior 18-month period comprised the lung cancer cohort. We defined IPNs as chest CTs with ICD-10 codes of R91.1 (solitary pulmonary nodule) or R91.8 (other nonspecific abnormal finding of lung field) on the same date as the CT; we used corresponding ICD-9 codes through September 2015. We classified lung cancer cohort cases by whether they had an LDCT (LDCT group), an IPN without an LDCT screen (IPN-only), or neither (Referent) within 18 months before diagnosis. We compared cancer stage and survival between these groups. Results: Of 627,547 subjects in the 5% sample cohort, 58.6% were women; 85.6% were non-Hispanic White (NH-Whites) and 7.7% non-Hispanic Black (NH-Blacks). Over median 5.0 years follow-up, 26.3% had chest CTs and 12.0% had IPNs. The IPN rate was similar by sex but significantly higher in NH-Whites (12.7%) than NH-Blacks (9.7%). The cumulative lung cancer rate following initial IPNs was 2.27% at two years. Of the 44,194 lung cancer cohort cases (85.8% NH-White, 8.2% NH-Black), 26.9%, 2.9% and 70.2% were in the IPN-only, LDCT, and Referent groups, respectively. NH-Whites comprised a higher proportion of LDCT than of IPN-only cases (90.1% vs. 88.4%), while for NH-Blacks, the reverse was true (5.4% vs. 6.5%). The ratio of LDCT:IPN lung cancer cases was 1:9. Among IPN-only and LDCT group cases, 52.0% and 50.3%, respectively, were localized stage, compared to 21.5% for the Referent group. Among all localized cases, 45.4% and 4.9% were in the IPN-only and LDCT groups, respectively. Comparing 3-year survival between IPN vs LDCT vs Referent groups, respectively: aggregate overall survival rates were 53.5% v 59.2% v 29.2%; aggregate lung cancer-specific survival, 71.1% v 75.3% v 46.6%; overall survival for localized cases, 73.2% v 80.7% v 62.9%; lung cancer-specific survival rates for localized cases, 88.2%, 91.8% and 81.4%. Conclusions: Subjects with IPNs had similar stage distribution and survival as LDCT-screened subjects. Almost half of localized cases had prior IPNs, compared to a &lt; 5% of LDCT-screened cases. IPN programs, by circumventing implementation barriers to LDCT, may expand access to early lung cancer detection, including to African American patients and in places where LDCT coverage is not available.

Outcomes from LDCT screening for lung cancer in an undeserved population: A quality initiative.

e13504 Background: Lung cancer is the leading cause of cancer-related mortality worldwide. USPSTF recommends annual lung cancer screening with low dose computed tomography (LDCT) for adults aged 50-80 years with 20-pack year smoking history and are currently smoking or have quit within the past 15 years. Unfortunately, adherence rates with screenings remain suboptimal. This study aimed to assess the compliance rates with LDCT recommendations in a community hospital and propose an implementation plan to enhance patient adherence. Methods: A retrospective study was conducted by analyzing the medical charts of 1090 patients who underwent LDCT screenings at Mercy Catholic Medical Center between January 2018 and June 2021. Medical records were reviewed to determine whether patients had appropriate follow-ups done based on the LUNG-RADs category with focus on those with higher LUNG-RADs designations. A survey was administered to current internal medicine residents to evaluate their understanding of screening guidelines. Based on the survey results and literature review, a plan to enhance adherence with screenings is proposed. Results: Total 1090 patients underwent LDCT screenings, comprising of 522 males and 568 females. 166 patients were assigned LUNG-RADs category 3, 4A, 4B, or 4X. Amongst these 166 patients, compliance rate with recommended follow-up imaging and/or biopsies was only 51.2% (95% confidence interval [CI], 44.0-59.0). 15% of patients had biopsies that were positive for malignancies. 70% of the residents participated in the survey. Only 57% demonstrated knowledge of the recommended age group for screening; only 47% knew the pack-year criteria for screening. Questions gauging the understanding of when to stop screening, implications of imaging findings, and estimated mortality reduction from LDCT screenings underscored the knowledge gap amongst physicians as a factor needing improvement. Conclusions: This study comprised of a patient population primarily from poor socioeconomic and educational background. Therefore, many of the patients in this study may not have fully comprehended the LDCT implications solely from receiving a letter with radiology impressions, leading to the high non-compliance rate observed. To enhance follow-ups, residents should be educated on LDCT screening indications and benefits so they can promote patient health better. After receiving LDCT results, providers should inform patients about the findings either via phone calls or in-person office visits and emphasize the importance of specific follow-ups. We propose the appointment of a designated coordinator to call patients who failed to follow-up to re-emphasize the importance and identify barriers to adherence (i.e., transportation, cost). Studies found an increase in adherence to screening from 22% to 66% after hiring a coordinator. Adherence rates can, thus, be improved by a collaborative team approach.

The Swiss Approach - feasibility of a national low-dose CT lung cancer screening program.

Lung cancer is the leading cause of cancer-related deaths in Switzerland. Despite this, there is no lung cancer screening program in the country. In the United States, low-dose computed tomography (LDCT) lung cancer screening is partially established and endorsed by guidelines. Moreover, evidence is growing that screening reduces lung cancer-related mortality and this was recently shown in a large European randomized controlled trial. Implementation of a lung cancer screening program, however, is challenging and depends on many country-specific factors. The goal of this article is to outline a potential Swiss lung cancer screening program. An exhaustive literature review on international screening models as well as interviews and site visits with international experts were initiated. Furthermore, workshops and interviews with national experts and stakeholders were conducted to share experiences and to establish the basis for a national Swiss lung cancer screening program. General practitioners, pulmonologists and the media should be part of the recruitment process. Decentralisation of the screening might lead to a higher adherence rate. To reduce stigmatisation, the screening should be integrated in a "lung health check". Standardisation and a common quality level are mandatory. The PLCOm2012 risk calculation model with a threshold of 1.5% risk for developing cancer in the next six years should be used in addition to established inclusion criteria. Biennial screening is preferred. LUNG RADS and NELSON+ are applied as classification models for lung nodules. Based on data from recent studies, literature research, a health technology assessment, the information gained from this project and a pilot study the Swiss Interest Group for lung cancer screening (CH-LSIG) recommends the timely introduction of a systematic lung cancer screening program in Switzerland. The final decision is for the Swiss Cancer Screening Committee to make.

Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research.

Lung cancer causes more deaths than breast, cervical, and colorectal cancer combined. Nevertheless, population‐based lung cancer screening is still not considered standard practice in most countries worldwide. Early lung cancer detection leads to better survival outcomes: patients diagnosed with stage 1A lung cancer have a >75% 5‐year survival rate, compared to <5% at stage 4. Low‐dose computed tomography (LDCT) thorax imaging for the secondary prevention of lung cancer has been studied at length, and has been shown to significantly reduce lung cancer mortality in high‐risk populations. The US National Lung Screening Trial reported a 20% overall reduction in lung cancer mortality when comparing LDCT to chest X‐ray, and the Nederlands‐Leuvens Longkanker Screenings Onderzoek (NELSON) trial more recently reported a 24% reduction when comparing LDCT to no screening. Hence, the focus has now shifted to implementation research. Consequently, the 4‐IN‐THE‐LUNG‐RUN consortium based in five European countries, has set up a large‐scale multicenter implementation trial. Successful implementation of and accessibility to LDCT lung cancer screening are dependent on many factors, not limited to population selection, recruitment strategy, computed tomography screening frequency, lung‐nodule management, participant compliance, and cost effectiveness. This review provides an overview of current evidence for LDCT lung cancer screening, and draws attention to major factors that need to be addressed to successfully implement standardized, effective, and accessible screening throughout Europe. Evidence shows that through the appropriate use of risk‐prediction models and a more personalized approach to screening, efficacy could be improved. Furthermore, extending the screening interval for low‐risk individuals to reduce costs and associated harms is a possibility, and through the use of volumetric‐based measurement and follow‐up, false positive results can be greatly reduced. Finally, smoking cessation programs could be a valuable addition to screening programs and artificial intelligence could offer a solution to the added workload pressures radiologists are facing.

The value of supplemental prone imaging in low-dose CT lung cancer screening. A technical note.

This technical note presents our experience with the additional prone examination of patients during low dose CT lung cancer screening. The prone examination adds only a minor amount of radiation and time to the study and can reduce false positive findings that are gravity-dependent.

Pearls and Pitfalls in Lung Cancer CT Screening

Annual LDCT lung cancer screening is recommended by the United States Preventive Services Task Force (USPSTF) for high-risk population based on the results from the National Lung Cancer Screening Trial (NLST) that showed a significant (20%) reduction in lung cancer-specific mortality rate with the use of annual low-dose computed tomography (LDCT) screening. More recently, the benefits of lung cancer screening were confirmed by the Dutch- Belgian NELSON trial in Europe. With the implementation of lung screening in large scale, knowledge of the limitations related to false positive, false negative and other potential pitfalls is essential to avoid misdiagnosis. This review outlines the most common potential pitfalls in the characterization of screen-detected lung nodules that include artifacts in LDCT, benign nodules that mimic lung cancer, and causes of false negative evaluations of lung cancer with LDCT and PET/CT studies. Awareness of the spectrum of potential pitfalls in pulmonary nodule detection and characterization, including equivocal or atypical presentations, is important for avoiding misinterpretation that can alter patient management.

One-off low-dose CT lung cancer screening in China: an appropriate strategy?

Lung cancer is devastating, with a 5-year survival rate of about 10%. High smoking prevalence in the past means that millions of people are at high risk of developing lung cancer. Two large-scale randomised controlled trials (RCTs) have shown that screening with high-quality, low-dose CT (LDCT) can detect lung cancer substantially earlier than when being diagnosed symptomatically, and thereby reduce mortality from the disease by 8–24% (point estimates of trials) in men and by 26–61% in women. 1 de Koning HJ van der Aalst CM de Jong PA et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020; 382: 503-513 Crossref PubMed Scopus (957) Google Scholar , 2 Aberle DR Adams AM Berg CD et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365: 395-409 Crossref PubMed Scopus (6627) Google Scholar The LUSI RCT recently confirmed that repeated LDCT is associated with a reduction in lung cancer mortality in women. 3 Becker N Motsch E Trotter A et al. Lung cancer mortality reduction by LDCT screening—results from the randomized German LUSI trial. Int J Cancer. 2020; 146: 1503-1513 Crossref PubMed Scopus (173) Google Scholar The evidence from these trials has led the way to careful but slow progress in implementation studies throughout Europe, 4 Rzyman W Szurowska E Adamek M Implementation of lung cancer screening at the national level: Polish example. Transl Lung Cancer Res. 2019; 8: S95-105 Crossref PubMed Scopus (20) Google Scholar , 5 Balata H Ruparel M O'Dowd E et al. Analysis of the baseline performance of five UK lung cancer screening programmes. Lung Cancer. 2021; 161: 136-140 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 6 Van der Aalst C Oudkerk M Haaf KT et al. Towards personalized lung cancer CT screening in Europe. Eur Respir J. 2020; 564171 Google Scholar insurance coverage in the USA (by the B recommendations of the US Preventive Services Task Force), 7 Meza R Jeon J Toumazis I et al. Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force. JAMA. 2021; 325: 988-997 Crossref PubMed Scopus (70) Google Scholar and preliminary recommendations in Australia and Europe to consider national lung cancer screening programmes. The common aim of such programmes is to invite current and former smokers in the age range 50–80 years with a specific expected minimum risk (eg, current or former smoking history of 20 pack-years, or a minimum PLCOm2012 risk score of around 2–3% for developing lung cancer in the next 6 years, with no difference between the sexes) for LDCT screening. But can the results of trials that were done in high-income countries with largely White populations simply be applied to other ethnic groups, such as those of Chinese and Asian descent, in which other risk profiles seem to be important too? In China, especially in women, the proportion of lung cancer cases attributable to tobacco use is only about 18%. 8 Li N Tan F Chen W et al. One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort study. Lancet Respir Med. 2022; (published online March 8.)https://doi.org/10.1016/S2213-2600(21)00560-9 Summary Full Text Full Text PDF Scopus (9) Google Scholar Notably, more than 700 000 lung cancer deaths were estimated in China in 2020, which is 40% of the total lung cancer deaths worldwide. 9 Ferlay JEM Lam F Colombet M et al. Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon, France2022https://gco.iarc.fr/today/online-analysis-table?v=2020&mode=cancer&mode_population=countries&population=900&populations=935_908_900_160&key=asr&sex=0&cancer=39&type=1&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&group_cancer=1&include_nmsc=0&include_nmsc_other=1#collapse-group-0-3Date accessed: January 18, 2022 Google Scholar One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort studyOne-off LDCT screening was associated with significantly lower lung cancer mortality and all-cause mortality in a large population in China. Our results point to the promise of one-off LDCT screening in countries with limited medical resources. Further studies are needed to explore interactions by subgroup—including sex, age, smoking status, and economic status—to develop population-specific screening strategies. Full-Text PDF

Lung cancer screening with low-dose CT: Simulating the effect of starting screening at a younger age in women

BackgroundThe US has recently lowered the entry age for lung cancer screening with low-dose computed tomography (LDCT) from 55 to 50 years. The effect of the younger age for starting screening on the rates of screen-detected and radiation-induced lung cancers in women remains unclear. MethodsA modeling study was conducted. A static cohort of 100,000 heavy female smokers was simulated to undergo annual lung cancer screening with LDCT. The number of screen-detected lung cancers (benefit) and radiation-induced lung cancers (harm) per 1000 screenees were calculated for scenarios with two starting ages (55–50 years) and fixed stopping age (75 years). The benefit-harm ratio and incremental benefit-harm ratio (IBHR) were calculated for each scenario. ResultsFor annual screening from 55 to 75 years, the number of screen-detected and radiation-induced lung cancers was 112.4 and 2.2, respectively. For annual screening from 50 to 75 years, those numbers were 117.0 and 3.4, respectively. The benefit-harm ratio decreased from 51 to 35 and the IBHR decreased from 6.3 to 4.0 when lowering the screening starting age from 55 to 50 years. ConclusionsThe risk of radiation induced lung cancers increased by 50% when lowering the screening starting age by 5 years in women. However, the benefits of LDCT lung cancer screening still outweigh the assumed radiation harm.

Abstract PO-235: Changes in low-dose CT lung cancer screening patterns post-COVID-19

Abstract Purpose: Nationally, only 23% of lung cancer cases are diagnosed at an early stage and on top of that Black Americans with lung cancer are 16% less likely to be diagnosed early. If everyone currently eligible were screened, close to 48,000 lives could be saved. Interestingly, pre-COVID-19 17% of the individuals getting screened for lung cancer were Black, and post-COVID-19 36% are Black. This study aims to explore potential reasons for this sudden increase in low-dose CT lung cancer screenings in Black patients by examining variables in the electronic health record and by interviewing pundits in clinical oncology practice. Methods: 416 deidentified electronic health records were collected from a data repository at the Medical College of Wisconsin. We analyzed low-dose CT screening for lung cancer among Black and white patients pre- and post-COVID-19 (4 cohorts). The post-COVID-19 cohorts looked at screening from 1/1/2020 – 7/8/2021, compared to a proportionate time frame pre-COVID-19 (1/1/2018 – 7/8/2019). Because of low numbers of other racial/ethnic backgrounds (Asian, Hispanic, Pacific Islander, etc.), only Black and white patients were examined in this study. Variables examined include insurance status, marital status, age, COVID-19 testing or diagnosis, gender, employment status, comorbidities (cardiovascular disease, chronic obstructive pulmonary disease, diabetes and hypertension), and lung cancer diagnosis. Results: Employment status, lung cancer diagnosis, and gender were all significantly different between Black and white cohorts pre-COVID-19. Post-COVID-19, similar differences are seen in employment status, while patterns in lung cancer diagnosis, gender, and insurance status are contradictory. Black patients pre-COVID-19 had a higher incidence of being men and a lower incidence of lung cancer diagnosis. On the contrary, post-COVID-19 Black patients have a higher incidence of being women and lung cancer diagnosis, and additionally a higher incidence of Medicare use. Despite the drastic differences in healthcare before and after COVID-19, COVID-19 testing and diagnosis did not appear to be linked to increased lung cancer screenings for Black patients. However, in conversations with thoracic surgeons and community health workers, we learned of significant screening efforts within Black populations due to grants funded during the COVID-19 pandemic. Conclusions: In this study, insurance status was the strongest difference between the pre- and post-COVID-19 Black cohorts. In a conversation with thoracic surgeons, we learned that a major initiative was launched post-COVID-19 that increased insurance access for Black populations. Increasing access to healthcare appears to be a promising first step in eradicating lung cancer disparities in Black populations. So, this research could serve as a guidepost to provide policymakers, researchers and healthcare providers, as well as patients and families, with data that pinpoints where future resources should be aimed in the effort to end lung cancer and its corresponding health disparities. Citation Format: Katherine Hullin, Jessica Olson. Changes in low-dose CT lung cancer screening patterns post-COVID-19 [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-235.

Abstract PO-258: Disparities in eligibility for low-dose CT (LDCT) lung cancer screening among a multiethnic population

Abstract Introduction: African Americans and Native Hawaiians have a higher risk of lung cancer and greater mortality rate than other racial/ethnic groups in the US. The guidelines for lung cancer screening by low-dose CT scan were derived from clinical trial data conducted primarily in white men. In 2021, to address the underlying ethnic/racial disparities in eligibility for lung cancer screening the United States Preventive Services Task Force (USPSTF) updated the 2013 guidelines from 55-80 years of age, current or former smokers (quit ≤15 years) with a 30 pack-year smoking history to include ever smokers ≥50 years of age and with a ≥20 pack-year history. We hypothesize that the disparities in eligibility across race/ethnicity will remain due to the greater age-specific risk and lower pack-years among African Americans and Native Hawaiians. Methods: We used the Multiethnic Cohort study (MEC) data to examine ineligibility to both USPSTF guidelines by sex and race/ethnicity among 1,761 incident lung cancer cases diagnosed within 7 years of study entry. This analysis included African and Japanese Americans, Latino, Native Hawaiians and whites. Smoking history was collected by a self-administered questionnaire at cohort entry. The difference in proportion of ineligible for each group compared to whites were assessed. Results: Among the 1,042 men and 719 women with incident lung cancer, under the 2013 guidelines, 54% of men and 70% of women would have been ineligible for lung cancer screening. Under the 2021 guidelines, 41% of men and 59% of women would have been eligible. For the 2013 guidelines, in men, the disparity was highest in Latinos (19% difference compared to whites), followed by Native Hawaiians (18%), and African (17%) and Japanese (9%) Americans. In women, the disparity was highest in African Americans (33%), followed by Latinas (25%), Japanese Americans (25%), and Native Hawaiians (13%). While an additional ~12% of overall lung cancer cases would have been eligible for screening using the updated guidelines, the disparity in eligibility compared to whites for each racial/ethnic group remained similar (range: 9% in Japanese American men to 33% in African American women). Eleven percent of men and 28% of women would have been ineligible for never smoking. Among ineligible ever smokers, more non-whites than whites were ineligible due to the 20 pack-year threshold (men: 77% vs 64% and women: 90% vs 76%). Also, while an overall 8% of both men and women would have been ineligible due to the age threshold, &amp;gt;20% of Native Hawaiian cases were ineligible due to age. Conclusions: Our findings demonstrate that despite the lower thresholds in the smoking history and age criteria in the updated USPSTF guidelines, racial/ethnic disparities in lung cancer screening eligibility remains. Reasons for these differences include a lower smoking pack-year history and greater age-specific risk among ever smokers, and a higher proportion of never smoker lung cancer cases. Additional analyses with cumulative smoking history are in progress. Citation Format: S. Lani Park, Kyla Yamashita, Lenora Loo, Daniel Stram, Yurii Shvetsov, Loic Le Marchand. Disparities in eligibility for low-dose CT (LDCT) lung cancer screening among a multiethnic population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-258.

Performance of a deep learning-based lung nodule detection system as an alternative reader in a Chinese lung cancer screening program

ObjectiveTo evaluate the performance of a deep learning-based computer-aided detection (DL-CAD) system in a Chinese low-dose CT (LDCT) lung cancer screening program. Materials and methodsOne-hundred-and-eighty individuals with a lung nodule on their baseline LDCT lung cancer screening scan were randomly mixed with screenees without nodules in a 1:1 ratio (total: 360 individuals). All scans were assessed by double reading and subsequently processed by an academic DL-CAD system. The findings of double reading and the DL-CAD system were then evaluated by two senior radiologists to derive the reference standard. The detection performance was evaluated by the Free Response Operating Characteristic curve, sensitivity and false-positive (FP) rate. The senior radiologists categorized nodules according to nodule diameter, type (solid, part-solid, non-solid) and Lung-RADS. ResultsThe reference standard consisted of 262 nodules ≥ 4 mm in 196 individuals; 359 findings were considered false positives. The DL-CAD system achieved a sensitivity of 90.1% with 1.0 FP/scan for detection of lung nodules regardless of size or type, whereas double reading had a sensitivity of 76.0% with 0.04 FP/scan (P = 0.001). The sensitivity for detection of nodules ≥ 4 - ≤ 6 mm was significantly higher with DL-CAD than with double reading (86.3% vs. 58.9% respectively; P = 0.001). Sixty-three nodules were only identified by the DL-CAD system, and 27 nodules only found by double reading. The DL-CAD system reached similar performance compared to double reading in Lung-RADS 3 (94.3% vs. 90.0%, P = 0.549) and Lung-RADS 4 nodules (100.0% vs. 97.0%, P = 1.000), but showed a higher sensitivity in Lung-RADS 2 (86.2% vs. 65.4%, P < 0.001). ConclusionsThe DL-CAD system can accurately detect pulmonary nodules on LDCT, with an acceptable false-positive rate of 1 nodule per scan and has higher detection performance than double reading. This DL-CAD system may assist radiologists in nodule detection in LDCT lung cancer screening.

A Proactive Patient Identification Algorithm Increased Low-Dose CT Lung Cancer Screening Eligible Patients Per United States Preventative Services Task Force Criteria

A Proactive Patient Identification Algorithm Increased Low-Dose CT Lung Cancer Screening Eligible Patients Per United States Preventative Services Task Force Criteria

P61.10 Swiss Pilot Low-Dose Computed Tomography Lung Cancer Screening Study

Low-dose computed tomography (LDCT) lung cancer screening is endorsed by United States guidelines and has recently been shown effective in a large European randomized controlled trial. Nevertheless, the actual realization of a lung cancer screening program is challenging and depends on country-specific factors. This pilot study aimed to evaluate implementation, execution and performance of LDCT lung cancer screening in Switzerland. Starting from October 2018, asymptomatic participants aged 55-74 years with more than 30 pack-years smoking history were enrolled at a tertiary hospital in Switzerland. Participants with history of lung cancer, major (palliative) health problems or those that had a thorax CT scan 18 months prior to enrollment were excluded. First line we evaluated lung cancer risk according NLST guidelines. Secondly, we estimated lung cancer risk using the PLCOm2012 model risk calculater with a threshold of 5%. Lung nodules were assessed according Lung-RADS 1.1 {ACoR. Lung-Screening Reporting and Data System (LungRADS) Version 1.1. 2019}. Participants were predominantly recruited through flyers, a newspaper article and pulmonary specialists. Screening consisted of one LDCT-scan and follow-up was recommended for suspicious nodules only. LDCT assessment was performed by two radiologists, one of them a board certified chest radiologist. Enrollment and follow-up are currently ongoing. To date, 75 participants with a median age of 62 years (interquartile range [IQR] 56-67 years) were included. The median number of pack years smoked was 49 (IQR 41-58 pack years) and 25 (33%) were female. The median PLCOm2012 6-year lung cancer probability was 2.7% (IQR 2.6-2.9%) and 19 (26%) participants had stopped smoking before enrollment. Of the 75 participants, 61 (81%) were found to have calcified or non-calcified lung nodules. 6 participants required follow up imaging of suspect nodules which resulted in a recall rate of 8%. At baseline, lung cancer was found in 2 (2.7%) participants. The lung cancers were one squamous cell carcinoma (stage IIIA) and one adenocarcinoma (stage IV). In this Swiss LDCT lung cancer screening pilot study using modified inclusion criteria, lung nodules were found in a significant number of participants of whom 2.7 % were diagnosed with lung cancer to date. To date, the recall rate for follow-up imaging is 8%.

Value of low-dose spiral CT combined with circulating miR-200b and miR-200c examinations for lung cancer screening in physical examination population.

The aim of this study is to investigate the clinical value of low-dose spiral CT (LDCT), plasma miR-200b, and miR-200c combined screening for lung cancer screening in the physical examination population. From January 2016 to December 2018, the Physical Examination Center of our hospital underwent low-dose spiral CT lung cancer screening for 10,823 people aged ≥40 years. The quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to detect the relative expressions of miR-200b and miR-200c in plasma, analyze the imaging characteristics of suspicious nodules in the lung and the relative expressions of miR-200b and miR-200c in plasma. A total of 2,919 pulmonary nodules were detected in the 10823 physical examination population, with a total detection rate of 26.97%, including 1523 males and 1396 females. 1081 positive nodules were detected with a detection rate of 9.99%. According to the Lung-RADS classification, the number of type 2 nodules was the highest, with a detection rate of 22.13%. Meanwhile, the rate of type 3 nodules was 3.15%, and the rate of type 4 nodules was 1.69%. The sensitivity, accuracy, and negative predictive value of LDCT, miR-200b, and miR-200c in the diagnosis of lung cancer were significantly improved compared with the individual tests, which were 94.74%, 90.16%, and 95.88%, respectively. Low-dose spiral CT combined with plasma miR-200b and miR-200c for lung cancer screening in the physical examination population can help to detect lung cancer patients with early symptoms that are not significant, and achieve early diagnosis and early treatment.