Lung Cancer Screening Eligibility Research Articles

Prevalence of cigarette and e-cigarette use among U.S. adults eligible for lung cancer screening based on updated USPSTF guidelines

BackgroundThe United States Preventative Services Taskforce recently updated lung cancer screening guidelines for U.S. adults with high-risk smoking histories. This has generated a previously undescribed patient population in which the prevalence of cigarette and e-cigarette use has not been described. MethodsWe performed a cross-sectional study using population-based data from the Behavioral Risk Factor Surveillance System (2017–2018). We defined lung cancer screening eligibility as adults 50–80 years old with ≥ 20 pack-year smoking history who were currently smoking or quit within the last 15 years. We assessed several smoking-related outcomes including current cigarette use, ever e-cigarette use, and current e-cigarette use among respondents. ResultsAmong 7541 screening-eligible adults, current cigarette use was reported by 3604 (47.8%) participants. Ever and current e-cigarette use were reported by 3003 (39.8%) and 670 (8.9%) participants, respectively. Compared to individuals who were previously eligible for screening, individuals newly eligible for screening (i.e., between 50 and 55 years old with a 20–30 pack-year smoking history) were more likely to currently smoke (aOR 1.828, 95% CI 1.649–2.026, p < 0.001). While newly eligible respondents were more likely to report a history of ever using an e-cigarette (aOR 1.144, 95% CI 1.034–1.266, p = 0.009), current e-cigarette use was similar in this group compared to those individuals who were previously screening-eligible (aOR 1.014, 95% CI 0.844–1.219, p = 0.88). ConclusionsCigarette and e-cigarette exposure are common among U.S. adults who are eligible for lung cancer screening. Expanded USPSTF criteria will capture a patient population with greater exposure to both of these products.

Evaluating Eligibility of US Black Women Under USPSTF Lung Cancer Screening Guidelines

This quality improvement study evaluates lung cancer screening eligibility among US Black women under the 2013 and 2021 USPSTF guidelines.

Primary lung cancer in women after previous breast cancer.

BackgroundBreast cancer is the most common malignancy among women in the USA. Improved survival has resulted in increasing incidence of second primary malignancies, of which lung cancer is the most common. The United States Preventive Services Task Force (USPSTF) guidelines for lung-cancer screening do not include previous malignancy as a high-risk feature requiring evaluation. The aim of this study was to compare women undergoing resection for lung cancer with and without a history of breast cancer and to assess whether there were differences in stage at diagnosis, survival and eligibility for lung-cancer screening between the two groups.MethodsWomen who underwent lung-cancer resection between 2000 and 2017 were identified. Demographic, clinicopathological, treatment and outcomes data were compared between patients with a history of breast cancer (BC-Lung) and patients without a history of breast cancer (P-Lung) before lung cancer.ResultsOf 2192 patients included, 331 (15.1 per cent) were in the BC-Lung group. The most common method of lung-cancer diagnosis in the BC-Lung group was breast-cancer surveillance or work-up imaging. Patients in the BC-Lung group had an earlier stage of lung cancer at the time of diagnosis. Five-year overall survival was not statistically significantly different between groups (73.3 per cent for both). Overall, 58.4 per cent of patients (1281 patients) had a history of smoking, and 33.3 per cent (731 patients) met the current criteria for lung-cancer screening.ConclusionDifferences in stage at diagnosis of lung cancer and treatment selection were observed between patients with and without a history of breast cancer. Overall, there were no statistically significant differences in genomic or oncogenic pathway alterations between the two groups, which suggests that lung cancer in patients who previously had breast cancer may not be affected at the genomic level by the previous breast cancer. The most important finding of the study was that a high percentage of women with lung cancer, regardless of breast-cancer history, did not meet the current USPSTF criteria for lung-cancer screening.

Lung cancer screening primer: Key information for primary care providers.

To review new evidence reported since the 2016 publication of the Canadian Task Force on Preventive Health Care recommendations and to summarize key facets of lung cancer screening to better equip primary care providers (PCPs) in anticipation of wider implementation of the recommendations. A new, large randomized controlled trial has been published since 2016, as have updates from 4 other trials. PubMed was searched for studies published between January 1, 2004, and December 31, 2020, using search words including lung cancer screening eligibility, lung cancer screening criteria, and lung cancer screening guidelines. All information from peer-reviewed articles, reference lists, books, and websites was considered. Lung cancers diagnosed at stage 4 have a 5-year survival rate of only 5% and have a disproportionate impact on those with lower socioeconomic status, rural populations, and Indigenous populations. By downstaging, or diagnosing lung cancers at an earlier and more treatable stage, lung cancer screening reduces mortality with a number needed to screen of 250 to prevent 1 death. Practical aspects of lung cancer screening are reviewed, including criteria to screen, appropriate low-dose computed tomography screening, and management of findings. Harms of screening, such as overdiagnosis and incidental findings, are discussed to allow PCPs to appropriately counsel their patients in the face of ongoing implementation of new lung cancer screening programs. Lung cancer screening, with its embedded emphasis on smoking cessation, is an excellent addition to PCPs' preventive health care tools. The implementation of formal and pilot lung cancer screening programs across Canada means that PCPs will be increasingly required to counsel their patients around the uptake of lung cancer screening.

Lung Cancer Screening Eligibility and Screening Patterns Among Black and White Adults in the United States

This cohort study compares the demographics of US adults who are currently being screened for lung cancer and assesses the potential association between proposed changes to the United States Preventive Services Task Force (USPSTF) screening recommendations and screening rates by race and age.

Evaluation of Population-Level Changes Associated With the 2021 US Preventive Services Task Force Lung Cancer Screening Recommendations in Community-Based Health Care Systems

The US Preventive Services Task Force (USPSTF) released updated lung cancer screening recommendations in 2021, lowering the screening age from 55 to 50 years and smoking history from 30 to 20 pack-years. These changes are expected to expand screening access to women and racial and ethnic minority groups. To estimate the population-level changes associated with the 2021 USPSTF expansion of lung cancer screening eligibility by sex, race and ethnicity, sociodemographic factors, and comorbidities in 5 community-based health care systems. This cohort study analyzed data of patients who received care from any of 5 community-based health care systems (which are members of the Population-based Research to Optimize the Screening Process Lung Consortium, a collaboration that conducts research to better understand how to improve the cancer screening processes in community health care settings) from January 1, 2010, through September 30, 2019. Individuals who had complete smoking history and were engaged with the health care system for 12 or more continuous months were included. Those who had never smoked or who had unknown smoking history were excluded. Electronic health record-derived age, sex, race and ethnicity, socioeconomic status (SES), comorbidities, and smoking history. Differences in the proportion of the newly eligible population by age, sex, race and ethnicity, Charlson Comorbidity Index, chronic obstructive pulmonary disease diagnosis, and SES as well as lung cancer diagnoses under the 2013 recommendations vs the expected cases under the 2021 recommendations were evaluated using χ2 tests. As of September 2019, there were 341 163 individuals aged 50 to 80 years who currently or previously smoked. Among these, 34 528 had electronic health record data that captured pack-year and quit-date information and were eligible for lung cancer screening according to the 2013 USPSTF recommendations. The 2021 USPSTF recommendations expanded screening eligibility to 18 533 individuals, representing a 53.7% increase. Compared with the 2013 cohort, the newly eligible 2021 population included 5833 individuals (31.5%) aged 50 to 54 years, a larger proportion of women (52.0% [n = 9631]), and more racial or ethnic minority groups. The relative increases in the proportion of newly eligible individuals were 60.6% for Asian, Native Hawaiian, or Pacific Islander; 67.4% for Hispanic; 69.7% for non-Hispanic Black; and 49.0% for non-Hispanic White groups. The relative increase for women was 13.8% higher than for men (61.2% vs 47.4%), and those with a lower comorbidity burden and lower SES had higher relative increases (eg, 68.7% for a Charlson Comorbidity Index score of 0; 61.1% for lowest SES). The 2021 recommendations were associated with an estimated 30% increase in incident lung cancer diagnoses compared with the 2013 recommendations. This cohort study suggests that, in diverse health care systems, adopting the 2021 USPSTF recommendations will increase the number of women, racial and ethnic minority groups, and individuals with lower SES who are eligible for lung cancer screening, thus helping to minimize the barriers to screening access for individuals with high risk for lung cancer.

How the Expansion of the U.S. Preventive Services Task Force Lung Cancer Screening Eligibility May Improve Health Equity Among Diverse Sexual and Gender Minority Populations.

This article discusses the potential implications of addressing lung cancer disparities among diverse sexual and gender minority (SGM) populations based on the recently expanded U.S. Preventive Services Task Force 2021 guidelines on lung cancer screening using low-dose computed tomography to include adults aged 50-80 years who have a 20 pack-year smoking history (one pack-year equals smoking one pack or 20 cigarettes per day for 1 year) and currently smoke or have quit within the past 15 years. Research on lung cancer screening barriers and facilitators and efforts to increase awareness and screening uptake among SGM populations are proposed.

ROLE OF NEXT GENERATION SEQUENCING WITH PERCEPTA BRUSHING IN RECLAFFYING LUNG NODULE RISK AFTER A NON-DIAGNSOTIC BRONCHOSCOPY

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: Lung cancer is most common cancer in the world and the most common cause of death from cancer in the United States. With the recent expansion of eligibility for lung cancer screening and expanded acceptance of screening, we are likely to see a growing number of patients with pulmonary nodules. Current ACCP Guidelines recommend non-surgical biopsy for nodule with a risk of malignancy between 5% and 65%, however up to 60% of lung cancer bronchoscopy results are inconclusive. Percepta Genomic Sequencing Classifier (GSC) is an RNA-seq based genomic classifier using cells from a bronchial brushing of benign mucosa to assess risk of lung cancer in a lung nodule in a patient with a history of smoking when the bronchoscopy is inconclusive. The test can reclassify risk. From a pre-bronch intermediate risk, GSC can up-classify to high risk with a 65% PPV or down-classify to low risk with a 91% NPV. We sought to identify the frequency with which Percepta GSC helps to reclassify malignancy risk in intermediate risk nodules to guide further decision-making. METHODS: This was a retrospective review of all inconclusive bronchoscopies in ever smokers with a lung nodule from January 2019 to October 2020 . All nodules were intermediate risk determined by physician-assessed risk (PAR). Right mainstem bronchial brushings for Percepta GSC had been performed in all cases, with the genomic classifier analysis initiated at the time of the non-diagnostic result. The frequency of up and down classification was analyzed. RESULTS: Out of 30 patients classified as intermediate per PAR, 13 (43.3%) patients had an Intermediate GSC result. 8 (26.6%) patients were re-classified with a High GSC result. 9 (30.0%) patients were re-classified with a Low GSC result. In total, in 17 of 30 (56.6%) of patients with a non-diagnostic bronchoscopy, the classifier provided new information to guide further decision-making. For the patients with a Low GSC result, we observed a significant reduction in additional invasive procedures compared to the pre-test management plan. It is interesting to note that out of 9 patient that got reclassified in low category, 1 patient lost to follow up. Seven patients had at least 12 months follow up on their ct chest with nodule size remaining stable. Interestingly one patient on biopsy showed granulomas with culture growing aspergillus and patient treated with voriconazole which resulted in resolution of nodule. CONCLUSIONS: Within this group of patients with a PAR of Intermediate, Percepta GSC provided additional information in the majority of cases where bronchoscopy was non-diagnostic and has helped our lung nodule work up algorithm. Down classification allowed for consideration of deferring CT-guided fine needle aspiration or surgical lung biopsy and pursuing a plan of CT surveillance, helping to avoid unnecessary procedures. Patients with Intermediate results proceeded on the standard diagnostic pathway, and patients re-classified as high risk were considered for more aggressive evaluation to avoid missing a false negative bronchoscopy result. CLINICAL IMPLICATIONS: Bronchoscopy is frequently used for evaluation of pulmonary lesions, but its sensitivity for detecting lung cancer can be limited. Use of the Percepta GSC bronchial genomic classifier can provide additional information when bronchoscopy is inconclusive, with a high NPV for a Low result and a high PPV for a High result, helping to guide decision making. DISCLOSURES: No relevant relationships by Sonya Bracone, source=Web Response No relevant relationships by Abhijit Raval, source=Web Response No relevant relationships by Ashka Raval, source=Web Response

Comparing U.S. Preventive Services Task Force 2013 versus 2021 lung cancer screening eligibility.

13 Background: Early detection of lung cancer provides the best opportunity for long-term survival. In 2021 US Preventive Services Task Force (USPSTF) expanded the 2013 risk-based Low-dose CT (LDCT) screening criteria, in part to reduce unintended race and gender disparities in lung cancer detection. We evaluated the impact of the updated USPSTF criteria in a cohort of patients from an incidental lung nodule program (ILNP). Methods: We implemented an ILNP in a community healthcare system in the mid-south US. Patients with lung lesions on routinely-performed radiologic studies were triaged using evidence-based guidelines. We prospectively tracked patient demographics, clinical characteristics, procedures, complications, and health outcomes. We classified all patients in the ILNP cohort based on USPSTF 2013 and 2021 screening criteria. Statistical analysis used the chi-square test. Results: The ILNP cohort included 14,642 patients from 2015-2021. This cohort was 56% female, 65% White, 29% Black, with a median age of 64 years. Overall 1,581 (10.8%) met 2013 and 2,051 (14.0%) met 2021 USPSTF criteria. 1.9% of subjects eligible by 2013 criteria were diagnosed with lung cancer compared to 2.2% by 2021 criteria. 470 additional patients met screening criteria when we expanded from USPSTF 2013 to 2021. As expected, these patients were younger and less likely to have Medicare insurance. These additional eligible patients were significantly more likely to be female (58% v 49%, p = 0.0011) or Black (28% vs. 18%, p &lt; 0.0001) compared to those eligible by 2013 criteria. 44 of the 470 (9%) were diagnosed with cancer: 36% adenocarcinoma, 18% squamous, and 11% small cell, 11% non-lung primary, 9% non-small cell lung cancer NOS, and 15% other or unknown histology. The median tumor size was 3 cm with an interquartile range from 1.7 to 4.2 cm. The clinical stage distribution was 34% I, 4.5% II, 15.9% III, and 31.8% IV. Conclusions: In this selective community-based cohort, USPSTF 2021 criteria identified a higher percentage of subjects with lung cancer and were more inclusive of women and minorities compared to USPSTF 2013 criteria.

LUNG CANCER SCREENING PARTICIPATION IN COMMUNITY-BASED HEALTH SYSTEMS FROM THE PROSPR-LUNG CONSORTIUM

TOPIC: Imaging TYPE: Original Investigations PURPOSE: From 2013 through 2020, the US Preventive Services Task Force recommended annual lung cancer screening (LCS) via low-dose computed tomography (LDCT) for 55- to 80-year-olds with 30+ pack-years of smoking history who currently smoke or quit smoking within the last 15 years. Because the population-level impact of LCS on reducing lung cancer mortality depends on high LCS participation among eligible populations, it is important to determine LCS participation in community settings and to track participation changes over time. METHODS: Study participants were patients ages 55-80 years old who received care within the five systems in the Population-based Research to Optimize the Screening Process (PROSPR) Lung Consortium from 2014 through 2019. Data on LCS participation and patient characteristics (age, sex, race/ethnicity, and cigarette smoking history) were obtained via electronic health records (EHR). In this population, we used smoking history according to EHR data as a proxy for LCS eligibility and calculated the percent of individuals who completed LCS via LDCT by year, overall and by health system. We also evaluated differences in the percent screened by age (55-64 years old vs. 65+), sex, and race/ethnicity using chi-square tests with the significance level of < 0.05. RESULTS: The number of patients who were ages 55-80 years old with EHR documentation of 30+ pack-years of smoking and who currently smoked or had a quit date within the past 15 years ranged from 21,234 in 2013 to 39,881 in 2019. Of these, 3% completed LCS via LDCT in 2014, 7% in 2015, 12% in 2016, 17% in 2017, 21% in 2018, and 23% in 2019. Among those with 30+ pack-years in 2019 (N=51,579), 77% had current or former smoking within the past 15 years and were considered eligible for LCS in 2019. Of these individuals, 27% overall had ever received LCS, but there was variation in the percent ever screened by health system, that ranged from 16% to 45%. Among those eligible for LCS, the percent having ever received LCS LDCT also varied by age (24% of those ages 55-64 years old vs. 29% of those ages 65-80 years old; p-value < 0.01). Within each health system, the percent of eligible individuals who received LCS LDCT was not significantly different by sex or by race/ethnicity. CONCLUSIONS: Although the percent of high-risk individuals receiving LCS via LDCT increased every year from 2014 to 2019, LCS rates in community-based healthcare settings remain well below screening rates for other types of cancer. Also, there is wide variation in LCS rates by health system. CLINICAL IMPLICATIONS: To optimize the impact of LCS for reducing lung cancer mortality in the United States, health systems will need to increase LCS participation. Additional research to understand how differences in health system implementation and maintenance of LCS programs impact LCS participation is needed. DISCLOSURES: No relevant relationships by Andrea Burnett-Hartman, source=Web Response No relevant relationships by Nikki Carroll, source=Web Response Spouse, stock holder relationship with Johnson and Johnson Please note: >10 years Added 04/28/2021 by Jennifer Croswell, source=Web Response, value=Stock No relevant relationships by Robert Greenlee, source=Web Response No relevant relationships by Stacey Honda, source=Web Response No relevant relationships by Christine Neslund-Dudas, source=Web Response No relevant relationships by Katharine Rendle, source=Web Response No relevant relationships by Debra Ritzwoller, source=Web Response Grant relationship with MagArray Inc. Please note: >$100000 by Anil Vachani, source=Web Response, value=Grant/Research Support Removed 04/17/2021 by Anil Vachani, source=Web Response Grant relationship with Broncus Medical Please note: $20001 - $100000 by Anil Vachani, source=Web Response, value=Grant/Research Support Removed 04/17/2021 by Anil Vachani, source=Web Response Scientific Medical Advisor relationship with Johnson and Johnson Please note: 2020 - present Added 04/22/2021 by Anil Vachani, source=Web Response, value=Consulting fee Grant relationship with Precyte Please note: 01/2021 to present Added 04/17/2021 by Anil Vachani, source=Web Response, value=Grant/Research Removed 04/17/2021 by Anil Vachani, source=Web Response

Racial and Ethnic Disparities in Lung Cancer Screening Eligibility.

Background To address disparities in lung cancer screening (LCS) that may exclude large numbers of high-risk African American smokers, revised U.S. Preventive Services Task Force (USPSTF) recommendations lowered LCS eligibility thresholds. However, there are limited recent data about the impact of newly revised guidelines on disparities in LCS eligibility. Purpose To evaluate the impact of revised USPSTF guidelines on racial and ethnic disparities in LCS eligibility. Materials and Methods Cross-sectional survey data from 20 states were retrospectively evaluated from the 2019 Behavioral Risk Factor Surveillance System survey (median response rate, 49.4%). Respondents without a history of lung cancer aged 55-79 years (ie, under the previous guidelines) or aged 50-79 years (ie, under the revised guidelines) were included. Multivariable logistic regression analyses were performed to evaluate the association between race and ethnicity and LCS eligibility. All analyses were performed accounting for complex survey design features (ie, weighting, stratification, and clustering). Results Under previous guidelines, 11% of 67 567 weighted survey respondents were eligible for LCS (White [12%], Hispanic [4%], African American [7%], American Indian [17%], Asian or Pacific Islander [4%], and other [12%]). Under revised USPSTF guidelines, 14% of 77 689 weighted survey respondents were eligible for LCS (White [15%], Hispanic [5%], African American [9%], American Indian [21%), Asian or Pacific Islander [5%], and other [18%]). Compared with White respondents, African American respondents (adjusted odds ratio [OR] = 0.36; 95% CI: 0.27, 0.47; P < .001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.09, 0.24; P < .001) were less likely to be eligible for LCS under previous guidelines. African American respondents (adjusted OR = 0.39; 95% CI: 0.32, 0.47; P < .001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.10, 0.23; P < .001) were less likely to be eligible under the revised guidelines. The Wald test showed no evidence of differences in the degree to which racial and ethnic minority groups were less likely to be eligible for LCS when comparing previous versus revised USPSTF guidelines (P = .76). Conclusion The revised U.S. Preventive Services Task Force guidelines (version 2.0) may perpetuate lung cancer disparities, as racial and ethnic minority groups are still less likely to be eligible for lung cancer screening. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Jacobs and Springfield in this issue.

Generalizability and Transportability of the National Lung Screening Trial Data: Extending Trial Results to Different Populations.

Randomized controlled trials (RCT) play a central role in evidence-based healthcare. However, the clinical and policy implications of implementing RCTs in clinical practice are difficult to predict as the studied population is often different from the target population where results are being applied. This study illustrates the concepts of generalizability and transportability, demonstrating their utility in interpreting results from the National Lung Screening Trial (NLST). Using inverse-odds weighting, we demonstrate how generalizability and transportability techniques can be used to extrapolate treatment effect from (i) a subset of NLST to the entire NLST population and from (ii) the entire NLST to different target populations. Our generalizability analysis revealed that lung cancer mortality reduction by LDCT screening across the entire NLST [16% (95% confidence interval [CI]: 4-24)] could have been estimated using a smaller subset of NLST participants. Using transportability analysis, we showed that populations with a higher prevalence of females and current smokers had a greater reduction in lung cancer mortality with LDCT screening [e.g., 27% (95% CI, 11-37) for the population with 80% females and 80% current smokers] than those with lower prevalence of females and current smokers. This article illustrates how generalizability and transportability methods extend estimation of RCTs' utility beyond trial participants, to external populations of interest, including those that more closely mirror real-world populations. Generalizability and transportability approaches can be used to quantify treatment effects for populations of interest, which may be used to design future trials or adjust lung cancer screening eligibility criteria.

Lung Cancer Screening Eligibility and Use: A Population Health Perspective of One Community.

BACKGROUND Low-dose chest CT (LDCT) is the only effective screening test for lung cancer. Annual lung cancer screening (LCS) is recommended by the US Preventive Services Task Force (USPSTF) for individuals at high risk for primary lung neoplasm.METHODS We retrospectively identified patients receiving LCS from January 2016 through March 2018 whose residential addresses were within our health center's county. We estimated driving distance from the patient's address to our health center and obtained sociodemographic characteristics from the electronic health record (EHR). The census-tract-level LCS-eligible population size was estimated, and their population characteristics determined via US Census Bureau, Centers for Disease Control and Prevention (CDC), and Behavioral Risk Factor Surveillance System (BRFSS) data. The Cochran-Mantel-Haenszel test was used to determine differences amongst the LCS-eligible and LCS-enrolled populations. Multivariable regression was used to determine the effects of sociodemographic characteristics on LCS eligibility.RESULTS There was modest correlation between census-tract-level LCS-eligible population size and LCS enrollment (r = 0.68, P < .001). 5.9% (364/6185) of the estimated LCS-eligible population in our county received LCS, with census-tract LCS rates ranging from 1.5% to 12.5%. Nonwhite race status (Hispanic and African American) was associated with decreased likelihood of LCS enrollment compared to White race (OR = 95% CI, 0.765 [0.61, 0.95] and 0.031 [0.008, 0.124], respectively). Older age, Medicaid, and uninsured statuses were positively correlated with LCS eligibility (P ≤ .01).LIMITATIONS This analysis comprises a single county. Other LCS facilities within our health system in neighboring counties, as well as individuals receiving LCS outside of our health system, are not captured.CONCLUSIONS The uptake of LCS remains low, with disproportionately lower screening rates amongst Hispanic and African American populations. Medicaid and uninsured patients in our community are also more likely to be LCS-eligible. These populations may be targets for interventions aimed at increasing LCS awareness and uptake.

A risk-based framework for assessing real-time lung cancer screening eligibility that incorporates life expectancy and past screening findings.

Current lung cancer risk-based screening approaches use a single risk-threshold, disregard life-expectancy, and ignore past screening findings. We address these limitations with a comprehensive analytical framework, the individualized lung cancer screening decision (ENGAGE) tool that aims to optimize lung cancer screening for US ever-smokers under dynamic risk assessment by incorporating life expectancy and past screening findings over time. ENGAGE employs a partially observable Markov decision process framework that integrates published risk prediction and disease progression models, to dynamically assess the trade-off between the expected health benefits and harms associated with screening. ENGAGE evaluates lung cancer risk annually and provides real-time screening eligibility that maximizes the expected quality-adjusted life-years (QALYs) of ever-smokers. We compare ENGAGE against the 2013 U.S. Preventive Services Task Force (USPSTF) lung cancer screening guideline and single-threshold risk-based screening paradigms. Compared with the 2013 USPSTF guidelines, ENGAGE expands screening coverage among ever-smokers (ENGAGE: 78%, USPSTF: 61%), while reducing the number of screening examinations per person (ENGAGE:10.43, USPSTF:12.07, P<.001), yields higher effectiveness in terms of increased lung cancer-specific mortality reduction (ENGAGE: 19%, USPSTF: 15%, P<.001) and improves screening efficiency (ENGAGE: 696, USPSTF: 819 screens per death avoided, P<.001). When compared against a single-threshold risk-based screening strategy, ENGAGE increases QALY requiring 30% fewer screens per death avoided (ENGAGE: 696, single-threshold: 889, P<.001), and reduces false positives by 40%. ENGAGE provides a comprehensive framework for dynamic risk-based assessment of lung cancer screening eligibility by incorporating life expectancy and past screening findings that can serve to guide future policies on the effectiveness and efficiency of screening. A novel decision-analytical screening framework was developed for lung cancer, the individualized lung cancer screening decision (ENGAGE) tool to provide personalized screening schedules for ever-smokers. ENGAGE captures the dynamic nature of lung cancer risk and incorporates life expectancy into the screening decision-making process. ENGAGE integrates past screening findings and changes in smoking behavior of individuals and provides informed screening decisions that outperform existing screening guidelines and single-threshold risk-based screening approaches. A personalized lung cancer screening program facilitated by a tool such as ENGAGE could enhance the efficiency of lung cancer screening.

The impact of income and education on lung cancer screening utilization, eligibility, and outcomes: a narrative review of socioeconomic disparities in lung cancer screening.

Non-small cell lung cancer (NSCLC) is the leading cause of cancer deaths in the US and worldwide. In particular, vulnerable populations such as those of low socioeconomic status (SES) are at the highest risk for and suffer the highest mortality from NSCLC. Although lung cancer screening (LCS) has been demonstrated to be a powerful tool to lower NSCLC mortality, it is underutilized by eligible smokers, and disparities in screening are likely to contribute to inequities in NSCLC outcomes. It is imperative that we collect and analyze LCS data focused on individuals of low socioeconomic position to identify and address barriers to LCS utilization and help close the gaps in NSCLC mortality along socioeconomic lines. Toward this end, this review aims to examine published studies that have evaluated the impact of income and education on LCS utilization, eligibility, and outcomes. We searched the PubMed, Ovid MEDLINE, and CINAHL Plus databases for all studies published from January 1, 2010, to October 21, 2020, that discussed socioeconomic-based LCS outcomes. The review reveals that income and education have impact on LCS utilization, eligibility, false positive rates and smoking cessation attempts; however, there is a lack of studies evaluating the impact of SES on LCS follow-up, stage at diagnosis, and treatment. We recommend the intentional inclusion of lower SES participants in LCS studies in order to clarify appropriate eligibility criteria, risk-based metrics and outcomes in this high-risk group. We also anticipate that low SES smokers and their providers will require increased support and education regarding smoking cessation and shared decision-making efforts.

One size does not fit all: Evaluating disparities in lung cancer screening eligibility amongst Hispanic/LatinX and African Americans.

6538 Background: Lung cancer (LC) is the leading cause of cancer death among Hispanic men. African Americans (AA) have the highest LC mortality rate in the United States (US). We sought to identify the tendencies for screening eligibility amongst Hispanic/LatinX (H/L) and AA prior to their LC diagnosis according to the National Comprehensive Cancer Network (NCCN) and The United States Preventive Service Task Force (USPSTF) guidelines. Methods: We conducted an observational study in patients diagnosed with LC from 2016 to 2019. Current and former smokers were included in the analysis. Charts were reviewed for demographics, smoking history, family history, personal history of other malignancy, and prior exposures to assess screening their eligibility prior to LC. The chi-square test was used to examine the association between race and ethnicity with each screening criteria. Results: A total of 530 subjects were reviewed, of which 428 were included in the analysis. One hundred and fifty three and 245 subjects were ineligible for NCCN and USPSTF screening criteria prior to their LC diagnosis. Twenty-eight of the subjects failing to meet NCCN criteria identified as AA and 12 as H/L. Forty and 20 of the USPSTF ineligible subjects identified as AA and H/L. There was a significant association between ethnicity and individual screening eligibility, where 52% of H/L met NCCN eligibility compared to 20% of H/L who met USPSTF eligibility (p = 0.0010). There was a significant association between ethnicity and USPSTF criteria (p = 0.0166), as 80% of H/L subjects were screening ineligible under USPSTF criteria compared to 56% of non-Hispanic or other [Table]. Conclusions: In our study, H/L had significant lower tendencies of meeting the USPSTF LC screening eligibility criteria than non-H/L or other. Notably, there was a profound association between ethnicity and eligibility of screening criteria, where a proportionally higher number of H/L who were ineligible under USPSTF criteria met NCCN criteria. These findings suggest that leniency in the screening criteria can possibly lead to earlier detection of lung cancer in high-risk individuals. Our study is in line with developing data that minority individuals at high-risk for lung cancer can be missed, mainly if current USPSTF criteria was to be applied. Recently, USPSTF has modify their criteria which may benefit more of these individuals. To improve rates of screening and overall mortality of minorities, organizations should continue to re-evaluate and liberalize their screening guidelines.[Table: see text]

Modeling Strategies to Optimize Cancer Screening in USPSTF Guideline–Noncompliant Women

In 2018, only half of US women obtained all evidence-based cancer screenings. This proportion may have declined during the COVID-19 pandemic because of social distancing, high-risk factors, and fear. To evaluate optimal screening strategies in women who obtain some, but not all, US Preventive Services Task Force (USPSTF)-recommended cancer screenings. This modeling study was conducted from January 31, 2017, to July 20, 2020, and used 4 validated mathematical models from the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network using data from 20 million simulated women born in 1965 in the US. Forty-five screening strategies were modeled that combined breast, cervical, colorectal, and/or lung cancer (LC) screenings; restricted to 1, 2, 3 or 4 screenings per year; or all eligible screenings once every 5 years. Modeled life-years gained from restricted cancer screenings as a fraction of those attainable from full compliance with USPSTF recommendations (maximum benefits). Results were stratified by LC screening eligibility (LC-eligible/ineligible). We repeated the analysis with 2018 adherence rates, evaluating the increase in adherence required for restricted screenings to have the same population benefit as USPSTF recommendations. This modeling study of 20 million simulated US women found that it was possible to reduce screening intensity to 1 carefully chosen test per year in women who were ineligible for LC screening and 2 tests per year in eligible women while maintaining 94% or more of the maximum benefits. Highly ranked strategies screened for various cancers, but less often than recommended by the USPSTF. For example, among LC-ineligible women who obtained just 1 screening per year, the optimal strategy frequently delayed breast and cervical cancer screenings by 1 year and skipped 3 mammograms entirely. Among LC-eligible women, LC screening was essential; strategies omitting it provided 25% or less of the maximum benefits. The top-ranked strategy restricted to 2 screenings per year was annual LC screening and alternating fecal immunochemical test with mammography (skipping mammograms when due for cervical cancer screening, 97% of maximum benefits). If adherence in a population of LC-eligible women obtaining 2 screenings per year were to increase by 1% to 2% (depending on the screening test), this model suggests that it would achieve the same benefit as USPSTF recommendations at 2018 adherence rates. This modeling study of 45 cancer screening strategies suggests that women who are noncompliant with cancer screening guidelines may be able to reduce USPSTF-recommended screening intensity with minimal reduction in overall benefits.

Factors associated with low-dose CT lung cancer screening participation in a high burden state: Results from the 2017-2018 BRFSS

IntroductionThe purpose of this study was to examine low-dose computed tomography (LDCT) for lung cancer screening (LCS) eligibility, utilization, and factors associated with self-reported participation among eligible individuals. MethodsData from the 2017 and 2018 Oklahoma Behavioral Risk Factor Surveillance System (BRFSS) were used and analysis was restricted to data from individuals eligible for screening based on the US Preventive Services Task Force (USPSTF) guidelines. Analyses using recursive partitioning and weighted logistic regression were conducted from November 2019 to March 2020. The final study sample consisted of 596 respondents. ResultsOnly 10.84 % of participants reported LCS participation. Differences in participation by sex were observed. Among males, those with COPD were more likely to report participating in screening. Among females, those who self-reported their health status as “fair or worse” were more likely to participate in LCS. ConclusionRates of utilization were higher in this study than in earlier estimates; however, utilization of LCS remains suboptimal. Although LCS participation rates were similar for males and females, differences were observed by sex. Opportunities exist to increase screening participation among eligible individuals, and findings from this study can be used for program planning such as patient engagement resources and effective clinical decision support. Policy statementThis study further demonstrates the complex nature of cancer screening participation, specifically LDCT LCS. Under the current USPSTF guidelines only a small proportion of the population is considered eligible thus to prevent lung cancer mortality, the eligibility criteria regarding smoking history and screening age may need to be reevaluated. Furthermore, this study adds to the evidence that strategies to increase screening participation among eligible individuals may need to differ by sex.

Patient Adherence in an Academic Medical Center's Low-dose Computed Tomography Screening Program.

Low-dose computed tomography (LDCT) screening is an important tool for reducing lung cancer mortality. This study describes a single center's experience with LDCT and attempts to identify any barriers to compliance with standard guidelines. This is a retrospective review of a single university-based hospital system from 2015 to 2019. All individuals who met eligibility for lung cancer screening were entered into a database. The definition of adherence with the screening program was determined by the recommended timeline for the follow-up LDCT. Cohorts were split by adherence and demographics were compared. A total of 203 LDCTs were performed in 121 patients who met eligibility for LDCT and had appropriate surveillance from 2015 to 2019. The average age was 64 years old. The overall adherence rate for prescribed LDCTs was 59.1%. Patients with Lung-RADS score 2 had 2.43 times higher odds of adherence relative to patients with Lung-RADS score 1 (odds ratio [OR]=2.43; 95% confidence interval [CI]: 1.23-4.83; P=0.011). African American patients had 42% lower odds of adherence relative to white patients (OR=0.58; 95% CI: 0.32-1.06; P=0.076). Patients with non-District of Columbia zip codes had 57% higher odds of adherence relative to those with District of Columbia zip codes, although this did not reach statistical significance (OR=1.57; 95% CI: 0.87-2.82; P=0.136). Despite the implementation of a multidisciplinary, academic LDCT screening program, overall adherence rate to prescribed follow-up scans was suboptimal. Socioeconomic disparities and African American race may negatively affect adherence to lung cancer screening LDCT guidelines. Patients with concerning findings on initial LDCT had a higher association of adherence to guidelines.

Broadened Eligibility for Lung Cancer Screening

Broadened Eligibility for Lung Cancer Screening