The Majority of Patients with Resectable Incidental Lung Cancers are Ineligible for Lung Cancer Screening
Nanruoyi Zhou1, John Deng1, Claire Faltermeier2, Sha'shonda Revels3, Paul Toste3, *Robert Cameron3, *Jay M. Lee3, *Jane Yanagawa3
1David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States, 2Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States, 3Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, California, United States
Objective: Lung cancer screening guidelines have been developed to identify patients at high risk for lung cancer. We sought to determine what proportion of asymptomatic patients who underwent resection for lung cancer at an academic center were identified through a lung cancer screening program versus incidentally. For patients with incidental lung cancers, we investigated how many were screen-eligible and what factors led to screen-ineligibility.
Methods: We performed a retrospective study using our prospectively collected single institution Society of Thoracic Surgeons database on patients who underwent resection for a primary lung cancer between January 2010 and April 2021. Patients who were asymptomatic and had sufficient data to assess screen-eligibility were included. Asymptomatic patients with lung cancers identified through surveillance for a personal history of lung cancer were excluded. We then assessed whether the incidentally-found patients were eligible for lung cancer screening using the United States Preventative Task Force (USPSTF), Centers for Medicare and Medicaid Services (CMS), and American Cancer Society (ACS) guidelines.
Results: Of 432 patients who underwent resection for primary lung cancer, 413 (96%) had sufficient data to determine screen-eligibility. Of these, 137 (33%) patients were symptomatic and 276 (67%) were asymptomatic. Of the asymptomatic population, 14 (5%) patients had lung cancer discovered on surveillance for a history of lung cancer and were excluded. Of the remaining 262 patients with primary lung cancer, 43 (16%) were discovered through a screening program and 219 (84%) patients were incidentally discovered. The majority of these 219 patients were female (n=136, 62%) and White, non-Hispanic (n=143, 65%), with a median age of 68 years (range 24-91). Histologically, 160 patients had adenocarcinoma (73%), 23 had squamous cell carcinoma (11%), and 36 had other histologies (16%). Of the 219 incidentally found patients, 53 (24%) would have been eligible for screening using current USPSTF guidelines, 47 (21%) using 2013 USPSTF guidelines, 46 (21%) using CMS guidelines, and 41 (19%) using ACS guidelines. Of the 166 patients who were screen-ineligible by current USPSTF criteria, 76 (46%) patients never smoked, 71 (43%) patients quit smoking >15 years ago, 54 (33%) did not smoke at least 20 pack years, and 38 (23%) were screen-ineligible due to age, with 23/38 (60%) being older than 80.
Conclusions: The majority of patients with resectable incidental lung cancers are not eligible for screening under current lung cancer screening guidelines criteria. This study reflects a need for improved methods to identify high-risk patients who may benefit from lung cancer screening.
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