How to Improve Lung Cancer Screening Programs? Focus on Patients Least Likely to Adhere, Study Finds

A new study finds that healthcare providers should focus on lung cancer screening (LCS) subjects who are less likely to remain in the program – such as those with negative low-dose CT (LDCT) exams and those who continue smoking – to maximize program adherence. The findings were published in the American Journal of Roentgenology (AJR).

As the researchers noted, for people with a long history of smoking, LDCT LCS has been shown to attenuate the risk of death mortality; however, adherence to an LCS program remains appreciably lower than in randomized controlled trials. In this study, three radiologists retrospectively recorded patient demographics, smoking history and behavior changes, Lung-RADS category, PPV and NPV, and adherence to screening recommendations for 260 subjects returning for follow-up LDCT from 2014 to 2019.

According to the results, 16.5% of subjects had positive scans, and of those 10.8% were Lung-RADS category 3, and 3.1% were 4A, while 2.3% were 4B, and 0.8% were 4X. Forty-three subjects (16.5%) had positive scans, of which 28/260 (10.8%) were Lung-RADS category 3, 8/260 (3.1%) were 4A, 6/260 (2.3%) were 4B, and 2/260 (0.8%) were 4X. Four study subjects were diagnosed with cancer (three lung, and one metastatic melanoma) Furthermore, the results showed that 55% of subjects were current smokers at baseline, and 46.5% smoked during the last round of LCS.

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Overall, the researchers observed that adherence to the program was 43%, though they noted this increased progressively the higher the Lung-RADS category. Additionally, adherence was higher in former vs. current smokers (50% vs. 36.2%; p = 0.002). Ultimately, there were only two significant independent predictors of adherence: having smoked previously and a positive (? 3) Lung-RADS category. “Our study demonstrates that a real-world LCS can perform similar to randomized controlled trials in regard to important performance metrics,” concluded first author Eduardo J. Mortani Barbosa, Jr., per a press release about the study.

“Such communications should emphasize that a negative LCS exam does not confer immunity to future lung cancer development,” the authors added, “and that continued participation in LCS, combined with smoking cessation, is essential to accrue the maximum benefits of mortality reduction amongst persons with substantial smoking history.”

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