Pack-year History Research Articles

Abstract A116: Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation

Abstract Purpose: Lung cancer is the leading cause of cancer death in the U.S. Lung cancer screening significantly reduces lung cancer mortality, but national uptake is low (<6%). Black and low-income Americans have higher lung cancer mortality rates and lower lung cancer screening rates than White and high-income Americans, respectively. Lower lung cancer screening uptake among Black and low-income populations may widen existing disparities in lung cancer mortality. Prior studies have found higher levels of medical mistrust among Black and low-income populations, perhaps arising from structural racism and other inequities. Indeed, medical mistrust may reduce cancer screening intentions, but little is known about how health systems can promote lung screening uptake while earning patient trust. To address this gap, this study aimed to identify diverse patient perspectives on increasing equity in lung screening uptake and addressing medical mistrust. Methods: We conducted 20 semi-structured interviews and four focus groups (about four participants per group) with a diverse sample of lung cancer screening-eligible individuals throughout the U.S. (i.e., individuals aged 50-80 years with eligible smoking histories). Interviews and focus groups investigated participant awareness of lung screening, barriers to screening, the role of medical mistrust in screening uptake, and perspectives on equitable screening implementation. We used an iterative inductive/deductive content analysis approach to identify key themes from interview and focus group transcripts. Results: Interview participants (n=20) were 60 years of age on average and had a mean smoking pack-year history of 42.5 years. Half of interview participants identified as Black (50%), slightly more than half of participants had a household income of <$30,000 (55%), and most participants were female (60%). Focus group participants had similar demographics. Most participants were unaware of lung cancer screening but were eager to learn more. As a key barrier, participants discussed that their doctors had never mentioned lung screening, which confused and frustrated participants who had long-term relationships with primary care doctors. Prior negative healthcare experiences (e.g., misdiagnoses and having serious symptoms dismissed by healthcare providers) were also discussed as screening barriers as they engendered mistrust and hesitancy to seek future care. Several Black participants cited personal and vicarious experiences of racism in the healthcare system as key barriers contributing to mistrust and screening hesitancy. Lastly, participants raised several suggestions to promote equitable screening implementation, such as the need to meaningfully engage with communities to raise screening awareness and address cost issues. Conclusions: Lung cancer screening interventions may be more successful if concerted efforts are taken to understand and address medical mistrust. Future work is needed to address the reasons patients may mistrust healthcare providers and systems that deliver lung cancer screening. Citation Format: Jennifer Richmond, Jessica R. Fernandez, Kemberlee R. Bonnet, Maria A. Pena, Allana T. Forde, David G. Schlundt, Consuelo H. Wilkins, Melinda C. Aldrich. Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A116.

EFFECTIVENESS OF SMOKING CESSATION INTERVENTIONS WITH LDCT LUNG CANCER SCREENING AMONG AFRICAN AMERICAN SMOKERS

Abstract Low dose computed tomography (LDCT) screening can detect lung cancer early and decrease lung cancer-specific mortality for current smokers but remains under-utilized among these populations. Although African-American smokers tend to smoke less and have lower smoking pack-year histories, they have lower quit rates, higher rates of mortality from lung cancer than other racial/ethnic groups. This study examined the effectiveness of a smoking cessation intervention integrating LDCT screening among African-American smokers. This study recruited 60 African-American daily smokers over the age of 55 who qualified for LDCT screening. Participants were randomly and equally assigned into two groups (intervention and control). Overall, the mean age was 61.0 years old (standard deviation, 5.5), 61.7% of the participants were female and, 91.7% had lower incomes (<$20,000). Descriptive statistics were used to summarize demographics, smoking status, knowledge, attitudes, and stage of change for smoking cessation. The findings showed that participants in the intervention group had a lower number of daily cigarettes smoked (9.5 vs. 11.0) and a higher reduction in the number of daily cigarettes smoked (-2.3 vs. -0.9) than those in the control group. Participants in the intervention group were more likely to be in the preparation stage of the stages of change model (50.0% vs. 40.0%), progress in the stage of change (36.7% vs. 16.7%), or report already having had quit smoking (10.0% vs. 3.3%) than those in the control group. LDCT screening represents a potential "teachable moment" for African-American smokers, which may encourage them to consider these strategies for smoking cessation.

Frequency and Intensity of Smoking, Duration of Smoking Cessation, and Risk of Early Postoperative Outcomes after High-risk Arterial Reconstructions

Introduction: The relative influence of smoking and smoking duration/intensity in a co-morbid cohort is uncertain. We examined whether smoking status, duration of cessation, and smoking frequency/intensity significantly affected postoperative morbidity and mortality risk. Methods: We collected single institution, retrospective data from consecutive patients undergoing open operative intervention for carotid, aortoiliac, or infrainguinal aneurysmal or occlusive arterial disease. Smoking cessation duration was calculated as the time between smoking cessation and index surgery. The primary outcome was a composite of 30-day mortality and morbidity. Logistic and Cox regressions estimated associations between the primary outcome and smoking status with interaction terms between cessation duration and intensity (pack-years) for former smokers. Results: Between 2010 and 2019, 1,087 patients underwent 1,523 high-risk surgeries. The mean duration of cessation was 19.3 years (standard deviation [SD] = 16.2). Mean pack-year history was 45.2 pack-years (SD=33.7) among former smokers and 54.8 pack-years (SD=38.5) among current smokers (p < 0.001). Smoking status did not independently predict an increased risk of postoperative mortality or morbidity (Odds Ratio [OR]=0.97, p = 0.85). In the former smoker group, neither smoking cessation duration (OR=0.99, p = 0.23) nor pack-years (OR=1.00, p = 0.99) were statistically significant predictors of adverse events (interaction p = 0.08). Long-term survival probabilities were lower among current smokers (Hazard Ratio [HR] = 1.31, p = 0.002) with no significant effect from either pack-years or cessation duration. Conclusion: Among patients undergoing procedures that represent systemic disease, the adverse effects of continued smoking are better appreciated in long-term survival probability reduction that is observed regardless of smoking frequency or intensity.

S2081 Rare Colonic Polyps: A Case of Langerhans Histiocytosis

Introduction: Langerhans Cell Histiocytosis (LCH) is a rare inflammatory myeloid disorder mostly seen in children before the age of 5. The clinical presentation is heterogeneous with potential for wide-ranging organ involvement, primarily in the bone, skin, and lungs. Gastrointestinal tract involvement is very rare in LCH, and in symptomatic patients, etiology could be confused with infectious, allergic, and autoimmune bowel diseases. In children, LCH GI tract involvement has been associated with decreased survival due to multisystem involvement and digestive complications including diarrhea, vomiting, malabsorption, and failure to thrive. Review of literature shows less than twenty adults with incidences of GI tract involvement of LCH and only 4 cases of adults with LCH colon polyps. Case Description/Methods: A 66-year-old man presented for screening colonoscopy. He reported generally good health without any GI or systemic symptoms or medical history. Family history was significant for leukemia in his brother. He currently smokes cigarettes and has a 2.5 pack-year history. On colonoscopy, 6 benign-appearing polyps were removed using cold snare polypectomy: 3 from the ascending colon (largest 0.5 cm in size), one from the splenic flexure of the transverse colon (0.4 cm in size), and 2 from the rectum (largest 0.4 cm in size). Quality of bowel preparation was excellent and the procedure was without complication. Rectal polyps were hyperplastic. Submucosal sections of the ascending and transverse colon polyps stained positive for CD1a, CD68, and S-100, consistent with Langerhans-type cells. The LCH diagnosis was further supported by irregular nuclei within focal nuclear grooves and an eosinophilic cytoplasm. Genomic testing of the colon sample revealed BRAFV600E mutation, the most recognized targetable mutation in LCH. He underwent further testing with PET scan and bone marrow biopsy, both of which were negative for LCH. Surveillance colonoscopy was recommended in 7 years (Figure 1). Discussion: With his lack of systemic disease and asymptomatic presentation, watchful waiting and Oncology follow-up was recommended. Given the unusual diagnosis of LCH via a colon polyp, it is possible for lesions to be clinically unsuspected and histologically overlooked. With increasing rates of screening colonoscopy, more polyps demonstrating LCH on histopathology may be identified. Reports of LCH in the GI tract and colon polyps are infrequent and characterization of outcomes will rely on further cases in this population.Figure 1.: Positive immunostaining for CD1a, classically expressed by Langerhans cells.

Outcomes of lung transplantation from donors with a history of substance abuse

ObjectiveThe study objective was to determine whether donor substance abuse (opioid overdose death, opioid use, cigarette or marijuana smoking) impacts lung acceptance and recipient outcomes. MethodsDonor offers to a single center from 2013 to 2019 were reviewed to determine if lung acceptance rates and recipient outcomes were affected by donor substance abuse. ResultsThere were 3515 donor offers over the study period. A total of 154 offers (4.4%) were opioid use and 117 (3.3%) were opioid overdose deaths. A total of 1744 donors (65.0%) smoked cigarettes and 69 donors (2.6%) smoked marijuana. Of smokers, 601 (35.0%) had less than 20 pack-year history and 1117 (65.0%) had more than 20 pack-year history. Substance abuse donors were younger (51.5 vs 55.2 P < .001), more often male (65.6 vs 54.8%, P < .001), more often White (86.2 vs 68.7%, P < .001), and had hepatitis C (8.3 vs 0.8%, P < .001). Donor acceptance was significantly associated with brain dead donors (odds ratio, 1.56, P < .001), donor smoking history (odds ratio, 0.56, P < .001), hepatitis C (odds ratio, 0.35, P < .001), younger age (odds ratio, 0.98, P < .001), male gender (odds ratio, 0.74, P = .004), and any substance abuse history (odds ratio, 0.50, P < .001), but not opioid use, opioid overdose death, or marijuana use. Recipient survival was equivalent when using lungs from donors who had opioid overdose death, who smoked marijuana, or who smoked cigarettes for less than 20 patient-years or more than 20 patient-years, and significantly longer in recipients of opioid use lungs. There was no significant difference in time to chronic lung allograft dysfunction for recipients who received lungs from opioid overdose death or with a history of opioid use, marijuana smoking, or cigarette smoking. ConclusionsDonor acceptance was impacted by cigarette smoking but not opioid use, opioid overdose death, or marijuana use. Graft outcomes and recipient survival were similar for recipients of lungs from donors who abused substances.

SMALL AIRWAY DYSFUNCTION IN SYMPTOMATIC SMOKERS: A RETROSPECTIVE STUDY

TYPE: Abstract TOPIC: Allergy and Airway PURPOSE: COPD diagnosis is confirmed using FEV1/FVC and FEV1 which lack the sensitivity to detect early lung pathology. Here, small airway tests may be more sensitive than conventional spirometric measures to detect early disease. The aim of this study was to assess the presence of small airway dysfunction (SAD) as measured by MMEF, in symptomatic smokers with/ without spirometric airflow obstruction (AO). METHODS: Retrospective study of smokers who underwent Pulmonary Function Tests as part of putative COPD assessment between January 2016 and April 2021 in a secondary referral hospital in the United Kingdom. Patients aged >30 and pack-year history >10 were included. SAD was defined by MMEF <80% predicted and AO was defined as FEV1/FVC <70%. RESULTS: 1458 smokers were included and grouped into: group 1 (no SAD/ no AO, n=259); group 2 (SAD/ no AO, n=273); group 3 (SAD/AO, n=924). All patients with AO had evidence of SAD. Compared to group 1 and 2, patients in group 3 had significantly lower overall lung function (FEV1, FEV1/FVC, MMEF, MMEF/FVC, FEV3/FVC, [p<0.0005]). Patients in group 2 had significantly lower lung function than group 1 (FEV1, FVC, FEV1/FVC, MMEF, MMEF/FVC [p <0.0005], FEV3/FVC [p=0.002]. CONCLUSIONS: The findings show that low MMEF is a physiological feature in patients with established AO, as well as symptomatic patients without spirometric defined AO. This likely reflects early damage preceding development of classical spirometric AO. CLINICAL IMPLICATIONS: Early monitoring of symptomatic smokers with low MMEF may help determine developing AO enabling preventative measures to be implemented. DISCLOSURE: Nothing to declare. KEYWORD: Small airway dysfunction

Clinical validation of a deep-learning–based model to predict lung cancer risk from chest X-rays.

10507 Background: Screening with chest CT prevents lung cancer death, but only 5% of eligible Americans are screened. The updated 2022 Centers for Medicare and Medicaid Services (CMS) criteria expand eligibility to 50-77 year-olds, current or former (&lt;15 years) smokers, with a ≥20 pack-year history. However, smoking quit date and pack-years are often not available in the electronic medical record (EMR), stymying identification of high-risk smokers for lung cancer screening (LCS). We previously developed a free, open-source deep-learning model (CXR-LC) that identifies smokers at high risk of lung cancer better than the 2015 CMS criteria, based on a chest X-ray (CXR) image automatically extracted from the EMR. CXR-LC was developed in the PLCO trial, an asymptomatic LCS population. The present study externally validates CXR-LC using existing CXRs obtained through usual care and compares CXR-LC to the expanded 2022 CMS lung screening eligibility criteria. Methods: Current or former smokers who had a routine clinical CXR in 2013-2014 were included. Patients with known lung cancer or who were undergoing LCS were excluded. Smoking status and 2022 CMS LCS eligibility were determined by manual review of the EMR. The primary outcome was 6-year incident lung cancer, identified using International Classification of Disease (ICD) codes and confirmed through discharge summaries and pathology reports. The CXR-LC model and the 2022 CMS eligibility criteria were compared for prediction of 6-year incident lung cancer. Results: Among 10,784 patients (mean age 63.1± 6.8 years; 61.0% male), CMS eligibility could be determined in 45% (4,886/10,784), with 55% missing pack-year or quit date data. In this population, 3.9% (191/4,886) developed lung cancer. The 2022 CMS criteria missed 57% (109/191) of lung cancers, while CXR-LC missed 8.9% (17/191, p &lt; 0.001). After adjusting for sex, race, and prevalent COPD, the hazard ratio for CXR-LC eligibility (3.6, 95% CI [2.2,6.0]) was greater than for CMS eligibility (2.7, 95% CI [2.0,3.7]). In the 5,897 patients for whom CMS eligibility could not be determined, CXR-LC eligible patients had a 3-fold higher rate of lung cancer than CXR-LC ineligible patients (3.8% vs. 1.3%, p &lt; 0.001). All CXR-LC eligible groups had 6-year lung cancer incidence &gt;3.5%, above accepted screening risk thresholds of &gt;1.5% and &gt;2%. Conclusions: Using routine CXRs from the EMR, CXR-LC identified high-risk smokers who may benefit from LCS with CT, complementary to the 2022 CMS eligibility criteria. [Table: see text]

Optimal Lung Cancer Screening Criteria Among Persons Living With HIV.

The US Preventive Services Task Force (USPSTF) 2021 updated recommendations on lung cancer screening with chest computed tomography to apply to individuals 50-80 years of age (previously 55-80 years), with a ≥20 pack-year history (previously ≥30), whether currently smoking or quit ≤15 years ago. Despite being at higher risk for lung cancer, persons with HIV (PWH) were not well-represented in the National Lung Screening Trial, which informed the USPSTF 2013 recommendations. It is unknown or unclear how PWH are affected by the 2021 recommendations. This study was a retrospective analysis of PWH with and without lung cancer in the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study. We identified PWH, ages 40-80 years, who currently or previously smoked, with (cases) and without lung cancer (noncases). The sensitivity and specificity of the old, new, and alternative screening criteria were evaluated in each cohort. We identified 52 women and 19 men with lung cancer and 1950 women and 1599 men without lung cancer. Only 11 women (22%) and 6 men (32%) with lung cancer met 2013 screening criteria; however, more women (22; 44%) and men (12; 63%) met 2021 criteria. Decreased age and tobacco exposure thresholds in women further increased sensitivity of the 2021 criteria. The 2021 USPSTF lung cancer screening recommendations would have resulted in more PWH with lung cancer being eligible for screening at the time of their diagnosis. Further investigation is needed to determine optimal screening criteria for PWH, particularly in women.

Heavy Smoking Patients Receiving a Lung Cancer Screen Want to Quit: A Call for Tailored Cessation Interventions.

BackgroundLung cancer screening for current or former heavy smokers is now recommended among all asymptomatic adults 50–80 years old with a 20 pack-year history of smoking. However, little is known about the smoking-related attitudes of this population.MethodAn assessment was conducted among 1,472 current smokers who presented for an annual lung cancer screen at one of 12 diagnostic imaging sites in Rhode Island between April 2019 and May 2020. Patients were asked about their use of smoking products, interest in quitting, and smoking-related attitudes.ResultsPatients smoked a median of 16 cigarettes per day; 86.6% were daily cigarette smokers and 30.1% were daily cigar smokers. In total, 91.4% of patients were, to some degree, interested in quitting smoking and 71.4% were seriously thinking about quitting in the next 6 months or sooner. Patients planned on smoking less regardless of whether their lung screen was positive or negative for cancer, though they were more likely to plan on smoking less if negative (on 0–3 pt Likert scale: 0.31, 95% CI [0.27, 0.34] vs. 0.77, 95% CI [0.72, 0.81]). Confidence in quitting and belief in one’s inherent ability to quit smoking varied substantially within the sample.ConclusionNearly all current smokers receiving a lung cancer screen have some interest in smoking cessation. Due to the heterogeneity in some smoking-related attitudes, tailored interventions for this population should be tested.

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

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

Treatable Traits in Misdiagnosed Chronic Obstructive Pulmonary Disease: Data from the Akershus Cardiac Examination 1950 Study.

Chronic obstructive pulmonary disease (COPD) is often misdiagnosed. We aimed to estimate the prevalence of misdiagnosed COPD in middle-aged Norwegians, and to assess potentially treatable clinical traits in over- and undiagnosed individuals. The Akershus Cardiac Examination (ACE) 1950 Study is a population-based study of the 1950 birth cohort of Akershus county including 3706 participants aged 62-65 years at baseline. COPD was defined as a forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio < lower limit of normal (LLN). Misdiagnosed COPD was defined according to self-reported COPD. A total of 259 (7.1%) participants had spirometry confirmed COPD. Of these, only 72 (28%) reported having COPD, thus 187 (72%) were undiagnosed. A total of 92 (2.5%) of the 164 particpants who reported having COPD had an FEV1/FVC ratio ≥ LLN and were overdiagnosed. They had lower lung function, and more respiratory symptoms, self-reported asthma, eosinophils, and sleep apnea than other non-COPD participants . The main predictor of being overdiagnosed was overweight. Spirometry in participants reporting wheezing or cough and current smokers or participants with ≥20 tobacco pack-year history would have identified 85% of the undiagnosed cases. Both over- and underdiagnosis of COPD is frequent. Undiagnosed individuals have better lung function and less symptoms, but similar prevalence of comorbidities and systemic inflammation. Overdiagnosed individuals have treatable traits including asthma, eosinophilic inflammation, and sleep apnea. The main predictor of being overdiagnosed was being overweight.

COMPARISON OF SPIROMETRY DATA AND SYMPTOMS BETWEEN MALE AND FEMALE SMOKERS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

BACKGROUND &amp; OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease, showing the exaggerated response of airways to any injurious stimulus. It is no longer considered as the disease of men as it is becoming increasingly prevalent in females. Evidence suggests that gender affects the clinical presentation of the disease. The objectives of the study is to compare spirometry data between male and female smokers with COPD and to study the association of cough, sputum, and dyspnea with gender in smokers with COPD.&#x0D; METHODOLOGY: This descriptive study was conducted at the University of Health Sciences Lahore. The study sample included 41 COPD patients with a history of smoking. After taking written informed consent, patients were recruited from the outpatient departments of tertiary care hospitals of Lahore by convenience sampling technique. A complete history was taken, and spirometry was done on each subject. The subjects were divided into male and female groups, followed by the comparison of Spirometry data between the groups and association of symptoms with gender using appropriate statistical techniques.&#x0D; RESULTS: The results of this study demonstrated females were significantly younger and exhibited a greater decline of lung functions with similar pack-years history compared to male smokers with COPD. The most common presentation of females was breathlessness compared to male patients, who had sputum production as the most common presentation.&#x0D; CONCLUSION: Significant differences were seen in spirometry and clinical presentation of the disease in male and female COPD groups, showing the onset and symptomology of the disease.

P040 Effect of parental smoking on Juvenile Idiopathic Arthritis activity

Abstract Background Juvenile idiopathic arthritis (JIA) is an heterogeneous group of autoimmune diseases considered as the main cause of chronic arthritis among children and teenagers. This group of children is thought to be more vulnerable because of chronic inflammation and long-term immunosuppressive therapy. Passive smoking, which is a major health problem, is likely to be particularly harmful for these children whose immunity is already compromised by their disease. The aim of our study was to assess the effect of parental smoking on disease activity in children with JIA Methods A monocentric cross-sectional study of patients with JIA according to the criteria of the International League Against Rheumatism (ILAR) was conducted in the rheumatology department of Kassab Institute. The following clinical and biological data were collected: sex, age, disease duration, BASDAI activity score, functional impairment assessed by the BASFI score, biological inflammation assessed by the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP). All parents were contacted and smoking data were recorded: parent smoking, pack-years history, smoking in an indoor or outdoor space, impact of passive smoking on disease activity. We considered any child with at least one smoking parent and living in the same house to be exposed to parental passive smoking. Patients were divided into two groups: group 1 (G1) including patients who are not exposed to parental smoking and group 2 (G2) including patients exposed to smoking by one or both parents. Data were analyzed using SPSS (Statistical Package for the Social Sciences) version 24 software. The significance level was set at a p-value &amp;lt; 0.05. Results Twenty-three patients were included: 15 girls and 8 boys. Sex ratio M/F was 0.53. The mean age was 16.5 + 8.1 years [8–40]. The mean disease duration was 4.9 + 4.9 years [0.15]. The mean ESR was 21.5 + 27.1 mm and the mean CRP was 4.7 + 7.1 mg/l. Nine patients had coxitis, including 4 who were exposed to passive smoking. Passive smoking noted in 11 patients (47.8%), including 6 boys and 5 girls. In 63.6% of the cases, this exposure occurred indoor in the family home. The number of cigarettes smoked per day was 11.7 + 8.4 [1,20]. Among the exposed patients, 36.4% considered that this exposure was an exacerbating factor of their disease. Clinical and biological data were comparable between the 2 groups as shown in table 1. Conclusion Although the adverse effect of maternal smoking during pregnancy on the risk of developing JIA in the child has been demonstrated, few studies have investigated the effect of parental smoking once the disease is established. Our study did not find a statistically significant association between smoking exposure and high disease activity or poor prognosis. However, further studies including a larger number of patients are needed to assess the potential effect of parental smoking on the prognosis of JIA.

Offering lung resection to current smokers: An opportunity for more equitable care

ObjectiveMinority patients with lung cancer are less likely to undergo surgical resection and experience worse survival than non-Hispanic White patients. Currently, 40% of thoracic surgeons require smoking cessation before surgery, which may disproportionately affect minority patients. Our objective was to assess the risk of smoking status on postoperative morbidity and mortality among patients with lung cancer. MethodsA prospectively maintained institutional database was queried for all patients who underwent surgical resection of a primary lung malignancy between 2006 and 2020. Operative mortality, major morbidity, and a composite of morbidity and mortality were compared between current smokers and prior smokers. ResultsA total of 601 patients underwent resection, and 236 (39.3%) were current smokers. Current smokers were more likely to be younger (P < .01), to have a greater pack-years history (P = .03), and to have worse pulmonary function test results (P < .01). Pretreatment stage, surgical approach, and extent of resection were similar between groups. There was no difference in operative mortality (0.9% vs 1.9%, P = .49), major morbidity (12.7% vs 9.3%, P = .19), or composite major morbidity and mortality between groups (13.1% vs 9.3%, P = .14). After adjusting for pulmonary function status, current smoking status was not associated with mortality or major morbidity on multivariable logistic regression (odds ratio, 1.51; 95% confidence interval, 0.76-3.03, P = .24). ConclusionsCurrent smokers experienced similar rates of mortality and major morbidity as prior smokers. In the context of continued racial and ethnic disparities in lung cancer survival, in particular decreased resection rates among minorities, smoking cessation requirements should not delay or prevent operative intervention for lung cancer.

Incidence of Second Primary Lung Cancer After Low-Dose Computed Tomography vs Chest Radiography Screening in Survivors of Head and Neck Cancer

In head and neck cancer survivors, lung cancer screening may aid in detecting a second primary lung cancer or metastatic head and neck cancer earlier in the course of disease, which may improve treatment outcomes. However, no randomized data exist to assess the value of lung cancer screening in this population. To evaluate the incidence of second primary lung cancer in survivors of head and neck cancer survivors with screening low-dose computed tomography (CT) vs chest radiography (CXR). For this ad hoc secondary analysis of a randomized clinical trial, head and neck cancer survivors were identified from the National Lung Screening Trial, which enrolled participants from August 2002 to April 2004. This randomized clinical trial compared screening using low-dose CT chest vs CXR in patients aged 55 to 74 years with at least a 30 pack-year history of cigarette smoking and who were current smokers or had quit within the past 15 years and who were at high risk for lung cancer. The incidences of second primary lung cancer and second primary head and neck cancer were compared with screening using low-dose CT vs CXR. Data were analyzed from December 1, 2020, to June 30, 2021. Screening low-dose CT of the chest vs CXR. The primary outcome was the incidence of a second primary lung cancer. Among 53 452 enrolled participants, we identified 171 survivors of head and neck cancer, of whom 82 were screened with low-dose CT of the chest and 89 with CXR. Participants' mean (SD) age was 61 (5) years, and 132 were men (77.2%). The incidence of lung cancer was higher among head and neck cancer survivors compared with participants without head and neck cancer (2080 per 100 000 person-years [2.1%] vs 609 per 100 000 person-years [0.6%]; adjusted rate ratio, 2.54; 95% CI, 1.63-3.95). In head and neck cancer survivors, the incidence of second primary lung cancer was 2610 cases per 100 000 person-years in the low-dose CT group vs 1594 cases per 100 000 person-years in the CXR group (rate ratio, 1.55; 95% CI, 0.59-3.63). In head and neck cancer survivors, overall survival was 7.07 years with low-dose CT vs 6.66 years with CXR (log-rank P = .48). The results of this ad hoc secondary analysis of a randomized clinical trial suggest that head and neck cancer survivors are at especially high risk for a second primary lung cancer. These findings underscore the importance of low-dose CT screening in head and neck cancer survivors with significant cigarette smoking history who are fit to undergo treatment with curative intent.

O04 Orbital lymphoma in a 72-year-old lady with rheumatoid arthritis: an argument for rituximab

O04 Orbital lymphoma in a 72-year-old lady with rheumatoid arthritis: an argument for rituximab

P61.05 Time to Loosen Up: Liberalizing Lung Cancer Screening Guidelines Might Save More Lives

The USPSTF recommended annual lung cancer (LC) screening with low-dose CT in current or former smoker adults, ages 55-80, with a 30 pack-year smoking history, that quit within 15 years. Other guidelines, such as NCCN, have similar criteria. In 2021, the USPSTF updated its screening guidelines, expanding the age group to adults ages 50-80 and lowering the smoking threshold to 20 or more pack-year history. We aimed to compare the screening eligibility with the new USPSTF proposed guidelines compared to the previous USPSTF LC screening guidelines in patients with LC prior to their diagnosis. We created an IRB-approved observational study. Patients who were current or former smokers diagnosed with LC between 2016 and 2019 were included in the analysis. Charts were reviewed for demographics and detailed smoking. Associations between eligibility with current and previous USPSTF screening guidelines were examined using the chi-square test. We reviewed 530 subject charts, of which 428 were included in the analysis. Of those, 186 subjects met the previous USPSTF screening criteria for LC. There were 242 subjects that were ineligible for screening according to previous USPSTF guidelines, mainly due to age and smoking history. With the newly approved USPSTF guidelines, 242 (56.5%) of the subjects would have been eligible for screening compared to the 186 (43.5%) subjects that were eligible (chi-square = 14.65, p=0.00012). [Table 1] Furthermore, 32 (37%) out of the 186 ineligible subjects under the new USPSTF recommended guidelines would have met screening criteria if all former smokers were included in the eligibility criteria regardless of their quitting date (chi-square = 5.117, p=0.023).Table 1Eligibility in old versus new USPSTF lung cancer screening guidelinesScreening Ineligible N (%)Screening Eligible N (%)P-valueOld USPSTF lung cancer screening guidelines242 (56.5)186 (43.5)p=0.000129New USPSTF lung cancer screening guidelines186 (43.5)242 (56.5) Open table in a new tab In our study, ineligible subjects mainly fail the screening criteria due to age and pack-year history of smoking. Regardless of not meeting all criteria for screening, these individuals were eventually diagnosed with cancer. Our study correlated with available data that suggests that with the current screening guidelines, individuals at high risk for lung cancer can be missed. In our study, there was a statistical association between an eligibility in subjects that would have met the more lenient currently approved guidelines. Liberalizing guidelines is associated with more high-risk subjects undergoing screening, therefore potentially increasing the rates for early detection. To improve rates of screening and overall LC mortality, organizations should continue to re-evaluate their guidelines and aim to keep expanding LC screening guidelines in attempts to improve LC mortality.

INTERESTING CASES OF LARGE CELL NEUROENDOCRINE LUNG CARCINOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Large-cell neuroendocrine carcinoma (LCNEC) is a rare form of pulmonary tumors with features of small cell lung carcinoma and non-small cell lung cancer. Due to its rarity, there is little known about its presentation and prognosis. We review 2 cases of LCNEC with different outcomes which will help contribute to the current literature of LCNEC. CASE PRESENTATION: Patient A was a 76-year-old male who presented to the Emergency Department with chief complain of dyspnea and shortness of breath. Patient had a history of COPD with 4-5L of home oxygen, hypertension, and a right lung mass. Patient A is a current smoker with 100 pack-year history. He had reported a recent unintentional weight loss of 40 pounds. CT Chest demonstrated a right chest mass measuring 11.9cm. Patient B is a 43-year-old male with no prior smoking history who presented to the ED with complaints of myalgias, sore throat, fevers, and shortness of breath. Patient A also began having generalized weakness, unintentional weight loss of 20lbs, and hoarseness which increased over the past month. Chest CTA demonstrated a large multi-spatial mediastinal mass with confluent adenopathy extending to the left hilum. Both patients underwent endobronchial ultrasound-guided biopsy with bronchioalveolar lavage that demonstrated large cell neuroendocrine carcinoma of the lung. Patient A underwent diagnostic studies 4 month after the mass was detected and Patient B underwent diagnostic studies the following day after mass detection. Patient A experiences an extended stay in the medical intensive care unit and was ultimately admitted to hospice. Patient A expired 24 hours after admission to hospice. Patient B began systemic chemotherapy and radiation with and oncologist and is currently improving. DISCUSSION: Further studies are aimed towards finding similarities in symptoms or laboratory values in order to identify this aggressive carcinoma earlier in its course. Our case reports highlight the aggressive nature of LCNEC. It reveals that advanced age, pulmonary comorbidities and delayed diagnosis all feed into a poor prognosis for LCNEC. CONCLUSIONS: LCNEC is an aggressive cancer that warrants an expediated work-up and early treatment. With time as we analyze more cases of LCNEC, our understanding of the cancer will improve. This will pave the way for better treatment and better prognosis in patients suffering from LCNEC. REFERENCE #1: Berry, M. F. (2020). Approach to the adult patient with a mediastinal mass. UpToDate. https://www-uptodate-com.mwu.idm.oclc.org/contents/approach-to-the-adult-patient-with-a-mediastinal-mass?search=Approach%20to%20the%20adult%20pateint%20with%20a%20mediastinal%20mass&source=search_result&selectedTitle=1˜150&usage_type=default&display_rank=1 REFERENCE #2: Glisson, B. S. (2020). Large cell neuroendocrine carcinoma of the lung. UpToDate. https://www-uptodate-com.mwu.idm.oclc.org/contents/large-cell-neuroendocrine-carcinoma-of-the-lung?search=Large Cell Neuroendocrine Carcinoma of the Lung&source=search_result&selectedTitle=1˜16&usage_type=default&display_rank=1 REFERENCE #3: Tazelaar, H. D. (n.d.). Pathology of lung malignancies. UpToDate. https://www-uptodate-com.mwu.idm.oclc.org/contents/pathology-of-lung-malignancies?search=Pathology of lung malignancies&source=search_result&selectedTitle=1˜150&usage_type=default&display_rank=1 DISCLOSURES: No relevant relationships by Andriana Saric, source=Web Response

NEUROFIBROMATOSIS-ASSOCIATED LUNG DISEASE: A CASE REPORT

TOPIC: Genetic and Developmental Disorders TYPE: Fellow Case Reports INTRODUCTION: Neurofibromatosis type I (NF-1) is a rare disorder that affects multiple organs, with cutaneous findings being the most well-known. It is an autosomal dominant disease caused by dysplasia of ectoderm and mesoderm with variable expression[1]. NF is characterized by a collection of neurofibromas, café au lait spots, and Lisch nodules. Neurofibromatosis is a rare disease and only 10-20% of the cases have associated diffuse lung disease (NF-DLD). Thus, many of the specific characteristics have yet to be elucidated[2]. CASE PRESENTATION: A 50-year-old white man with NF-1 diagnosed by skin biopsy 2 years ago was seen by his PCP due to worsening shortness of breath associated with a productive cough. Levofloxacin was ordered, but 5 days later symptoms persisted so he was referred to the ED.He reported a prior tube thoracostomy after spontaneous right-sided pneumothorax.Family history was remarkable for neurofibromatosis in his mother and spontaneous pneumothorax in his brother. However, his brother does not have any of the cutaneous findings consistent with NF.He is a former smoker with a 20 pack-year history, quitting a month before admission. He works in a furniture company with exposure to wood dust and chemical fumes for more than 30 years.He denies any fever, chills, chest pain, or weight change. Denies any sick contacts.Physical examination demonstrated no respiratory distress. He had mild bibasilar crackles and multiple neurofibromas throughout his body, more so on his back. SARS-CoV-2, influenza A, influenza B, RSV PCR were all negative. Chest x-ray demonstrated peripheral interstitial opacities. He was started on empiric antibiotic coverage for community-acquired pneumonia. Chest CT showed evidence of upper lobe predominant cystic disease and pulmonary reticular abnormalities in the lower lobes consistent with neurofibromatosis associated diffuse lung disease. Centrilobular emphysema and mild bronchiectatic changes were also noted. He was started on bronchodilators with a 5-day course of prednisone. Respiratory status returned to baseline and he was discharged with a LABA+LAMA inhaler and follow-up with the pulmonary clinic. DISCUSSION: The exact prevalence of NF-DLD is unknown. Based on the limited case reports, NF-DLD is more predominant in men, occurring during the third or fourth decade of life with dyspnea being the more common presenting symptom. Whether smoking plays a role in NF-DLD is still unknown. The typical HRCT finding in NF-DLD is upper-lobe cystic and bullous disease with basilar interstitial lung disease. HRCT results demonstrate bibasilar reticular opacities 50%, bullae 50%, ground-glass opacities 37%, cysts, and emphysema 25%[3]. CONCLUSIONS: NF-DLD is considered one of the rare etiologies of cystic lung disease characterized by upper lobe cystic and bullous disease and lower lobe interstitial changes. REFERENCE #1: V. M. Riccardi, "Von Recklinghausen Neurofibromatosis," https://doi.org/10.1056/NEJM198112313052704, Jan. 19, 2010. https://www.nejm.org/doi/pdf/10.1056/NEJM198112313052704 REFERENCE #2: J. H. Ryu, J. G. Parambil, P. S. McGrann, and G. L. Aughenbaugh, "Lack of Evidence for an Association Between Neurofibromatosis and Pulmonary Fibrosis," Chest, vol. 128, no. 4, pp. 2381–2386, Oct. 2005, doi: 10.1378/chest.128.4.2381. REFERENCE #3: A. C. Zamora, H. R. Collard, P. J. Wolters, W. R. Webb, and T. E. King, "Neurofibromatosis-associated lung disease: a case series and literature review," European Respiratory Journal, vol. 29, no. 1, pp. 210–214, Jan. 2007, doi: 10.1183/09031936.06.00044006. DISCLOSURES: No relevant relationships by Susanti Ie, source=Web Response No relevant relationships by seyed pourshahid, source=Web Response No relevant relationships by Seyedmohammad Pourshahid, source=Web Response No relevant relationships by Edmundo Rubio, source=Web Response

Examination of the Association Between Access to Care and Lung Cancer Screening Among High-Risk Smokers.

Objective: The purpose of this study was to examine the influence of access to care on the uptake of low-dose computed tomography (LDCT) lung cancer screening among a diverse sample of screening-eligible patients.Methods: We utilized a cross-sectional study design. Our sample included patients evaluated for lung cancer screening at a large academic medical center (AMC) between 2015 and 2017 who met 2013 USPSTF guidelines for LDCT screening eligibility. The completion of LDCT screening (yes, no) was the primary dependent variable. The independent variable was access to care (insurance type, living within the AMC service area). We utilized binary logistic regression analyses to examine the influence of access to care on screening completion after adjusting for demographic factors (age, sex, race) and smoking history (current smoking status, smoking pack-year history).Results: A total of 1,355 individuals met LDCT eligibility criteria, and of those, 29.8% (n = 404) completed screening. Regression analysis results showed individuals with Medicaid insurance (OR, 1.51; 95% CI, 1.03-2.22), individuals living within the AMC service area (OR, 1.71; 95% CI, 1.21–2.40), and those aged 65–74 years (OR, 1.49; 95% CI, 1.12–1.98) had higher odds of receiving LDCT lung cancer screening. Lower odds of screening were associated with having Medicare insurance (OR, 0.30; 95% CI, 0.22–0.41) and out-of-pocket (OR, 0.27; 95% CI, 0.15–0.47).Conclusion: Access to care was independently associated with lowered screening rates. Study results are consistent with prior research identifying the importance of access factors on uptake of cancer early detection screening behaviors.