Lung Cancer Screening Guidelines Research Articles

Geographic Accessibility and Completion of Initial Low-Dose CT-Based Lung Cancer Screening in an Urban Safety-Net Population.

Recent modifications to low-dose CT (LDCT)-based lung cancer screening guidelines increase the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between travel time and initial LDCT completion within an integrated, urban safety-net health care system. Using Esri's StreetMap Premium, OpenStreetMap, and the r5r package in R, we determined projected private vehicle and public transportation travel times between patient residence and the screening facility for LDCT ordered in March 2017 through December 2022 at Parkland Memorial Hospital in Dallas, Texas. We characterized associations between travel time and LDCT completion in univariable and multivariable analyses. We tested these associations in a simulation of 10,000 permutations of private vehicle and public transportation distribution. A total of 2,287 patients were included in the analysis, of whom 1,553 (68%) completed the initial ordered LDCT. Mean age was 63 years, and 73% were underrepresented minorities. Median travel time from patient residence to the LDCT screening facility was 17 minutes by private vehicle and 67 minutes by public transportation. There was a small difference in travel time to the LDCT screening facility by public transportation for patients who completed LDCT versus those who did not (67 vs 66 min, respectively; P=.04) but no difference in travel time by private vehicle for these patients (17 min for both; P=.67). In multivariable analysis, LDCT completion was not associated with projected travel time to the LDCT facility by private vehicle (odds ratio, 1.01; 95% CI, 0.82-1.25) or public transportation (odds ratio, 1.14; 95% CI, 0.89-1.44). Similar results were noted across travel-type permutations. Black individuals were 29% less likely to complete LDCT screening compared with White individuals. In an urban population comprising predominantly underrepresented minorities, projected travel time is not associated with initial LDCT completion in an integrated health care system. Other reasons for differences in LDCT completion warrant investigation.

Abstract 981: Robustness of fragmentation-based cell-free DNA approaches to clonal hematopoiesis

Abstract INTRODUCTION: Clonal hematopoiesis (CH) is the result of the clonal expansion of hematopoietic stem cells which acquire and pass on somatically gained mutations, including SNVs as well as arm level losses and gains, defined here as mosaic deletions and amplifications (mDAs). The proportion of blood cells in circulation containing CH alterations increases with age and environmental exposures such as smoking, leading to a higher prevalence in many high-risk cancer screening populations. CH remains a major confounder for mutation-based liquid biopsy tests evaluating circulating cell-free DNA (cfDNA), since these assays are unable to discriminate between mutations originating from the tumor as opposed to CH. While the impact of CH mutations on fragmentation-based methods of detecting ctDNA appears to be limited, the effect of mDAs has not yet been explored. METHODS: To assess the impact of mDAs on screening efforts using whole genome sequencing (WGS) of cfDNA, we performed copy number analyses on cfDNA from plasma collected from 895 individuals consisting of high-risk individuals meeting the USPSTF guidelines for annual lung cancer screening using low-dose computed tomography. From a subset of 203 available donors (157 without cancer and 46 with lung cancer), matched genomic DNA from white blood cells (WBCs) were extracted from the isolated buffy coat and WGS was performed to evaluate whether ploidy in cfDNA plasma is derived from WBCs. Genome-wide fragmentation features (short to long ratios and fragment size densities), coverage-based statistics, and copy number (CN) statistics adjusting for mDAs were calculated (CNadj). Machine learning models to calculate the probability of cancer based on these features were then derived. RESULTS: 3.8% (95% CI 0.9%-6.8%) of individuals without cancer had an mDA in their WBCs that were also observed in the plasma (p < 0.01, permutation test). Fragmentation features were not different in regions with mDAs in individuals without cancer (p = 0.619; permutation test) but were altered in regions of tumor-derived chromosomal changes in patients with cancer (p < 0.01; permutation test). Coverage-based statistics were impacted by mDAs (p < 0.01; Wilcoxon test). Machine learning models fit with CNadj showed improved performance over CN. However, machine learning models fit with fragmentation features compensated for this difference overall showing robustness to mDAs (p = 0.45; bootstrap) demonstrating the robustness of cfDNA fragmentomes for detecting lung cancer. CONCLUSIONS: While coverage-based statistics of WGS analyses of cfDNA may be affected by mDAs, fragmentation-based approaches relying on cfDNA fragment length are robust to effects of CH. CNadj is an improved statistic for detecting tumor-derived chromosomal copy number changes in cfDNA, providing increased specificity by conditioning on fragment size distributions. Citation Format: Stephen Cristiano, Bahar Alipanahi, Jamie E. Medina, Lorenzo Rinaldi, Nicholas Dracopoli, Robert B. Scharpf, Alessandro Leal, Victor E. Velculescu, Jennifer Tom. Robustness of fragmentation-based cell-free DNA approaches to clonal hematopoiesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 981.

Abstract 6075: Most cancer deaths are unaddressed by current screening paradigms

Abstract Cancer is the leading cause of death at ages ≤80 in the US. To understand the burden of cancer death potentially addressable by new or improved screening approaches, we estimated the proportion of US cancer deaths without recommended guideline-based screening, especially after accounting for lung cancer screening eligibility and adherence. Using 2018-2019 mortality data from the National Center for Health Statistics and published estimates of the proportion of screening-eligible lung cancer patients, we estimated that 31.4% of nearly 600,000 annual cancer deaths were from colorectal, female breast, cervical, and smoking-eligible lung cancers (Table). Further accounting for adherence to lung cancer screening guidelines reduced the estimated proportion of screened cancer deaths to 17.4%; thus, 82.6% of cancer deaths may not be addressed by current guideline-based screening. Among the cancers not covered by guideline-based screening are uncommon cancer types, which (as defined by the National Cancer Institute) comprised 30.4% of cancer deaths. According to incidence-based mortality data from Surveillance, Epidemiology, and End Results registries, 24.7% of all cancer deaths were from stage 4 cancer types without guideline-based screening. These estimates, based on population data without patient-level information on mode of diagnosis, almost certainly underestimate the percentage of cancer deaths missed by currently available screening efforts. The large proportion of cancer deaths unaddressed by guideline-based screening represents a vast opportunity for new cancer screening technologies that are safe, effective, accessible, and affordable to enable earlier detection and successful treatment of the full spectrum of cancer types that contribute to the overall cancer burden. Table. Deaths from cancer by primary type in 2018-2019, US National Center for Health Statistics, with eligibility for and adherence to guideline-based low-dose computed tomography screening for lung cancer All cancer types Lung Colon/rectum Breast (female) Uterine cervix Total screened % of all All cancer deaths 1,198,854 281,681 104,059 84,745 8,290 478,775 39.9% Eligible for screening based on smoking (63.7% of lung)* 179,431 104,059 84,745 8,290 376,525 31.4% Adherent to smoking-guideline-based screening (6.6% of lung)† 11,842 104,059 84,745 8,290 208,936 17.4% *Modeled estimate of proportion of lung cancer patients eligible for screening (Landy et al. 2023). †Lung cancer screening receipt from 2019 American College of Radiology Lung Cancer Screening Registry (Fedewa et al. 2022). Citation Format: Ellen T. Chang, Anuraag Kansal, Earl A. Hubbell, Graham A. Colditz, Allison W. Kurian, Christina A. Clarke. Most cancer deaths are unaddressed by current screening paradigms [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6075.

LDCT screening results among eligible and ineligible screening candidates in preventive health check-ups population: a real world study in West China

To compare the LDCT screening results between eligible and ineligible screening candidates in preventive health check-ups population. Using a real-world LDCT screening results among people who took yearly health check-up in health management center of West China Hospital between 2006 and 2017. Objects were classified according to the China National Lung Cancer Screening Guideline with Low-dose Computed Tomography (2018 version) eligibility criteria. Descriptive analysis were performed between eligible and ineligible screening candidates. The proportion of ineligible screening candidates was 64.13% (10,259), and among them there were 4005 (39.04%) subjects with positive screenings, 80 cases had a surgical lung biopsy. Pathology results from lung biopsy revealed 154 cancers (true-positive) and 26 benign results (false-positive), the surgical false-positive biopsy rate was 4.17%, and ineligible group (7.69%) was higher than eligible group (2.47%), P < 0.05. Further, in ineligible screening candidates, the proportion of current smokers was higher among males compared to females (53.85% vs. 4.88%, P < 0.05). Of the 69 lung cancer patients detected in ineligible screening candidates, lung adenocarcinoma accounts for a high proportion of lung cancers both in male (75.00%) and female (85.00%). The proportion of ineligible screening candidates and the surgical false-positive biopsy rate in ineligible candidates were both high in health check-ups population.

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.

FACTORS ASSOCIATED WITH LOW-DOSE COMPUTED TOMOGRAPHY LUNG CANCER SCREENING IN THE UNITED STATES

Abstract Low-dose computed tomography (LDCT) screening is recommended for high-risk smokers to decrease lung cancer-related mortality. In the US, the uptake of LDCT screening among eligible smokers is suboptimal. The impacts of social-environmental and individual factors on LDCT screening uptake are not clear. The current study investigated multi-level factors associated with the utilization of LDCT screening using national data. Methods: The 2017-2021 Behavioral Risk Factor Surveillance System (BRFSS) data and other state-level variables (Medicaid expansion status and the number of screening facilities) were applied. Our study outcome is the utilization of LDCT screening among study participants who met the US Preventive Services Task Force guidelines for lung cancer screening. The final study sample consisted of 15640 respondents from 29 states. All analyses were weighted to account for the complex sampling design applied in BRFSS. Results: The overall utilization rate of LDCT screening is only 18.4%. The LDCT utilization rate varied by state (6.2 -31.1%). Among the respondents, individuals who were employed, never married, had good health status, didn’t have personal physician, experienced cost problems, never had routine checkups, and did not experience certain chronic conditions (cancer, asthma, COPD) had a lower utilization rate of LDCT screening compare with their counterpart. Conclusion: Utilization of LDCT screening among eligible smokers remains low. Risk factors associated with LDCT screening identified from this study can be used to guide future lung cancer screening programs or revise the LDCT screening guidelines to meet the needs of high-risk smokers.

Opportunistic Screening With Low-Dose Computed Tomography and Lung Cancer Mortality in China

ImportanceDespite the recommendations of lung cancer screening guidelines and the evidence supporting the effectiveness of population-based lung screening, a common barrier to effective lung cancer screening is that the participation rates of low-dose computed tomography (LDCT) screening among individuals with the highest risk are not large. There are limited data from clinical practice regarding whether opportunistic LDCT screening is associated with reduced lung-cancer mortality.ObjectiveTo evaluate whether opportunistic LDCT screening is associated with improved prognosis among adults with lung cancer in mainland China.Design, Setting, and ParticipantsThis cohort study included patients diagnosed with lung cancer at Weihai Municipal Hospital Healthcare Group, Weihai City, China, from 2016 to 2021. Data were analyzed from January 2022 to February 2023.ExposuresData collected included demographic indicators, tumor characteristics, comorbidities, blood indexes, and treatment information. Patients were classified into screened and nonscreened groups on the basis of whether or not their lung cancer diagnosis occurred through opportunistic screening.Main Outcomes and MeasuresFollow-up outcome indicators included lung cancer–specific mortality and all-cause mortality. Propensity score matching (PSM) was adopted to account for potential imbalanced factors between groups. The associations between LDCT screening and outcomes were analyzed using Cox regression models based on the matched data. Propensity score regression adjustment and inverse probability treatment weighting were used for sensitivity analysis.ResultsA total of 5234 patients (mean [SD] baseline age, 61.8 [9.8] years; 2518 [48.1%] female) with complete opportunistic screening information were included in the analytical sample, with 2251 patients (42.91%) receiving their lung cancer diagnosis through opportunistic screening. After 1:1 PSM, 2788 patients (1394 in each group) were finally included. The baseline characteristics of the matched patients were balanced between groups. Opportunistic screening with LDCT was associated with a 49% lower risk of lung cancer death (HR, 0.51; 95% CI, 0.42-0.62) and 46% lower risk of all-cause death (HR, 0.54; 95% CI, 0.45-0.64).Conclusions and RelevanceIn this cohort study of patients with lung cancer, opportunistic lung cancer screening with LDCT was associated with lower lung cancer mortality and all-cause mortality. These findings suggest that opportunistic screening is an important supplement to population screening to improve prognosis of adults with lung cancer.

Lung cancer screening in the prison population.

114 Background: The United States incarcerated population is large and aging resulting in greater incidence of cancer. Inmates are a vulnerable population with increased rates of tobacco use that can place them at risk of developing lung cancer. The goal of this study is to determine whether inmates within the Connecticut (CT) Department of Corrections (DOC) with a history of smoking are screened for lung cancer and to implement a process by which they may be screened. Methods: We conducted a retrospective chart review of patients within the CT DOC that have been diagnosed with a lung nodule or lung mass between the years 2018-2021. Each chart was reviewed to determine if these patients met the current United States Preventative Service Task Force (USPSTF) guidelines for lung cancer screening with low dose CT scan (LDCT). After identifying an opportunity for improvement, we then implemented a shared decision-making clinic to screen inmates. Patients were scheduled for LDCT if they met eligibility criteria and consented to CT scan. Results: 28 patients of charts reviewed were identified as eligible for LDCT screening from the years of 2018-2021. These results showed that 9 (32%) patients out of 28 had LDCT completed. 7 (25%) of these patients had biopsy proven lung cancer. 300 inmates residing within the CTDOC were found to have a significant smoking history. Thus far, 11 patients have been evaluated in our shared decision-making clinic. 7 patients met criteria for LDCT and underwent CT scan. All 7 patients require annual follow up for 3 years. 1 patient declined meeting with our providers. We will continue to offer screening to all eligible and consenting inmates. Conclusions: Through our study we have identified a need to improve screening for lung cancer in the DOC population. We have implemented a process by which inmates can be screened with help from our DOC, Pulmonology, and Radiology colleagues. We will continue the current process to screen and obtain consent for the 300 inmates identified as having a significant smoking history. To our best knowledge, this is the first study that demonstrates a sustainable workflow to screen DOC inmates for lung cancer.

Efforts to increase the application of low-dose computed tomography (LDCT): A resident-led strategy to improve lung cancer screening in an urban primary care clinic.

132 Background: Lung cancer carries the highest mortality rate of all malignancies, implicated in approximately 20% of cancer-related deaths in the United States. The 2011 National Lung Screening Trial (NLST) established a 20% reduction in lung cancer-associated mortality associated with annual LDCT screening in high-risk populations compared to screening chest radiography. In 2013 the United States Preventative Services Task Force (USPSTF) adopted this approach into their recommendations, with a subsequent update in 2021 establishing a recommended annual LDCT screening for those at high risk. There remains a concerning lack of access to PCP-initiated LDCT screening in medically underserved (e.g., urban, rural) areas, translating to relatively low rates of early lung cancer detection. Methods: Any patient meeting the 2021 USPSTF criteria (at least 20-pack-year history of tobacco use, who still smoke or have quit within the past 15 years) was deemed eligible. Excluded were those meeting these criteria and any patient who had received LDCT within the past 12 months. The pre-intervention stage of this study included a 15-week data collection of chart review to establish baseline rates. The intervention involved an educational flyer detailing the guidelines for lung cancer screening, placed in each clinic exam room to promote patient self-assessment of eligibility. Results: In the 15-week control group (i.e., pre-intervention), 177 patients were eligible for LDCT screening, with 65 successful LDCT orders and 112 not ordered (36.7% screened appropriately) and 27 (41.5%) LDCT orders completed. Through the 15 weeks of post-intervention data, 193 patients were eligible for LDCT screening, with 99 orders placed and 94 not (51.3% screened appropriately), and 42 (42.4%) of these LDCT orders were completed. Conclusions: The initial goal set for this project was a 50% lung cancer screening rate among eligible patients, with at least 50% of those LDCT orders performed by the patient. There was a remarkable improvement in LDCT ordering rates; however, the primary goal of these ordering improvement rates was to translate them into a higher percentage of patients completing these orders. Despite the increase in LDCT orders, the percentage completed stagnated (41.5% pre-intervention, 42.4% post-intervention). It was essential to our team that the interventions remain cost-effective. We did achieve this using printed flyers, allowing for patient-initiated involvement in the process. Using these interventions as a template, a clinic in any setting may benefit their LDCT ordering rates. However, these measures alone will not improve the percentage of patients completing the LDCT orders. As our project continues, we plan to modify the intervention to reflect constructive feedback from the resident physicians and patients involved.

Screening for lung cancer: 2023 guideline update from the American Cancer Society.

Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50-80years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50-80years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.

Absolute lung cancer risk increases among individuals with >15 quit-years: Analyses to inform the update of the American Cancer Society lung cancer screening guidelines.

This report quantifies counteracting effects of quit-years and concomitant aging on lung cancer risk, especially on exceeding 15 quit-years, when the US Preventive Services Task Force (USPSTF) recommends curtailing lung-cancer screening. Cox models were fitted to estimate absolute lung cancer risk among Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) and National Lung Screening Trial (NLST) participants who ever smoked. Absolute lung cancer risk and gainable years of life from screening for individuals aged 50 to 80 in the US-representative National Health Interview Survey (NHIS) 2015-2018 who ever smoked were projected. Relaxing USPSTF recommendations to 20/25/30 quit-years versus augmenting USPSTF criteria with individuals whose estimated gain in life expectancy from screening exceeded 16.2days according to the Life Years From Screening-CT (LYFS-CT) prediction model was compared. Absolute lung cancer risk increased by 8.7%/year (95% CI, 7.7%-9.7%; p<.001) as individuals aged beyond 15 quit-years in the PLCO, with similar results in NHIS and NLST. For example, mean 5-year lung cancer risk for those aged 65 years with 15 quit-years=1.47% (95% CI, 1.35%-1.59%) versus 1.76% (95% CI, 1.62%-1.90%) for those aged 70 years with 20 quit-years in the PLCO. Removing the quit-year criterion would make 4.9 million more people eligible and increase the proportion of preventable lung cancer deaths prevented (sensitivity) from 63.7% to 74.2%. Alternatively, augmentation using LYFS-CT would make 1.7million more people eligible while increasing the lung cancer death sensitivity to 74.0%. Because of aging, absolute lung cancer risk increases beyond 15 quit-years, which does not support exemption from screening or curtailing screening once it has been initiated. Compared with relaxing the USPSTF quit-year criterion, augmentation using LYFS-CT could prevent most of the deaths at substantially superior efficiency, while also preventing deaths among individuals who currently smoke with low intensity or long duration.

487P Evaluating the performance of the USPSTF lung cancer screening guidelines in an Asian population of lung cancer patients

487P Evaluating the performance of the USPSTF lung cancer screening guidelines in an Asian population of lung cancer patients

Cost effective quality improvement initiative in lung cancer screening: A single institutional pilot program.

458 Background: US Preventive Services Task Force (USPSTF) recommends lung cancer screening (LCS) with annual low-dose computed tomography (LDCT) screening for individuals aged 50-80 years with ≥20 pack-year smoking history. Nevertheless, only 4%-13% of eligible individuals are screened nationally. Lung cancer mortality is higher in the South where low socioeconomic status and racial minorities predominate and the screening rate in Alabama is between 4.7% - 7.7%. Thomas Hospital belongs to this catchment area and the goal of our study was to improve LCS with LDCT by embarking on a quality improvement initiative which was commenced as a pilot program for a larger healthcare system (&gt;5 large outpatient clinics with over 12,000 visits/month). Methods: Data were obtained retrospectively by reviewing the electronic medical records of eligible patients for LCS from 01/22 to 01/23 who visited the Thomas Hospital Internal Medicine Residency Clinic (pilot study site). A multidisciplinary team was created involving Thoracic oncologists, radiologists, Thoracic surgeons, resident physicians, and PCPs to identify barriers to LCS and discuss methods on how to improve LCS. We identified areas to be improved on and utilized performance improvement tools such as a Pareto chart and a PICK chart. Data was then collected prospectively. Results: In the initial 12-month period, only 6.95% (total n=185) of patients who qualified for LCS had LDCT done for LCS. The major barriers to screening were poor smoking history documentation, lack of proper identification of screening candidates, lack of awareness of screening guidelines, infrequent follow-up, discrepancies in smoking history within the EMR, and lack of a consistent system for LDCT referral. We identified 4 main initiatives which were introduced monthly, one at a time. The interventions include Educational services/Awareness campaigns on LCS, Distribution of current LCS guidelines in the clinic rooms/offices, Patient self-reported questionnaire on smoking history, and Implementation of an EPIC flag tool for LCS. We reviewed our performance after the interventions and the total LCS after 4 interventions included 48 (47%) patients compared to 102 patients who fit the screening criteria. 5 patients had LDCT ordered but yet to be completed and 6 patients had findings that needed immediate evaluation and received appropriate referrals. Conclusions: Lung cancer screening remains suboptimal in the United States, especially in the southern region. With our approach, the screening rates have increased exponentially only within a few months compared to the previous year and this model is to be adopted by other clinics affiliated with the umbrella health system. LDCT does carry certain risks including false positive results and unnecessary biopsies; hence shared decision-making is needed before ordering the test.

EP04.06-01 Compliance with Lung Cancer Screening Guidelines Among At-Risk Patients at a Rural Teaching Hospital in West Texas

EP04.06-01 Compliance with Lung Cancer Screening Guidelines Among At-Risk Patients at a Rural Teaching Hospital in West Texas

Risk Model–Based Lung Cancer Screening and Racial and Ethnic Disparities in the US

The revised 2021 US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening have been shown to reduce disparities in screening eligibility and performance between African American and White individuals vs the 2013 guidelines. However, potential disparities across other racial and ethnic groups in the US remain unknown. Risk model-based screening may reduce racial and ethnic disparities and improve screening performance, but neither validation of key risk prediction models nor their screening performance has been examined by race and ethnicity. To validate and recalibrate the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012) model-a well-established risk prediction model based on a predominantly White population-across races and ethnicities in the US and evaluate racial and ethnic disparities and screening performance through risk-based screening using PLCOm2012 vs the USPSTF 2021 criteria. In a population-based cohort design, the Multiethnic Cohort Study enrolled participants in 1993-1996, followed up through December 31, 2018. Data analysis was conducted from April 1, 2022, to May 19. 2023. A total of 105 261 adults with a smoking history were included. The 6-year lung cancer risk was calculated through recalibrated PLCOm2012 (ie, PLCOm2012-Update) and screening eligibility based on a 6-year risk threshold greater than or equal to 1.3%, yielding similar eligibility as the USPSTF 2021 guidelines. Predictive accuracy, screening eligibility-incidence (E-I) ratio (ie, ratio of the number of eligible to incident cases), and screening performance (sensitivity, specificity, and number needed to screen to detect 1 lung cancer). Of 105 261 participants (60 011 [57.0%] men; mean [SD] age, 59.8 [8.7] years), consisting of 19 258 (18.3%) African American, 27 227 (25.9%) Japanese American, 21 383 (20.3%) Latino, 8368 (7.9%) Native Hawaiian/Other Pacific Islander, and 29 025 (27.6%) White individuals, 1464 (1.4%) developed lung cancer within 6 years from enrollment. The PLCOm2012-Update showed good predictive accuracy across races and ethnicities (area under the curve, 0.72-0.82). The USPSTF 2021 criteria yielded a large disparity among African American individuals, whose E-I ratio was 53% lower vs White individuals (E-I ratio: 9.5 vs 20.3; P < .001). Under the risk-based screening (PLCOm2012-Update 6-year risk ≥1.3%), the disparity between African American and White individuals was substantially reduced (E-I ratio: 15.9 vs 18.4; P < .001), with minimal disparities observed in persons of other minoritized groups, including Japanese American, Latino, and Native Hawaiian/Other Pacific Islander. Risk-based screening yielded superior overall and race and ethnicity-specific performance to the USPSTF 2021 criteria, with higher overall sensitivity (67.2% vs 57.7%) and lower number needed to screen (26 vs 30) at similar specificity (76.6%). The findings of this cohort study suggest that risk-based lung cancer screening can reduce racial and ethnic disparities and improve screening performance across races and ethnicities vs the USPSTF 2021 criteria.

Persistent race- and sex-based disparities in lung cancer screening eligibility

ObjectiveTo evaluate race- and sex-based disparities in lung cancer screening eligibility under the 2013 US Preventive Services Task Force, 2021 US Preventive Services Task Force, and National Comprehensive Cancer Network lung cancer screening guidelines. MethodsParticipants in the Southern Community Cohort Study with a smoking history diagnosed with lung cancer from 2002 to 2021 were identified for analysis. Differences in age at lung cancer diagnosis and smoking characteristics were evaluated among 4 groups: Black men, Black women, White men, and White women. ResultsA total of 2011 patients with lung cancer met study inclusion criteria, of whom 968 (48.1%) were women and 1248 (62.1%) were Black. Under the 2013 guideline, Black men with lung cancer were significantly less likely to be eligible for screening when compared with White men with lung cancer (37.7% vs 62.4%; P < .001), and Black women with lung cancer were significantly less likely to be eligible for screening when compared with White women with lung cancer (27.8% vs 56.7%; P < .001). Under the 2021 guideline, 62.6% of Black and 73.8% of White men (P < .001) with lung cancer would have been eligible for screening, resulting in an 11.2 percentage point difference in screening eligibility between Black and White men. Under the 2021 guideline, 50.3% of Black and 74.9% of White (P < .001) women with lung cancer would have been eligible for screening; notably, there remained a 24.6 percentage point difference in screening eligibility between Black and White women. In multivariable-adjusted analysis, under the 2021 USPSTF guideline, Black men with lung cancer had 46% lower odds of being eligible for screening compared with White men with lung cancer (multivariable-adjusted odds ratio [aOR], 0.54; 95% CI, 0.39-0.76; P < .001) and Black women with lung cancer had 66% lower odds of being eligible for screening compared with White women with lung cancer (aOR, 0.34; 95% CI, 0.25-0.46; P < .001). The National Comprehensive Cancer Network guideline increased the proportion of patients with lung cancer eligible for screening in each group. ConclusionsIn this analysis of patients with lung cancer in the Southern Community Cohort Study, there remained a large gap in lung cancer screening eligibility between Black and White men and women under the 2021 US Preventive Services Task Force guideline. Only 50% of Black women and 63% of Black men diagnosed with lung cancer would have qualified for screening.

1735P Impact of revised US Preventive Services Task Force (USPSTF) 2021 lung cancer screening guideline on long-term cancer survivors in the United States

1735P Impact of revised US Preventive Services Task Force (USPSTF) 2021 lung cancer screening guideline on long-term cancer survivors in the United States

Ascending thoracic aortic aneurysm size at presentation and growth by diameter

To investigate the hypothesis that lung cancer screening allows for earlier identification of ascending thoracic aortic aneurysms (aTAAs) and that growth rates for aTAAs are greatest at larger sizes. This single referral centre retrospective study manually gathered computed tomography (CT) data from 732 patients presenting from July 2002 to August 2022. Five hundred and seventeen patients with aTAA >39 mm were identified to compare presenting diameter by year of presentation. Four hundred and thirty-two patients had CT examinations >3 months apart, allowing for growth analysis. Patients were separated by initial examination date (before or after 12/31/2013) for presenting size comparison. Patients were then divided into five groups based on aTAA diameter for growth rate analysis. At identification, patients had a median aTAA diameter of 44 mm (IQR 41-47 mm). Patients with aTAAs identified prior to December 2013 (n=129) had an average aTAA diameter 1.7 mm larger than those identified later (n=388; p=0.003). The growth analysis showed an average growth rate of 0.1 mm/year (p<0.001) across the entire cohort. Patients with an aTAA diameter of ≥55 mm (n=12) grew the fastest at 1.9 mm/year (p<0.001). In the <40 mm group (n=43), the aTAAs expanded at 0.2 mm/year, faster than the 0.1 mm/year of the slowest expanding 45-49 mm group (n=130; p=0.04). aTAA size at discovery was larger before lung cancer screening guidelines took effect in December 2013. The largest aTAAs expanded fastest, but growth rates were slowest in the medium-sized 45-49 mm diameter group.

[Construction of a Risk Prediction Model for Lung Cancer Based on Lifestyle Behaviors in the UK Biobank Large-Scale Population Cohort].

To identify the risk factors related to lifestyle behaviors that affect the incidence of lung cancer, to build a lung cancer risk prediction model to identify, in the population, individuals who are at high risk, and to facilitate the early detection of lung cancer. The data used in the study were obtained from the UK Biobank, a database that contains information collected from 502 389 participants between March 2006 and October 2010. Based on domestic and international guidelines for lung cancer screening and high-quality research literature on lung cancer risk factors, high-risk population identification criteria were determined. Univariate Cox regression was performed to screen for risk factors of lung cancer and a multifactor lung cancer risk prediction model was constructed using Cox proportional hazards regression. Based on the comparison of Akaike information criterion and Schoenfeld residual test results, the optimal fitted model assuming proportional hazards was selected. The multiple factor Cox proportional hazards regression was performed to consider the survival time and the population was randomly divided into a training set and a validation set by a ratio of 7:3. The model was built using the training set and the performance of the model was internally validated using the validation set. The area under the receiver operating characteristic (ROC) curve ( AUC) was used to evaluate the efficacy of the model. The population was categorized into low-risk, moderate-risk, and high-risk groups based on the probability of occurrence of 0% to <25%, 25% to <75%, and 75% to 100%. The respective proportions of affected individuals in each risk group were calculated. The study eventually covered 453 558 individuals, and out of the cumulative follow-up of 5 505 402 person-years, a total of 2 330 cases of lung cancer were diagnosed. Cox proportional hazards regression was performed to identify 10 independent variables as predictors of lung cancer, including age, body mass index (BMI), education, income, physical activity, smoking status, alcohol consumption frequency, fresh fruit intake, family history of cancer, and tobacco exposure, and a model was established accordingly. Internal validation results showed that 8 independent variables (all the 10 independent variables screened out except for BMI and fresh fruit intake) were significant influencing factors of lung cancer ( P<0.05). The AUC of the training set for predicting lung cancer occurrence at one year, five years, and ten years were 0.825, 0.785, and 0.777, respectively. The AUC of the validation set for predicting lung cancer occurrence at one year, five years, and ten years were 0.857, 0.782, and 0.765, respectively. 68.38% of the individuals who might develop lung cancer in the future could be identified by screening the high-risk population. We established, in this study, a model for predicting lung cancer risks associated with lifestyle behaviors of a large population. Showing good performance in discriminatory ability, the model can be used as a tool for developing standardized screening strategies for lung cancer.

Development of an Electronic Health Record–Based Algorithm for Predicting Lung Cancer Screening Eligibility in the Population-Based Research to Optimize the Screening Process Lung Research Consortium

PURPOSE Lung cancer screening (LCS) guidelines in the United States recommend LCS for those age 50-80 years with at least 20 pack-years smoking history who currently smoke or quit within the last 15 years. We tested the performance of simple smoking-related criteria derived from electronic health record (EHR) data and developed and tested the performance of a multivariable model in predicting LCS eligibility. METHODS Analyses were completed within the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR-Lung). In our primary validity analyses, the reference standard LCS eligibility was based on self-reported smoking data collected via survey. Within one PROSPR-Lung health system, we used a training data set and penalized multivariable logistic regression using the Least Absolute Shrinkage and Selection Operator to select EHR-based variables into the prediction model including demographics, smoking history, diagnoses, and prescription medications. A separate test data set assessed model performance. We also conducted external validation analysis in a separate health system and reported AUC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy metrics associated with the Youden Index. RESULTS There were 14,214 individuals with survey data to assess LCS eligibility in primary analyses. The overall performance for assigning LCS eligibility status as measured by the AUC values at the two health systems was 0.940 and 0.938. At the Youden Index cutoff value, performance metrics were as follows: accuracy, 0.855 and 0.895; sensitivity, 0.886 and 0.920; specificity, 0.896 and 0.850; PPV, 0.357 and 0.444; and NPV, 0.988 and 0.992. CONCLUSION Our results suggest that health systems can use an EHR-derived multivariable prediction model to aid in the identification of those who may be eligible for LCS.