Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
Wei Liao , Nicholas Faris , Carrie Fehnel , Jordan Goss , Alicia Pacheco , Paul F Pinsky , Matthew Smeltzer , Raymond U. Osarogiagbon
Background: LDCT screening saves lives, but <10% of eligible persons participate; eligibility criteria are imperfect; geographic, racial and socio-economic disparities have emerged. ILNP may expand access to early detection. We compared rates of lung cancer diagnosis in LDCT and ILNP population subsets. Methods: Prospective observational cohort study of enrollees in LDCT and ILNP in a community healthcare system in AR, MS and TN. We compared LDCT vs 4 ILNP cohorts (C) based on USPSTF 2021 LDCT eligibility criteria: <50 years (C1, too young); >80 years (C2, too old); 50 – 80 years (C3, ineligible smoking history); 50 – 80 years (C4, eligible). For certain analyses, we stratified the LDCT cohort by baseline (T0) Lung-RADS score (0-2 v 3-4). We used a Cox model to calculate crude and adjusted hazard ratios (aHR) for lung cancer diagnosis within 24 months of enrollment. Results: From 2015-2021, 7050 persons were in LDCT- 6073 (86%) Lung-RADS 0-2 (no/benign lesions), 977 (14%) Lung-RADS 3 or 4 (possibly malignant lesion) on T0 scan; 17,579 were in ILNP, 16%, 10%, 57% and 16% respectively in C1-4. Demographics and tobacco use history of the ILNP cohorts differed strikingly; C4 was very similar to LDCT (Table). Black persons were significantly more in C1 (too young) and C3 (insufficient tobacco use). Diagnosis of lung cancer at 36 months ranged from 1% in C1 to 15% in C4, compared to 3% in LDCT; aHR for lung cancer diagnosis within 2 years ranged from 0.23 to 5.12 (all LDCT ref), but ranged from 0.04 to 1.02 with reference to LDCT Lung-RADS 3-4. Most patients in LDCT and ILNP C2-4 had early stage. There were proportionately more Black lung cancer patients in C1-4, and 3 times more Black patients in C3 and 4 than in LDCT. Conclusions: ILNP provides early-detection access to a larger, more diverse population than LDCT, potentially alleviating race and socio-economics-based outcomes disparities.
LDCT* | LNP* | ||||
---|---|---|---|---|---|
N = 7050 | C1 | C2 | C3 | C4 | |
N = 2888 | N = 1824 | N = 10093 | N = 2774 | ||
Demographics | |||||
Age: Median yrs (Q1-Q3) | 65(60 - 70) | 44(40 - 47) | 85(82 - 88) | 66(58 - 72) | 66(60 - 71) |
Female | 50 | 59 | 58 | 55 | 50 |
Black race | 19 | 38 | 19 | 29 | 19 |
Uninsured | 1 | 18 | 3 | 9 | 4 |
Smoking history | |||||
Former | 32 | 13 | 41 | 29 | 29 |
Never | 0 | 46 | 45 | 45 | 0 |
≥20 Pack years | 87 | 19 | 34 | 14 | 100 |
Missing | 10 | 57 | 48 | 62 | 0 |
Quit Duration <15 years | 88 | 42 | 12 | 16 | 100 |
Missing | 2 | 45 | 32 | 38 | 0 |
Largest lesion, median mm (Q1 - Q3) | 4(2 - 6) | 7(5 - 10) | 8(5 - 15) | 7(5 - 11) | 9(5 - 15) |
Cumulative # of Lung Cancer Patients (n, %) | |||||
12 months | 149(2) | 19(1) | 96(5) | 314(3) | 371(13) |
24 | 183(3) | 19(1) | 102(6) | 345(3) | 408(15) |
36 | 205(3) | 20(1) | 102(6) | 364(4) | 426(15) |
Black race | 15 | 40 | 18 | 30 | 22 |
Histology | |||||
Adeno | 45 | 55 | 48 | 52 | 47 |
Squamous | 31 | 10 | 29 | 18 | 29 |
Small | 16 | 10 | 5 | 12 | 12 |
Clinical Stage | |||||
Stage I/II | 60 | 30 | 52 | 57 | 56 |
Stage III | 18 | 20 | 18 | 21 | 22 |
Stage IV | 19 | 50 | 26 | 22 | 20 |
aHR (95% CI) | |||||
Ref all LDCT | - | 0.23 (0.14, 0.38) | 1.93 (1.50, 2.48) | 1.21 (1.01, 1.46) | 5.12 (4.34, 6.05) |
Ref Lung-RADS 3-4 | - | 0.04 (0.03, 0.07) | 0.39 (0.30, 0.51) | 0.24 (0.19, 0.29) | 1.02 (0.85, 1.24) |
*Numbers are column % unless otherwise stated.
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