When it rains it pours.

Top Line: While low-dose CT lung cancer screening programs reduce lung cancer mortality, utilization is frustratingly low and screening criteria leave many at-risk people ineligible for screening.

The Study: In the latter group, non-white patients and those with lower smoking intensity or more remote smoking history often don’t meet screening criteria. The DELUGE study prospectively compared cancer diagnosis characteristics between a large LDCT screening program and a lung nodule management program in the Mississippi Delta region. Akin to a LDCT screening program, the Lung Nodule Program was run by navigators who contacted ordering providers with specific recommendations regarding nodule follow-up and management. The LDCT Program enrolled 5,659 patients who met 2013 USPSTF criteria for lung cancer screening. The Lung Nodule Program enrolled 15,461 patients with a suspicious lung nodule on standard diagnostic imaging. Compared to the standard LDCT Screening Program, the Lung Nodule Program included significantly more Black patients (27% v 16%), former smokers (40% v 28%), and never smokers (13%). The median duration since quitting smoking was 16 years in the Lung Nodule Program v 8 years in the LDCT program. Similar proportions of patients had a history of cancer (26% v 30%).  For every patient enrolled in the LDCT program, 2.7 were enrolled in the Lung Nodule program. Overall, 2.7% of LDCT patients were diagnosed with lung cancer compared to 4.5% of Lung Nodule patients, and ~60% of patients in both groups were diagnosed with stage I-II lung cancer. But numerically, the Lung Nodule Program had a much larger impact on lung cancer detection. For every LDCT patient diagnosed with lung cancer, 5 were diagnosed in the Lung Nodule program. Furthermore, 4.5 times as many patients in the Lung Nodule Program were diagnosed with Stage I-II lung cancer than in the LDCT program. Sadly, most patients in the Lung Nodule Program who were diagnosed with lung cancer were not even eligible for LDCT screening. Overall only 46% of all lung cancers diagnosed across both groups were eligible for screening based on the 2013 criteria while 54% would have been eligible with the 2021 criteria.

TBL: A dedicated program for identifying and managing lung nodules is complementary to a LDCT screening program and greatly expands the ability to detect early stage lung cancer while being more inclusive of minority populations, non-smokers, and those with lower intensity or more remote smoking history. | Osarogiagbon, J Clin Oncol 2022