Lung Cancer Screening Participants Research Articles

Barriers and Facilitators Impacting Lung Cancer Screening Uptake Among Black Veterans: A Qualitative Study.

Racial disparities in lung cancer screening (LCS) are well established. Black Veterans are among those at the highest risk for developing lung cancer but are less likely to complete LCS. We sought to identify barriers and facilitators to LCS uptake among Black Veterans. A qualitative study using semistructured interviews was conducted with 32 Black Veterans to assess for barriers, facilitators, and contextual factors for LCS and strategies to improve screening. Veterans were purposively sampled by age, sex, and LCS participation status (ie, patients who received a low-dose CT [LDCT], patients who contacted the screening program but did not receive an LDCT, and patients who did not connect with the screening program nor receive an LDCT). Interview guides were developed using the Theoretical Domains Framework and Health Belief Model. Data were analyzed using rapid qualitative analysis. Barriers of LCS uptake among Black Veterans include self-reported low LCS knowledge and poor memory, attention, and decision processes associated with the centralized LCS process. Facilitators of LCS uptake among Black Veterans include social/professional role; identity and social influences; perceived susceptibility, threat, and consequences due to smoking status and military or occupational exposures; emotion, behavioral regulation, and intentions; and high trust in providers. Environmental context and resources (eg, transportation) and race and racism serve as contextual factors that did not emerge as having a major impact on LCS uptake. Strategies to improve LCS uptake included increased social messaging surrounding LCS, various forms of information dissemination, LCS reminders, balanced and repeated shared decision-making discussions, and streamlined referrals. We identified addressable barriers and facilitators for LCS uptake among Black Veterans that can help focus efforts to improve disparities in screening. Future studies should explore provider perspectives and test interventions to improve equity in LCS.

Demographics and socioeconomic determinants of health predict continued participation in a CT lung cancer screening program

PurposeWe developed machine learning (ML) models to assess demographic and socioeconomic status (SES) variables’ value in predicting continued participation in a low-dose CT lung cancer screening (LCS) program. Materials and Methods480 LCS subjects were retrospectively examined for the following outcomes: (#1) no follow-up (single LCS scan) vs. multiple follow-ups (220 and 260 subjects respectively) and (#2) absent or delayed (>1 month past the due date) follow-up vs timely follow-up (356 and 124 subjects respectively). We quantified the contributions of 14 socioeconomic, demographic, and clinical predictors to LCS adherence, and validated and compared prediction performances of multivariate logistic regression (MLR), support vector machine (SVM) and shallow neural network (NN) models. ResultsFor outcome #1, age, sex, race, insurance status, personal cancer history, and median household income were found to be associated with returning for follow-ups. For outcome #2, age, sex, race, and insurance status were significant predictor of absent/delayed LCS follow-up. Across 5-fold cross-validation, the MLR model achieved an average AUC of 0.732 (95% CI, 0.661-0.803) for outcome #1 and 0.633 (95% CI, 0.602-0.664) for outcome #2 and is the model with best predictive performance overall, whereas NN and SVM tended to overfit training data and fell short on testing data performance for either outcome. ConclusionsWe identified significant predictors of LCS adherence, and our ML models can predict which subjects are at higher risk of receiving no or delayed LCS follow-ups. Our results could inform data-driven interventions to engage vulnerable populations and extend the benefits of LCS.

176MO Low-dose computed tomography lung cancer screening participants live longer than matched controls: A population-based study

176MO Low-dose computed tomography lung cancer screening participants live longer than matched controls: A population-based study

"We need to work towards it, whatever it takes."-participation factors in the acceptability and feasibility of lung cancer screening in Australia: the perspectives of key stakeholders.

Low dose computed tomography (LDCT) screening, targeted at those at high-risk, has been shown to significantly reduce lung cancer mortality and detect cancers at an early stage. Practical, attitudinal and demographic factors can inhibit screening participation in high-risk populations. This study aimed to explore stakeholders' views about barriers and enablers (determinants) to participation in lung cancer screening (LCS) in Australia. Twenty-four focus groups (range 2-5 participants) were conducted in 2021 using the Zoom platform. Participants were 84 health professionals, researchers, policy makers and program managers of current screening programs. Focus groups consisted of a structured presentation with facilitated discussion lasting about 1 hour. The content was analysed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Screening determinants were identified across each stage of the proposed screening and assessment pathway. Challenges included participant factors such as encouraging participation for individuals at high-risk, whilst ensuring that access and equity issues were carefully considered in program design. The development of awareness campaigns that engaged LCS participants and health professionals, as well as streamlined referral processes for initial entry and follow-up, were strongly advocated for. Considering practical factors included the use of mobile vans in convenient locations. Participants reported that LCS in Australia was acceptable and feasible. Participants identified a complex set of determinants across the proposed screening and assessment pathway. Strategies that enable the best chance for program success must be identified prior to implementation of a national LCS program.

The relationship of fat and muscle measurements with emphysema and bronchial wall thickening in smokers.

Differences in body composition in patients with COPD may have important prognostic value and may provide opportunities for patient-specific management. We investigated the relation of thoracic fat and muscle with computed tomography (CT)-measured emphysema and bronchial wall thickening. Low-dose baseline chest CT scans from 1031 male lung cancer screening participants from one site were quantified for emphysema, bronchial wall thickening, subcutaneous fat, visceral fat and skeletal muscle. Body composition measurements were performed by segmenting the first slice above the aortic arch using Hounsfield unit thresholds with region growing and manual corrections. COPD presence and severity were evaluated with pre-bronchodilator spirometry testing. Participants had a median age of 61.5 years (58.6-65.6, 25th-75th percentile) and median number of 38.0 pack-years (28.0-49.5); 549 (53.2%) were current smokers. Overall, 396 (38.4%) had COPD (256 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 140 GOLD 2-3). Participants with COPD had less subcutaneous fat, visceral fat and skeletal muscle (p<0.001 for all). With increasing GOLD stages, subcutaneous (p=0.005) and visceral fat values (p=0.004) were higher, and skeletal muscle was lower (p=0.004). With increasing severity of CT-derived emphysema, subcutaneous fat, visceral fat and skeletal muscle values were lower (p<0.001 for all). With increasing CT-derived bronchial wall thickness, subcutaneous and visceral fat values were higher (p<0.001 for both), without difference in skeletal muscle. All statistical relationships remained when adjusted for age, pack-years and smoking status. COPD presence and emphysema severity are associated with smaller amounts of thoracic fat and muscle, whereas bronchial wall thickening is associated with fat accumulation.

Evaluation of Conventional Cardiovascular Risk Factors and Ordinal Coronary Artery Calcium Scoring in a Lung Cancer Screening Cohort.

(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50-79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.

General practice focussed strategies to increase participation in lung cancer screening – a systematic review protocol

Background Lung cancer is the leading cause of cancer-related mortality worldwide. Despite this, the uptake of lung cancer screening (LCS) using low-dose CT is substantially low in comparison to established cancer screening programmes. Additionally, those at higher risk of the disease are the least likely to participate in screening, including current smokers and those experiencing socioeconomic deprivation. General practice (which may be referred to as primary care or family medicine depending on location) plays a vital role in screening through the identification of eligible individuals, overcoming participation barriers, and facilitating shared decision-making. Given the low rates of participation, it is important to understand which, if any, strategies from general practice could improve the effectiveness of a national programme. Objectives To assess and quantify the effects of strategies implemented in general practice to increase participation in LCS. Method A systematic review and meta-analysis, where possible, will be conducted following PRISMA reporting guidelines. Searches of PubMed, Embase, CINAHL, Cochrane Library, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform will be conducted. All randomised trials, non-randomised studies, and quantitative descriptive studies that report recruitment strategies based in general practice and LCS outcomes will be eligible. Screening and data extraction will be conducted independently by two reviewers. The risk of bias and overall certainty of findings will be assessed using the MMAT and GRADE tools, respectively. The Template for Intervention Description and Replication (TIDieR) checklist will be used for data extraction and the Behavioural Change Techniques (BCT) Taxonomy for data analysis of the components of interventions. Conclusion This review will provide data on the most effective general practice-based recruitment strategies aimed at improving LCS participation. Understanding the most effective and equitable strategies is important in the development of successful LCS and ensuring individuals at the greatest risk can participate.

Abstract C110: Mobile low dose computerized tomographic (LDCT) scanning program identifies pre-malignant lung cancer lesions in a Native American population: A study of Indian Health Service and Levine Cancer Institute

Abstract BACKGROUND: Native Americans (NA) are an under-served population for healthcare, including lung cancer screening. Randomized trials have shown LDCT screening for lung cancer improves survival but with severe under-representation of NA due to financial and insurance constraints, geography and lack of access. They are over-represented in national statistics of presentation with advanced disease and lung cancer deaths. In our region, the Indian Health Service (IHS) has recorded less than 5% of eligible heavy smokers from the Catawba and other tribes have undergone LDCT lung screening. We previously reported that a free, mobile LDCT unit achieved a shift to earlier diagnosis in African Americans (AAs) and other under-served groups with improved 4 year survival and reduced costs of care (1).We adapted our initial trial to include a structured evaluation of efficacy and utility of mobile LDCT in heavy smokers in our NA population. We hypothesized that mobile LDCT would overcome key obstructions to lung cancer screening in NA. METHODS: We used a coach fitted with a portable 32 slice low-dose CT scanner; all films were reviewed by a central panel via the LUNGRADS protocol (1). Eligible subjects were invited to participate by IHS staff. Levine Cancer Institute committed to treat any identified cancers, irrespective of insurance status to avoid delay. Technical details of the unit have been reported (1). RESULTS: 91 heavy smokers have been screened, representing 60% participation rate, with the following characteristics: M:F=1:1; median age 61 years (44-77 years); 68% had some form of health insurance which did not cover lung cancer screening (termed "under-insured") and 32% were uninsured; 73% still smoking; median pack year history 48 (range 22-98). No lung cancers were identified but 10% had LUNGRADS 3-4 (moderate-high risk) lesions, 36% had LUNGRADS 2 lesions and 20% had scattered, non-diagnostic lung lesions; patients with LUNGRADS 4 lesions were offered biopsy to define whether cancer was present. All subjects have been recruited into ongoing follow up LDCT and smoking cessation programs. DISCUSSION: NA traditionally have had the highest level of advanced lung cancer at presentation with high mortality rate from lung cancer. We have increased participation in LDCT lung cancer screening from 5% to 60% of eligible heavy smokers, and have identified a unique sub-population of 10% with potentially premalignant disease that will require meticulous follow-up to achieve early diagnosis of lung cancer. Our previous studies in impoverished AAs and other under-served groups have identified a shift from 20% to 60% early stage cancer at diagnosis; similar benefits are expected in NAs. This is the first such study in NAs and suggests mobile LDCT should be considered by health services responsible for their care. Studies of the science of cancer in the under-served should also focus on pragmatic solutions with potential for early improvement in outcome. REFERENCES: 1. Raghavan D et al, The Oncologist, 2020, 25: e777-e781. Citation Format: Kia Dungan, Hollis Reed, Darcy Doege, Daniel Carrizosa, Melissa Wheeler, Derek Raghavan. Mobile low dose computerized tomographic (LDCT) scanning program identifies pre-malignant lung cancer lesions in a Native American population: A study of Indian Health Service and Levine Cancer Institute [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C110.

Bronchiectasis is associated with lower lung function in lung cancer screening participants.

Bronchiectasis is a frequent incidental finding on chest computed tomography (CT), but its relevance in lung cancer screening is not fully understood. We investigated the association between bronchiectasis and respiratory symptoms, pulmonary function, and emphysema in lung cancer screening participants with and without chronic obstructive pulmonary disease (COPD). We included 3260 (ex-)smokers from the Dutch-Belgian lung cancer screening trial (NELSON). Bronchiectasis was scored by chest radiologists. The relationship with pulmonary function (FEV1%predicted, FEV1/FVC), respiratory complaints (cough, dyspnea, wheezing, mucus hypersecretion), and CT-quantified emphysema (15th percentile) was examined with independent t-tests and multivariate regression. Bronchiectasis was present in 5.4% (n = 175/3260). There was no difference in prevalence between subjects with and without COPD (68/1121 [5.9%] vs. 109/2139 [5.1%]; p = .368). COPD subjects with bronchiectasis had a lower FEV1%predicted (76.2% vs. 85.0%; p < .001), lower FEV1/FVC (0.58 vs. 0.62; p < .001), and more emphysema (- 938 HU vs. - 930 HU; p = .001) than COPD subjects without bronchiectasis. In COPD subjects, bronchiectasis was independently associated with a lower FEV1%predicted (B = - 7.7; CI [- 12.3, - 3.3]), lower FEV1/FVC (B = - 2.5; CI [- 4.3, - 0.8]), more cough (OR 2.4; CI [1.3, 4.3]), more mucus hypersecretion (OR 1.8; CI [1.0, 3.1]) and more dyspnea (OR 2.3; CI [1.3, 3.9]). In those without COPD (n = 2139), bronchiectasis was associated with more cough, mucus hypersecretion, and wheezing, but not with deteriorating lung function. Bronchiectasis was present in 5.4% of our lung cancer screening participants and was associated with more respiratory symptoms and, in those with COPD, with lower lung function and more emphysema. In a lung cancer screening population, bronchiectasis has a prevalence of 5.4% with a mainly mild severity. This finding is of little clinical relevance unless mild COPD is also present. In those subjects, bronchiectasis was associated with a lower lung function, more respiratory symptoms, and more emphysema. • Bronchiectasis was found in 5.4% of lung cancer screening participants, consisting of (ex-)smokers with and without mild COPD. • In those with mild COPD, bronchiectasis was associated with a lower lung function, more respiratory symptoms, and more emphysema. • Incidental findings of mild bronchiectasis are not very relevant in a lung cancer screening population, unless COPD is also present.

Empowering women’s health: Opportunity to bridge breast cancer screening to lung cancer screening.

121 Background: Lung cancer (LC) is the leading cause of cancer-related death for women in the United States (US). It surpasses the combined mortality rate of breast, cervical and ovarian cancers. Early detection of LC at stage I increases the 5-year survival rate to 80%. Lung Cancer Screening (LCS) is an effective tool for early detection. However, while 78% of women over 50 in the US undergo Breast Cancer Screening (BCS), only 6% of eligible women receive LCS. Methods: This is a retrospective study of all women diagnosed with primary LC presenting to Indiana University Simon Comprehensive Cancer Center from January 2019 to December 2020. We collected sociodemographic characteristics and information related to smoking history, LCS and BCS. We excluded patients with a prior history of lung or breast cancer who were under surveillance, and those with unknown smoking history. We assessed the BCS and LCS eligibility and utilization according to the U.S. Preventive Services Task Force latest recommendations. We also determined the utilization of LCS in women who have received BCS. Results: Among the 307 women who met the eligibility criteria, 87.6% were white, 51.8% had a Medicare insurance, 41.7% were ever-smoker, and 64.5% had advanced stages of LC (Stage II-Stage IV). Approximately half of our cohort was eligible for LCS, but only 20% received LCS. On the other hand, 72% were eligible for BCS and 58% of them underwent BCS. Among women who received BCS and were eligible for LCS, only25% underwent LCS. The median time from BCS to LC diagnosis was approximately 2.2 years. Among the 178 women who received BCS within one year prior to LC diagnosis, 27% underwent LCS. Among the remaining women who did not have LCS,66.7% of women were already in a later stage (Stage II-IV) at the time of LC diagnosis. Conclusions: Our study demonstrates that majority of women, who met the eligibility criteria for BCS and LCS, received BCS but not LCS prior to their LC diagnosis. This shows that despite the potential mortality benefit, LCS is still underutilized. Receiving LCS at the time of BCS can provide a valuable opportunity to increase LCS participation among eligible women and the potential of diagnosing LC at earlier stages.

Individual- and neighborhood-level characteristics of lung cancer screening participants undergoing telemedicine shared decision making

BackgroundAlthough lung cancer screening (LCS) for high-risk individuals reduces lung cancer mortality in clinical trial settings, many questions remain about how to implement high-quality LCS in real-world programs. With the increasing use of telemedicine in healthcare, studies examining this approach in the context of LCS are urgently needed. We aimed to identify sociodemographic and other factors associated with screening completion among individuals undergoing telemedicine Shared Decision Making (SDM) for LCS.MethodsThis retrospective study examined patients who completed Shared Decision Making (SDM) via telemedicine between May 4, 2020 – March 18, 2021 in a centralized LCS program. Individuals were categorized into Complete Screening vs. Incomplete Screening subgroups based on the status of subsequent LDCT completion. A multi-level, multivariate model was constructed to identify factors associated with incomplete screening.ResultsAmong individuals undergoing telemedicine SDM during the study period, 20.6% did not complete a LDCT scan. Bivariate analysis demonstrated that Black/African-American race, Medicaid insurance status, and new patient type were associated with greater odds of incomplete screening. On multi-level, multivariate analysis, individuals who were new patients undergoing baseline LDCT or resided in a census tract with a high level of socioeconomic deprivation had significantly higher odds of incomplete screening. Individuals with a greater level of education experienced lower odds of incomplete screening.ConclusionsAmong high-risk individuals undergoing telemedicine SDM for LCS, predictors of incomplete screening included low education, high neighborhood-level deprivation, and new patient type. Future research should focus on testing implementation strategies to improve LDCT completion rates while leveraging telemedicine for high-quality LCS.

Lung cancer screening by low-dose CT among asbestos-exposed workers in Germany

Abstract Introduction The German Social Accident Insurance (DGUV) has introduced lung cancer screening (LCS) by means of annual low-dose CT. Eligibility criteria for the main cohort are age ≥55 years, smoking history of ≥ 30 pack years and occupational asbestos exposure (OAE) of ≥ 10 years with onset before 1985. Medical counselling prior to CT scan is mandatory and supports shared decision-making. After being launched in pilot regions, LCS has been rolled out nationwide since 2017. As guidelines recommend a systematic evaluation for LCS, the research project EVALUNG has been implemented since 2022. Methods EVALUNG was designed to evaluate process and outcome of LCS combining quantitative and qualitative elements. The quantitative part is based exclusively on routine administrative and medical data. So far, anonymised data with selected items were used to assess availability of data and potential quality indicators, and to perform initial descriptive analyses in terms of participation rates, suspicious findings and detected lung cancer in first round screening. Results By end of 2021, 22,794 eligible persons were offered participation in LCS at least once. Based on first round screening, 12,808 pre-screening medical consultations were carried out and resulted in 9,277 initial CT scans, corresponding to a participation rate of 40.7 % of invited persons, and 72.4 % after medical consultation, respectively. Overall, 931 CT findings (10.0%) required control scans within a shortened interval. A total of 103 persons (1.1 %) were diagnosed with lung cancer, of which almost half (n = 54) were legally recognised as occupational disease. Conclusions EVALUNG shows feasibility of a screening evaluation of an occupational cohort based on routine data. However, not all quality indicators for LCS can be covered yet and outcome parameters need to be investigated in more detail in this cohort. Linkage with cancer registry data is an option to enhance data and will be explored further in the project. Key messages • Routine administrative data can be used to assess basic outcomes from LCS in an occupational cohort from Germany. Linkage with registry data is desirable to investigate detailed LCS indicators. • Detection rate in first round LCS in an occupational cohort from Germany was 1.1% and half of detected cases were legally recognised as occupational disease.

Health Care Utilization and Costs in Lung Cancer Screening Participants—A Propensity-Matched Economic Analysis

IntroductionLung cancer screening (LCS) for high-risk populations has been firmly established to reduce lung cancer mortality, but concerns exist regarding unintended downstream costs. MethodsMean health care utilization and costs were compared in the Alberta Lung Cancer Screening Study in a cohort undergoing LCS versus a propensity-matched control group who did not. ResultsA cohort of 651 LCS participants was matched to 336 unscreened controls. Over the study period (mean 3.6 y), a modest increase in the number of claims (22.4 versus 21.9 per person-year [PY]; Δ 0.50 [95% confidence interval: 0.15–0.86], p = 0.006) and outpatient visits (4.01 versus 3.50 per PY; Δ 0.51 [0.37–0.65], p <0.0001), but not in inpatient admissions, was noted in the screened cohort. Claims payments, inpatient costs, and cancer care costs were similar in the screening arm versus the unscreened. Outpatient encounter costs per participant were higher in the screened group ($2662.18 versus $2040.67 per PY; Δ −$621.51 [−1118.05 to −124.97], p = 0.014). Removing the additional computed tomography screening examinations rendered differences not significant. Mean total costs were not significantly different at $6461.10 per PY in the screening group and $6125.31 in the unscreened group (Δ −$335.79 [−2009.65 to 1338.07], p = 0.69). ConclusionsModest increases in outpatient costs are noted in individuals undergoing LCS, in part attributable to the screening examinations, without differences in overall health care costs. Health care costs and utilization seem otherwise similar in individuals participating in LCS and those who do not.

Long-term outcomes of lung cancer screening in males and females

BackgroundThis study explored female and male overall mortality and lung cancer (LC) survival in two LC screening (LCS) populations, focusing on the predictive value of coronary artery calcification (CAC) at baseline low-dose computed tomography (LDCT). MethodsThis retrospective study analysed data of 6495 heavy smokers enrolled in the MILD and BioMILD LCS trials between 2005 and 2016. The primary objective of the study was to assess sex differences in all-cause mortality and LC survival. CAC scores were automatically calculated on LDCT images by a validated artificial intelligence (AI) software. Sex differences in 12-year cause-specific mortality rates were stratified by age, pack-years and CAC score. ResultsThe study included 2368 females and 4127 males. The 12-year all-cause mortality rates were 4.1 % in females and 7.7 % in males (p < 0.0001), and median CAC score was 8.7 vs. 41 respectively (p < 0.0001). All-cause mortality increased with rising CAC scores (log-rank test, p < 0.0001) for both sexes. Although LC incidence was not different between the two sexes, females had lower rates of 12-year LC mortality (1.0 % vs. 1.9 %, p = 0.0052), and better LC survival from diagnosis (72.3 % vs. 51.7 %; p = 0.0005), with a similar proportion of stage I (58.1 % vs. 51.2 %, p = 0.2782). ConclusionsOur findings demonstrate that female LCS participants had lower rates of all-cause mortality at 12 years and better LC survival than their male counterparts, with similar LC incidence rates and stage at diagnosis. The lower CAC burden observed in women at all ages might contribute to explain their lower rates of all-cause mortality and better LC survival.

Impact of risk perception and disease cognition on the willingness to participate in screening for lung cancer in a high-risk population.

Risk perception and disease cognition may influence the efficiency of lung cancer screening by affecting the participation rate. There is still some uncertainty regarding the association between risk perception and disease cognition and how they affect participation in lung cancer screening. Therefore, we explored the influence of risk perception and disease cognition on the willingness to participate in screening among people at high risk of lung cancer. Subjects with high-risk factors for lung cancer were recruited in Lu'an City, Anhui Province, China. Questionnaires were used to determine their demographic characteristics, risk perception, disease cognition, and willingness to engage in screening. Of the 1955 subjects with high risk factors for lung cancer, 1136 (58.12%) were willing to participate in lung cancer screening. Univariable and multivariable analyses showed that disease cognition ( adj OR = 2.012, 95% CI: 1.528-2.649, P = 0.000), cognitive risk ( adj OR = 7.661, 95% CI: 6.049-9.704, P = 0.000), and affective risk ( adj OR = 5.964, 95% CI: 4.552-7.815, P = 0.000) were significant factors in promoting screening participation. For those with moderate risk perception, improving disease cognition was a key approach to increase screening participation. This study elucidated the relationship between various factors and lung cancer screening participation and proposed a feasible route for the screening implementation, providing a theoretical basis to further improve the participation rate and efficiency of lung cancer screening.

Vertebral CT attenuation outperforms standard clinical fracture risk prediction tools in detecting osteoporotic disease in lung cancer screening participants.

Compare accuracy of vertebral Hounsfield Unit (VHU) attenuation and FRAX and Garvan Fracture Risk Calculators in identifying low bone mineral density (BMD) and prevalent vertebral compression fractures (VF) in lung cancer screening (LCS) participants. Baseline CT scans from a single site of the International Lung Screen Trial were analysed. BMD was measured using VHU (of the most caudally imaged vertebra) and quantitative CT (QCT) (low BMD defined as <110 HU and <120 mg/cm3, respectively). Prevalent VF were classified semi-quantitatively. 10-year FRAX and Garvan fracture risks were calculated using dual energy X-ray absorptiometry (DXA) femoral neck T-score where available. Discrimination was assessed by area under receiver-operating characteristic curves (AUC). 535 LCS participants were included; 41% had low VHU-BMD, 56% had low QCT-BMD and 10% had ≥1 VF with ≥25% vertebral height loss. VHU demonstrated 94% specificity and 70% sensitivity in identifying low QCT-BMD. VHU was superior to fracture risk tools in discriminating low QCT-BMD (AUC: VHU 0.94 vs FRAX 0.67, Garvan 0.64 [p < 0.05]). In 64 participants with recent DXA scans, VHU was superior to FRAXT-score and GarvanT-score in discriminating low QCT-BMD (AUC: VHU 0.99, FRAXT-score 0.71, GarvanT-score 0.71 [p < 0.05]). VHU was non-inferior to FRAXT-score and GarvanT-score in discriminating VF (AUC: VHU 0.65, FRAXT-score 0.53, GarvanT-score 0.61). VHU outperforms clinical risk calculators in detecting low BMD and discriminates prevalent VF equally well as risk calculators with T-scores, yet is significantly simpler to perform. VHU measurement could aid osteoporosis assessment in high-risk smokers undergoing LCS.

Impact of the COVID-19 pandemic on the primary lung cancer screening program in Akita Prefecture, a region with the fastest aging population in Japan.

Akita Prefecture has the largest proportion of older inhabitants and the highest cancer mortality rate in Japan. Lung cancer is one of the biggest killers, and early detection is critical. Chest X-ray examinations are the main screening method for lung cancer; however, the COVID-19 pandemic has affected the screening system. Here, we evaluate how COVID-19 has affected lung cancer screening in Akita Prefecture. Using the Akita General Health Corporation database, the average annual number of chest X-ray screening tests, close examinations and lung cancer diagnoses (stratified by sex and age) was evaluated during 2016-2019, and compared with the 2020 values. Furthermore, data on lung cancer registrations from 2018 to 2020 were obtained from the Collaborative Akita Prefecture Hospital-Based Cancer Registration System and analyzed. The average annual number of screening tests, close examinations and lung cancer diagnoses declined (by >50%) between 2016 to 2019 and 2020, especially among older people (aged ≥65 years). Furthermore, by stage, the number of patients with early-stage lung cancer (stage 0-I) decreased, and the number with advanced-stage cancer (stage IV) increased. The COVID-19 pandemic reduced lung cancer screening participation, especially among the older adult population in Akita Prefecture, resulting in a decrease in lung cancer diagnoses through screening. This might have reduced the number of early-stage cancer registrations. It is necessary to improve health education among the public regarding the importance of chest X-ray screening. Geriatr Gerontol Int 2023; 23: 622-627.

Lung cancer screening beliefs in Armenia.

In Armenia, an upper-middle income country, 93% of deaths are from non-communicable diseases and over half of the male population smokes. Armenia has more than double the global lung cancer incidence. Over 80% of lung cancer is diagnosed at stages III or IV. However, there is a significant mortality benefit in detecting early-stage lung cancer via screening with low-dose computed tomography. This study employed a rigorously-translated, previously-validated survey based on the Expanded Health Belief Model to understand how Armenian male smokers' beliefs would affect lung cancer screening participation. Survey responses highlighted key health beliefs that would mediate screening participation. Most respondents felt they were at risk for lung cancer, but over 50% also believed their cancer risk was equivalent to (or less than) non-smokers' risk. Respondents also overwhelmingly agreed a scan could help detect cancer earlier, but fewer agreed early detection could reduce cancer mortality. Important barriers included absence of symptoms and costs of screening and treatment. Overall, the potential to reduce lung cancer-related deaths in Armenia is high, but there are a number of central health beliefs and barriers that would limit screening uptake and effectiveness. Improved health education, careful consideration of socioeconomic screening barriers, and appropriate screening recommendations may be useful in overcoming these beliefs.

Lung Cancer Screening Among Mammography Patients: Knowledge, Eligibility, Participation, and Interest.

To determine lung cancer screening eligibility, knowledge, and interest and to quantify the effect of the expanded 2021 lung cancer screening eligibility criteria among women presenting for screening mammography, a group with demonstrable interest in cancer screening. A single-page survey was distributed to patients presenting for screening mammography, from January-March 2020 and June 2020-January 2021, at 2 academic medical centers on the East and West Coasts. The population served by the East Coast institution has greater poverty, greater ethnic/racial diversity, and lower education levels. Survey questions included age, smoking history, lung cancer screening knowledge, participation, and interest. Lung cancer screening eligibility was determined for both 2013 and 2021 USPSTF guidelines. Descriptive statistics were calculated, and data were compared between groups using the Chi-square test, Mann-Whitney nonparametric test, and the 2-sample t test. 5512 surveys were completed; 33% (1824) of women reported a history of smoking-30% (1656) former smokers and 3% (156) current smokers. Among women with a smoking history, 7% (127/1824) were eligible for lung cancer screening using 2013% and 11% (207/1824) using the 2021 USPSTF criteria. Interest in lung cancer screening was high (73%; 151/207) among eligible women using 2021 USPSTF criteria, but only 42% (87/207) had heard of lung cancer screening and only 28% (57/207) had received prior LDCT screening. Eligible screening mammography patients reported high levels of interest in lung cancer screening but low levels of knowledge and participation. Linking mammography and LDCT appointments may improve lung cancer screening participation.

Using User-Centered Design to Facilitate Adherence to Annual Lung Cancer Screening: Protocol for a Mixed Methods Study for Intervention Development.

Lung cancer is the leading cause of cancer-related death in the United States, with the majority of lung cancer occurrence diagnosed after the disease has already metastasized. Lung cancer screening (LCS) with low-dose computed tomography can diagnose early-stage disease, especially when eligible individuals participate in screening on a yearly basis. Unfortunately, annual adherence has emerged as a challenge for academic and community screening programs, endangering the individual and population health benefits of LCS. Reminder messages have effectively increased adherence rates in breast, colorectal, and cervical cancer screenings but have not been tested with LCS participants who experience unique barriers to screening associated with the stigma of smoking and social determinants of health. This research aims to use a theory-informed, multiphase, and mixed methods approach with LCS experts and participants to develop a set of clear and engaging reminder messages to support LCS annual adherence. In aim 1, survey data informed by the Cognitive-Social Health Information Processing model will be collected to assess how LCS participants process health information aimed at health protective behavior to develop content for reminder messages and pinpoint options for message targeting and tailoring. Aim 2 focuses on identifying themes for message imagery through a modified photovoice activity that asks participants to identify 3 images that represent LCS and then participate in an interview about the selection, likes, and dislikes of each photo. A pool of candidate messages for multiple delivery platforms will be developed in aim 3, using results from aim 1 for message content and aim 2 for imagery selection. The refinement of message content and imagery combinations will be completed through iterative feedback from LCS experts and participants. Data collection began in July 2022 and will be completed by May 2023. The final reminder message candidates are expected to be completed by June 2023. This project proposes a novel approach to facilitate adherence to annual LCS through the development of reminder messages that embrace content and imagery representative of the target population directly in the design process. Developing effective strategies to increase LCS adherence is instrumental in achieving optimal LCS outcomes at individual and population health levels. DERR1-10.2196/46657.