Title: Evaluating Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scan in a Community Hospital: A Retrospective Study

Author(s): Stanley Ifeanyi Ozogbo, MD; Timothy Barreiro, DO; David Gemmel, PhD

Email: sozogbo@mercy.com

Introduction: Lung cancer remains the leading cause of cancer-related deaths globally; the National Lung Screening Trial (NLST) demonstrated clearly that early detection through low-dose CT (LDCT) lung cancer screening had a mortality benefit. Optimization of LDCT lung cancer screening in high-risk populations is a crucial preventive service in primary care settings. Despite the United States Preventive Services Task Force (USPSTF) recommendations, however, LDCT screening rates remain low.  The 2023 “State of Lung Cancer” report shows that only 4.5% of those at high risk were screened nationally, a decline from 5.8% in 2022. Ohio’s screening rate of 6.9% was significantly higher than the national average. The purpose of this study was to ascertain the rate of LDCT screening among tissue-confirmed lung cancers.

Methods: A retrospective analysis of tissue-confirmed non-small cell lung cancer (NSCLC) in the tumor registry (n=116) was reviewed.  In the EMR of patients diagnosed with lung cancer, documentation of LDCT was abstracted, along with other registry data, including demographics, histology, clinical and pathological stage, recurrence, and vital status.

Results: In a series of accessioned lung cancer patients with NSCLC (adenocarcinoma), the average age was 67.5 + 10 years, 60.3% were male and 9.5% were nonwhite.  The rate of LDLCT screening among patients with lung cancer was 24.1% (28/116).  Mortality in the series was 27.61% (32/116).  AJCC clinical and pathological stage was associated with mortality (both p < 0.05).  Among survivors, 7.1% of presentations were pathologically AJCC staged 3 or 4; among non-survivors, 25.1% of presentations were stage 3 or 4. No difference by stage and LDLCT was noted. LDLCT patients were younger than non-screened patients, 64 vs 69 years (t=1.983, p = 0.05).  No sex or race differences by screening were observed.

Discussion/Conclusion: During local enrollment in NLST for NCI, downstaging was noted in the tumor registry, with a higher proportion of early cancers (stage 1) noted.  In the current series, no difference in stage by screening was found.  In contrast to screening rates for breast, prostate, or colorectal cancer, lung cancer screening is low, compared to rates for mammography, DRE and PSA, and colonoscopy.  This is particularly disconcerting given the high case lethality of lung cancer. Screening for lung cancer in community hospital settings can enhance early detection and improve patient mortality. Implementing targeted education campaigns, expanding access to screening services, and optimizing communication between healthcare providers and patients are essential to increase LDLCT screening rates.