Tomography Screening For Lung Cancer Research Articles

Special issue "The advance of solid tumor research in China": Participants with a family history of cancer have a higher participation rate in low-dose computed tomography for lung cancer screening.

We aimed to determine participation in low-dose computed tomography (LDCT) of individuals with a family history of common cancers in a population-based screening program to provide timely evidence in high-risk populations in China. The analysis was conducted using data from the Cancer Screening Program in Urban China (CanSPUC), which recruited 282 377 participants aged 40 to 74 years from eight cities in the Henan province. Using the CanSPUC risk score system, 55 428 participants were evaluated to have high risk for lung cancer and were recommended for LDCT. We calculated the overall and group-specific participation rates using family history of common cancers and compared differences in participation rates between different groups. Odds ratios (ORs) and 95% confidence intervals were derived by multivariable logistic regression. Of the 55 428 participants, 22 260 underwent LDCT (participation rate, 40.16%). Family history of lung, esophageal, stomach, liver and colorectal cancer was associated with increased participation in LDCT screening. The odds of participants with a family history of one, two, three and four or more cancer cases undergoing LDCT screening were 1.9, 2.7, 2.8 and 3.5 times, respectively, than those without a family history of cancer. Compared to those without a history of cancer, participation in LDCT gradually increased as the number of cancer cases in the family increased (P< .001). Our findings suggest that there is room for improvement in lung cancer screening given the relatively low participation rate. Lung cancer screening in populations with a family history of cancer may improve efficiency and cost-effectiveness; however, this requires further verification.

Pregnancy may have little influence on ground-glass opacities suspected for lung adenocarcinoma.

Owing to the popularity of low-dose computed tomography in lung cancer screening, young women spotted with ground-glass opacities (GGO) is a growing subgroup in clinical practice. We aim to investigate the influence of pregnancy on GGOs suspected for lung adenocarcinoma. This retrospective study collected a series of female patients who were pregnant in follow-up of GGO lesions. The last CT images of GGO before pregnancy (CT1) and the first CT images after pregnancy (CT2) were reviewed to assess any radiologic change. Young female patients who were not pregnant in long-term (> 12months) follow-up of GGO were enrolled as a comparison group. We also enrolled patients who gave birth within 2years before surgical resection of GGOs. Four patients were enrolled according to the criteria. There was no significant change of the GGOs in all four patients with a median follow-up duration of 45.5 (range 17-86) months. Two patients were diagnosed pathologically to be minimally invasive adenocarcinoma, one was invasive adenocarcinoma and one did not underwent surgery. Six patients were enrolled in the comparison group and no significant change was witnessed in all the nodules. In those patients who gave birth within two years before surgical resection of GGOs, we found that the majority present as preinvasive lesions, and those with invasive adenocarcinomas were bigger in size and possess more solid component radiologically. Pregnancy seems to have little impact on GGOs suspected for lung adenocarcinoma. Therefore, pregnancy might be safely planned during the follow-up of GGOs.

Estimating Eligibility for Lung Cancer Screening by Neighborhood in Philadelphia Using Previous and Current USPSTF Guidelines.

The National Lung Screening Trial established the benefits of low-dose computed tomography for lung cancer screening (LCS) to identify lung cancer at earlier stages. In February 2021, the US Preventive Services Task Force (USPSTF) revised the eligibility recommendations to increase the number of high-risk individuals eligible for LCS and, in effect, expand screening eligibility for vulnerable populations. One strategy for facilitating LCS is to implement targeted screening in geographic areas with the greatest need. In Philadelphia, although neighborhood smoking rates have been defined, it is not known which neighborhoods have the greatest number of people eligible for LCS. In this study, the authors estimate eligibility for LCS within Philadelphia neighborhoods using both previous and current USPSTF guidelines. They used the Public Health Management Corporation's Household Health Survey from 2010, 2012, and 2015 to identify the number of people within ever-smoker groups (current every day, current occasional, and former smokers) by neighborhood in Philadelphia. Using the 2015 National Health Interview Survey (NHIS) Cancer Supplement, they identified the percentages within ever-smoker groups that were LCS eligible using the previous and current USPSTF guidelines. Finally, they applied the percentages eligible for the ever-smoker groups from the NHIS to the numbers in these groups within Philadelphia neighborhoods. They found that the number of Philadelphians eligible for LCS increased from 41,946 to 89,231 after the revised USPSTF guidelines. The current USPSTF guidelines increased eligibility for LCS within all Philadelphia neighborhoods, with the greatest increases in the River Wards planning district. Local providers should use these results to prioritize LCS services within neighborhoods with greatest eligibility.

Preliminary results of low-dose computed tomography screening for lung cancer in asymptomatic participants.

Low dose computed tomography (LDCT) is the best method for early diagnosis of lung cancer. Even though it has been widely used in clinic, the selection of screening objects and the management scheme of pulmonary nodules are still not unified among research institutions. This study aims to evaluate the effect of LDCT in detection effect and follow-up process for pulmonary nodules in asymptomatic participants. A total of 1 600 asymptomatic participants (37 to 82 years old), who came from Yantian District People's Hospital, Southern University of Science and Technology, received LDCT. The lung nodules were categorized into positive nodules and semi-positive nodules, and according to the density of positive nodules they were categorized into 4 types: solid nodules (SN), partial solid nodules (pSN), pure ground glass nodules (pGGN), and pleural nodules (PN). The number, detection rate, imaging findings, follow-up change of lung nodules, and the postoperative pathological results of positive nodules were recorded and analyzed. Lung nodules were found in 221 cases by LDCT. The total detection rate of lung nodule was 13.8% (221/1 600), and the detection rate in positive nodules was 4.9% (79/1 600). The detected nodules were mainly single (173 cases), solid (133 cases) and semi-positive nodules (142 cases). Most of nodules (177 cases) had no change in the follow-up process. The enlargement and/or increased density of nodules (5 cases) were lung cancer. Pathological results were obtained in 10 cases, 8 cases were malignant (1 small cell lung cancer and 7 adenocarcinomas), 2 cases were benign (cryptococcal infection and alveolar epithelial dysplasia). The detection rate of lung cancer was 0.5% (8/1 600), and the proportion of early lung cancer was 75% (6/8). LDCT screening can identify and increase the detection rate in the early lung cancer, which is an effective screening method. It is safe and feasible to take regular follow-up and re-examination for nodules with diameter less than 5 mm. When the size and or density of nodule increases, it indicates the malignant prognosis of the nodule and timely clinical intervention is needed.

Lung cancer screening use and implications of varying eligibility criteria by race and ethnicity: 2019 Behavioral Risk Factor Surveillance System data.

In 2021, the US Preventive Services Task Force (USPSTF) expanded the eligibility criteria for low-dose computed tomographic lung cancer screening (LCS) to reduce racial disparities that resulted from the 2013 USPSTF criteria. The annual LCS rate has risen slowly since the 2013 USPSTF screening recommendations. Using the 2019 Behavioral Risk Factor Surveillance System (BRFSS), this study 1) describes LCS use in 2019, 2) compares the percent eligible for LCS using the 2013 versus 2021 USPSTF criteria, and 3) determines the percent eligible using the more detailed PLCOm2012Race3L risk-prediction model. The analysis included 41,544 individuals with a smoking history from states participating in the BRFSS LCS module who were ≥50 years old. Using the 2013 USPSTF criteria, 20.7% (95% confidence interval [CI], 19.0-22.4) of eligible individuals underwent LCS in 2019. The 2013 USPSTF criteria was compared to the 2021 USPSTF criteria, and the overall proportion eligible increased from 21.0% (95% CI, 20.2-21.8) to 34.7% (95 CI, 33.8-35.6). Applying the 2021 criteria, the proportion eligible by race was 35.8% (95% CI, 34.8-36.7) among Whites, 28.5% (95% CI, 25.2-31.9) among Blacks, and 18.0% (95% CI, 12.4-23.7) among Hispanics. Using the 1.0% 6-year threshold that is comparable to the 2021 USPSTF criteria, the PLCOm2012Race3L model selected more individuals overall and by race. Using data from 20 states and using multiple imputation, higher LCS rates have been reported compared to prior BRFSS data. The 2021 expanded criteria will result in a greater number of screen-eligible individuals. However, risk-based screening that uses additional risk factors may be more inclusive overall and across subgroups. In 2013, lung cancer screening (lung screening) was recommended for high risk individuals. The annual rate of lung screening has risen slowly, particularly among Black individuals. In part, this racial disparity resulted in expanded 2021 criteria. Survey data was used to: 1) describe the number of people screened in 2019, 2) compare the percent eligible for lung screening using the 2013 versus 2021 guidelines, and 3) determine the percent eligible using more detailed criteria. Lung screening rates increased in 2019, and the 2021 criteria will result in more individuals eligible for screening. Using additional criteria may identify more individuals eligible for lung screening.

Recent Advances in the Diagnosis and Management of Multiple Primary Lung Cancer

Simple SummaryWith the wide application of computed tomography and lung cancer screening, the incidence of multiple primary lung cancer, that is, the occurrence of two or more primary malignant lung tumors in a patient, has been increasingly reported. The optimal strategy for the diagnosis and treatment of multiple primary lung cancers is controversial. Surgery remains the main treatment modality, whereas other treatment methods, including radiotherapy and local ablation, are also feasible, particularly for inoperable patients. Next-generation sequencing and novel therapies, such as targeted agents and immune-checkpoint inhibitors, have provided new insights into this topic.With the wide application of computed tomography in lung cancer screening, the incidence of multiple primary lung cancer (MPLC) has been increasingly reported. Despite the established criteria, the differentiation between MPLC and intrapulmonary metastasis remains challenging. Although histologic features are helpful in some circumstances, a molecular analysis is often needed. The application of next-generation sequencing could aid in distinguishing MPLCs from intrapulmonary metastasis, decreasing ambiguity. For MPLC management, surgery with lobectomy is the main operation method. Limited resection does not appear to negatively affect survival, and it is a reasonable alternative. Stereotactic ablative radiotherapy (SABR) has become a standard of care for patients refusing surgery or for those with medically inoperable early-stage lung cancer. However, the efficacy of SABR in MPLC management could only be found in retrospective series. Other local ablation techniques are an emerging alternative for the control of residual lesions. Furthermore, systemic therapies, such as targeted therapy for oncogene-addicted patients, and immunotherapy have shown promising results in MPLC management after resection. In this paper, the recent advances in the diagnosis and management of MPLC are reviewed.

Innovations in Bronchoscopy: Robotic-assisted Bronchoscopy

Low-dose computed tomography screening for lung cancer has led to the increased detection of peripheral pulmonary nodules (PPN). Bronchoscopic modalities of PPN biopsy (ultrathin bronchoscope, radial endobronchial ultrasound, electromagnetic navigational bronchoscopy) have not consistently shown diagnostic yields as high as ultrasound- or computed tomography-guided transthoracic needle aspiration or surgical lung biopsy. Robotic-assisted bronchoscopy gained US Food and Drug Administration approval in 2018 and 2019, and preliminary data have shown an improvement in the ability to navigate to PPN, obtain a diagnosis and evaluate tissue for molecular markers, all while maintaining a safety profile similar to that of traditional bronchoscopic methods. In this article, we aim to briefly summarize the data available on this novel technology and its potential for future applications.

An Ordinal Radiomic Model to Predict the Differentiation Grade of Invasive Non-Mucinous Pulmonary Adenocarcinoma Based on Low-Dose Computed Tomography in Lung Cancer Screening

An Ordinal Radiomic Model to Predict the Differentiation Grade of Invasive Non-Mucinous Pulmonary Adenocarcinoma Based on Low-Dose Computed Tomography in Lung Cancer Screening

P61.06 Participants With Family History of Cancer Have a Higher Participation Rate of Low-Dose Computed Tomography for Lung Cancer Screening

Family history of cancer is an important risk factor for lung cancer. Studies have shown that it may also affect the willingness to lung cancer screening. To describe the low-dose computed tomography (LDCT) participation rate with a history of common cancers in a population-based screening program. The analysis was conducted in the context of the Cancer Screening Program in Urban China, which recruited 282,377 eligible participants aged 40-74 years from 8 cities in Henan province from 2013 to 2019. A total of 55,428 participants were evaluated to be high-risk for lung cancer by an established risk score system and were subsequently recommended for LDCT. In this study, we calculated the overall and group-specific participation rates by a family history of common cancers, as well as compared the differences in participation rates between different groups. Obtain odds ratios (ORs) and 95% CIs derived by multiple logistic regression model. Of 55,428 with high-risk for lung cancer, 22,260 subjects undertook LDCT (participation rate of 40.16%). We found that a family history of lung cancer, esophageal cancer, stomach cancer, liver cancer, and colorectal cancer were associated with increased participation in LDCT screening. The odds of participants with a family history of one cancer, two cancers, three cancers, and four or more cancers undertaking LDCT screening were 0.9-fold, 1.7-fold, 1.8-fold, and 2.5-fold higher than participants with no family history of cancer (OR: 1.88, 95% CI: 1.80-1.96; OR: 2.65, 95% CI: 2.51-2.79; OR: 2.83, 95% CI: 2.64-3.04; OR: 3.46, 95% CI: 3.15-3.79), respectively. Compared with those without a history of cancer, as the number of cancer family history increases, compliance gradually increases (P<0.001). There was room for improvement regarding lung cancer screening yield given the relatively low participation rate. Lung cancer screening in populations with a family history of cancer may be a choice.

Cost Utility Analysis of a Pilot Study for the Korean Lung Cancer Screening Project.

PurposeThe aim of this study was to evaluate the cost utility of a pilot study of Korean Lung Cancer Screening Project.Materials and MethodsWe constructed a Markov model consisting of 26 states based on the natural history of lung cancer according to the Surveillance, Epidemiology, and End Results summary stage (localized, regional, distant). In the base case, people aged 55–74 years were under consideration for annual screening. Costs and quality-adjusted life years were simulated to calculate the incremental cost utility ratio. Sensitivity analyses were performed on the uncertainty associated with screening target ages, stage distribution, cost, utility, mortality, screening duration, and discount rate.ResultsThe base case (US$25,383 per quality-adjusted life year gained) was cost-effective compared to the scenario of no screening and acceptable considering a willingness-to-pay threshold of US$27,000 per quality-adjusted life years gained. In terms of the target age of screening, the age between 60 and 74 years was the most cost-effective. Lung cancer screening was still cost-effective in the sensitivity analyses on the cost for treatment, utility, mortality, screening duration, and less than 5% discount rates, although the result was sensitive to a rise in positive rates or variation of stage distribution.ConclusionOur results showed the cost-effectiveness of annual low-dose computed tomography screening for lung cancer in high-risk populations.

Impact of low-dose computed tomography for lung cancer screening on lung cancer surgical volume: The urgent need in health workforce education and training.

This study aimed to investigate the time trend variation in the surgical volume and prognostic outcome of patients with lung cancer after the gradual prolonged implementation of a low-dose computed tomography (LDCT) lung cancer screening program.Using the hospital-based cancer registry data on number of patients with lung cancer and deaths from 2008 to 2017, we conducted a retrospective study using a hospital-based cohort to investigate the relationship between changes in lung cancer surgical volume, the proportion of lung-sparing surgery, and prolonged prognostic outcomes after the gradual implementation of the LDCT lung cancer screening program in recent years.From 2008 to 2017, 3251 patients were diagnosed with lung cancer according to the hospital-based cancer registry. The 5-year mortality rate decreased gradually from 83.54% to 69.44% between 2008 and 2017. The volume of total lung cancer surgical procedures and proportion of lung-sparing surgery performed gradually increased significantly from 2008 to 2017, especially from 2014 to 2017 after implementation of a large volume of LDCT lung cancer screening examinations. In conclusion, our real-world data suggest that there will be an increase in cases of operable early-stage lung cancers, which in turn will increase the surgical volume and proportion of lung-sparing surgery, after the gradual implementation of the LDCT lung cancer screening program in recent years. These findings suggest the importance of a successful national policy regarding LDCT screening programs, regulation of shortage of thoracic surgeons, thoracic radiologist workforce training positions, and education programs.

"It's Really Like Any Other Study": Rural Radiology Facilities Performing Low-Dose Computed Tomography for Lung Cancer Screening.

Rationale: The majority of eligible people have not been screened for lung cancer. There is emerging evidence that there are location-based disparities applicable to lung cancer screening (LCS). Objectives: To describe LCS radiologic services in rural Oregon and understand the barriers and facilitators to implementation of LCS using low-dose computed tomography (LDCT). Methods: This was a mixed-method descriptive study using surveys and semistructured interviews of key informants. We approached representatives from all 37 small and rural hospitals in Oregon. We purposively interviewed key informants from a subset based on LDCT implementation outcomes. Results: We surveyed representatives from 29 radiology facilities and qualitatively interviewed 18 key informants from 19 facilities (representing 12 healthcare systems). Among the surveyed radiology facilities, 59% were performing LDCT for LCS. Key informants reported that facilities that performed this service were often motivated by community needs and were less motivated by financial gain or evidence strength, and all described the importance of having a champion. Key informants described that LCS programmatic components that were within their normal scope of practice (e.g., specifying the LDCT parameters) were burdensome to establish but that barriers were surmountable. Most informants reported they did not perform other components of high-quality programs (e.g., ensuring adherence to recommended follow-up testing) and suggested that these steps were important but were the responsibility of primary care providers. Conclusions: Many rural hospital facilities in Oregon offer LDCT for LCS but do not perform all the recommended components of a screening program. Disparities in LCS use and adherence are unlikely to be solved by an exclusive focus at the radiology facility level and may require additional interventions at the primary care level.

Predictors of attrition in a smoking cessation trial conducted in the lung cancer screening setting

SignificanceAlthough it is a requirement that tobacco treatment is offered to cigarette smokers undergoing low-dose computed tomographic lung cancer screening (LCS), not all smokers engage in treatment. To understand the barriers to tobacco treatment in this setting, we evaluated predictors of attrition in a smoking cessation trial among individuals undergoing LCS. MethodsPrior to LCS, 926 participants, 50–80 years old, completed the baseline (T0) phone assessment, including demographic, clinical, tobacco, and psychological characteristics.Following LCS and receipt of the results, participants completed the pre-randomization (T1) assessment. ResultsAt the T1 assessment, 735 (79%) participants were retained and 191 (21%) dropped out. In multivariable analyses, attrition was higher among those who: smoked >1 pack per day (OR = 1.44, CI 1.01, 2.06) or had undergone their first (vs. annual) LCS scan (OR = 1.70, CI 1.20, 2.42). Attrition was lower among those with: more education (associates (OR = 0.67, CI = 0.46, 0.98) or bachelor's degree (OR = 0.56, CI 0.35, 0.91) vs. high school/GED), some (vs. none/a little) worry about lung cancer (OR = 0.60, CI 0.39, 0.92), or a screening result that was benign (OR = 0.57, CI 0.39, 0.82) or probably benign (OR = 0.38, CI 0.16, 0.90) vs. negative. ConclusionsThis study illuminated several LCS-related factors that contributed to trial attrition. Increasing tobacco treatment in this setting will require targeted strategies for those who report little lung cancer worry, are undergoing their first LCS exam, and/or who have a negative LCS result. Addressing attrition and reducing barriers to tobacco treatment will increase the likelihood of cessation, thereby reducing the risk of developing lung cancer.

Low positive predictive value of computed tomography screening for lung cancer irrespective of commonly employed definitions of target population.

Screening for lung cancer (LC) by low-dose computed tomography (LDCT) has been demonstrated to reduce LC mortality in randomized clinical trials (RCTs), and its implementation is in preparation in many countries. However, definition of the target population, which was based on various combinations of age ranges and definitions of heavy smoking in the RCTs, is subject to ongoing debate. Using epidemiological data from Germany, we aimed to estimate prevalence of preclinical LC and positive predictive value (PPV) of LDCT in potential target populations defined by age and smoking history. Populations aged 50 to 69, 55 to 69, 50 to 74 and 55 to 79 years were considered in this analysis. Sex-specific prevalence of preclinical LC was estimated using LC incidence data within those age ranges and annual transition rates from preclinical to clinical LC obtained by meta-analysis. Prevalence of preclinical LC among heavy smokers (defined by various pack-year thresholds) within those age ranges was estimated by combining LC prevalence in the general population with proportions of heavy smokers and relative risks for LC among them derived from epidemiological studies. PPVs were calculated by combining these prevalences with sensitivity and specificity estimates of LDCT. Estimated prevalence of LC was 0.3% to 0.5% (men) and 0.2% to 0.3% (women) in the general population and 0.8% to 1.7% in target populations of heavy smokers. Estimates of PPV of LDCT were <20% for all definitions of target populations of heavy smokers. Refined preselection of target populations would be highly desirable to increase PPV and efficiency of LDCT screening and to reduce numbers of false-positive LDCT findings.

Computed Tomographic Screening for Lung Cancer

Lung cancer is the leading cause of cancer deaths worldwide. Although lung cancer screening has been advocated, for a long time level 1 evidence has been absent, leaving physicians with the challenge of treating patients with mostly incurable disease. Even in 2014, the 5-year survival for lung cancer will only be around 16% despite sophisticated imaging and diagnostic tools. Physicians are thus taking a more proactive route, including early screening for lung cancer and efforts to curb tobacco use. This review discusses lung cancer screening in the context of the National Lung Screening Trial, risk of overdiagnosis, cost-effectiveness, U.S. Preventive Services Task Force recommendations, lung cancer screening in the community, improving the specificity of lung cancer screening, and treatment options for early-stage lung cancer. Tables review key principles of computed tomographic screening, cost-effectiveness of computer tomographic screening, predictors of malignancy in the Pan-Canadian screening study model, and follow-up and management of newly detected indeterminate nodules. Figures show common causes of cancer death in the United States, estimated new cancer cases and cancer deaths in men and women, a four-stage system used in clinical and surgical evaluation of lung cancer, secondary prevention lung cancer screening goals, and a low-dose computer tomographic scan. This review contains 5 figures, 5 tables, and 31 references.

Lung cancer classification with Convolutional Neural Network Architectures

One of the most common malignant tumors in the world today is lung cancer, and it is the primary cause of death from cancer. With the continuous advancement of urbanization and industrialization, the problem of air pollution has become more and more serious. The best treatment period for lung cancer is the early stage. However, the early stage of lung cancer often does not have any clinical symptoms and is difficult to be found. In this paper, lung nodule classification has been performed; the data have used of CT image is SPIE AAPM-Lung. In recent years, deep learning (DL) was a popular approach to the classification process. One of the DL approaches that have used is Transfer Learning (TL) to eliminate training costs from scratch and to train for deep learning with small training data. Nowadays, researchers have been trying various deep learning techniques to improve the efficiency of CAD (computer-aided system) with computed tomography in lung cancer screening. In this work, we implemented pre-trained CNN include: AlexNet, ResNet18, Googlenet, and ResNet50 models. These networks are used for training the network and CT image classification. CNN and TL are used to achieve high performance resulting and specify lung cancer detection on CT images. The evaluation of models is calculated by some matrices such as confusion matrix, precision, recall, specificity, and f1-score.

Main achievements of low-dose computed tomography in lung cancer screening

The objective of the study : to summarize current data on the use of low-dose computed tomography (LDCT) for lung cancer screening (LCS). Subjects and methods : Relevant articles published from 2016 to 2019 were searched for the following key words: lung cancer screening, low-dose computed tomography, ultra-low-dose computed tomography. The search was performed in the open databases of PubMed, Google Scholar, Elibrary. 23 Russian and 778 English publications were found. Among them, relevant publications with high citation indices were selected. Results . By 2019, there have been significant changes in the methodology of LDCT in LCS, and these changes can be considered as one of the priority state areas of modern health care. The article considers the main and potential additional goals of screening for lung cancer, the parameters of inclusion into lung cancer risk groups according to the data of various global studies. It describes data on the recommended maximum permissible doses of radiation exposure in different countries and the economic efficiency of screening. In addition, the technical requirements for a computed tomography scanner in LCS and methods for interpreting LDCT have been systematized.

Incidental finding of renal cell carcinoma in an asymptomatic patient on low-dose computed tomography screening for lung cancer

INTRODUCTION In 2013, the United States Preventive Services Task Force recommended annual low-dose computed tomography (CT) screening for lung cancer in high-risk adults with a significant smoking history. These screenings result in large numbers of incidental findings, and although most of these do not warrant further investigation, there have been reported cases of incidental findings identified on CT screening that led to successful treatment of a previously undiagnosed comorbidity. CASE HISTORY Here, we report a case of papillary renal cell carcinoma that was detected incidentally on low-dose CT in an asymptomatic individual, a rare diagnosis considering that renal neoplasms account for <1% of incidental findings on these screenings. CONCLUSION This case highlights the value of investigating these incidental findings, with the goal of detecting underlying disease in some cases before it would have presented symptomatically.

Clinician Variation in Ordering and Completion of Low-Dose Computed Tomography for Lung Cancer Screening in a Safety-Net Medical System

BackgroundLess than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians’ participation in lung cancer screening has not been determined. Patients and MethodsWe studied medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system. We analyzed associations between provider characteristics and LDCT orders and completion using chi-square, Fisher exact, and Student t tests, as well as ANOVA and multinomial logistic regression. ResultsAmong an estimated 194 adult primary care physicians, 144 (74%) ordered at least 1 LDCT, as did 39 specialists. These 183 medical providers ordered 1594 LDCT (median, 4; interquartile range, 2-9). In univariate and multivariate models, family practice providers (P < .001) and providers aged ≥ 50 years (P = .03) ordered more LDCT than did other clinicians. Across providers, the median proportion of ordered LDCT that were completed was 67%. The total or preceding number of LDCT ordered by a clinician was not associated with the likelihood of LDCT completion. ConclusionIn an integrated safety-net healthcare system, most adult primary care providers order LDCT. The number of LDCT ordered varies widely among clinicians, and a substantial proportion of ordered LDCT are not completed.

The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries.

Lung cancer accounts for an alarming human and economic burden in low- and middle-income countries (LMICs). Recent landmark trials from high-income countries (HICs) by demonstrating that low-dose computed tomography (LDCT) screening effectively reduces lung cancer mortality have engendered enthusiasm for this approach. Here we examine the effectiveness and affordability of LDCT screening from the viewpoint of LMICs. We consider resource-restricted perspectives and discuss implementation challenges and strategies to enhance the feasibility and cost-effectiveness of LDCT screening in LMICs.