Scientific Session 13 — Chest ImagingWednesday, May 3, 2017
2301. Low-Dose CT Lung Cancer Screening in a High-Risk Population
Guichet P*, Sakioka J, Cen S, Liu B, Lee C. Keck School of Medicine of Ubiversity of Southern California, Los Angeles, United States
Address correspondence to P. Guichet (email@example.com)
Objective: The purpose of our study was to describe the preliminary results of our clinical low-dose CT lung cancer screening program targeting a socioeconomically disadvantaged and high-risk population different from that studied in the National Lung Screening Trial (NLST).
Materials and Methods: All patients met United States Preventive Services Task Force or National Comprehensive Cancer Network eligibility criteria (or both) for lung cancer screening. A dedicated screening coordinator enrolled eligible patients, scheduled their screening examinations, and organized their transportation to and from the medical center. A 2-year grant from a 501(c)(3) tax-exempt public charity covered all expenses, including the creation of an online database for patient tracking.
Results: A total of 816 patients were referred to the program from July 21, 2015, through August 13, 2016; 148 patients declined screening, and 115 could not be contacted. Of 553 patients who agreed to participate, 225 met eligibility criteria for lung cancer screening. In all, 188 patients (113 men [60%], 75 women [40%]) underwent their baseline low-dose CT during this time period. Mean age was 59 years (range, 50–78 years) and median BMI was 27.0 (range, 16–69). Patients had smoked for a median of 40 pack-years (range, 20–191 pack-years), and 83% (n = 156) of patients were current smokers. The ethnic makeup of the population was 80% (n = 151) black, 11% (n = 20) Hispanic/Latino, 6% (n = 12) white, and 1% (n = 2) Asian. Sixty-five percent (n = 132) of patients had no more than a high school education, 39% (n = 73) of patients reported occupational exposure to one or more lung carcinogens, and 5% (9) reported radon exposure. Eighty-seven percent (n = 163) of patients received a Lung-RADS score of 1 (n = 58) or 2 (n = 105), 7% (n = 14) received a score of 3, 4% (n = 7) received a score of 4A, and 2% received a score of 4B (n = 3) or 4X (n = 1). Two patients (1%) have been diagnosed with lung cancer to date; one with stage IIIB small cell lung cancer and one with stage IV lung cancer. Thirty-seven percent (n = 69) of patients had potentially clinically significant incidental findings including moderate to severe coronary calcifications (n = 25), extrapulmonary masses (n = 19), interstitial lung disease (n = 14), severe emphysema (n = 10), aortic aneurysm (n = 2), aortic valve calcifications (n = 2), and advanced metastatic disease of extrathoracic origin (n = 1).
Conclusion: Lung cancer screening with low-dose CT in a socioeconomically disadvantaged and high-risk population is feasible but may yield a different cancer profile than screening in more affluent communities. More follow-up time is required to determine whether the reduction in lung cancer mortality demonstrated in the NLST applies to this high-risk population.