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Lutzow LK, Magarinos J, Dass C, Ma GX, Erkmen CP. Lung Cancer Screening in a Safety-Net Hospital: Rare Harms Inform Decision-Making. Ann Thorac Surg 2021; 114:1168-1175. [PMID: 34516963 DOI: 10.1016/j.athoracsur.2021.07.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lung cancer screening (LCS) with Low-Dose CT (LDCT) decreases lung cancer mortality; however, screening benefits and harms are poorly described in minority populations. Our purpose is to report benefits and harms of LCS implemented in a safety-net institution. Because harms are rare, there is a paucity of clinical experience guiding Shared Decision Making (SDM) with diverse populations. METHODS We conducted a prospective, observational study of patients undergoing LCS between September 2014 and March 2019 with 2-year follow-up. LDCT results, lung cancer diagnosis, stage, treatment, false-positive, false-negative procedure from a false-positive, complication from procedures, and death were recorded. Patient cases highlighting the challenges of delivering LCS to an underserved population were evaluated in the context of current evidence. RESULTS 995 patients underwent screening, of which the majority were African American (54.9%), with 2.9% receiving a cancer diagnosis, a false-positive rate of 9.4% and a 0.7% rate of procedures resulting from a false-positive. Five patient cases highlight challenges namely 1) false-positive resulting in surgery, 2) false-negative,3) incidental finding, 4) delay in diagnosis, and 5) mortality from cause other than lung cancer. CONCLUSIONS LCS of a predominantly African American population with 2-year follow-up demonstrates early detection and treatment of lung cancer with few harms. Though rare, harms must be clearly described with population-specific evidence. We report clinical perspective of rare harms that can provide guidance to providers and patients.
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Affiliation(s)
- Lynde K Lutzow
- Department of Surgery, Temple University Health Systems, Philadelphia, PA
| | - Jessica Magarinos
- Department of Surgery, Temple University Health Systems, Philadelphia, PA
| | - Chandra Dass
- Department of Radiology, Temple University Health Systems, Philadelphia, PA
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine at Temple University Hospital Philadelphia, PA
| | - Cherie P Erkmen
- Center for Asian Health, Lewis Katz School of Medicine at Temple University Hospital Philadelphia, PA; Department of Thoracic Medicine and Surgery, Temple University Health Systems, Philadelphia, PA.
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O'Dwyer E, Halpenny DF, Ginsberg MS. Lung cancer screening in patients with previous malignancy: Is this cohort at increased risk for malignancy? Eur Radiol 2020; 31:458-467. [PMID: 32728771 DOI: 10.1007/s00330-020-07026-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/09/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the rate of second primary lung cancer (SPLC) and describe the clinical characteristics and radiological findings in individuals with a prior history of cancer presenting to a low-dose computed tomography (LDCT) lung cancer screening program at a tertiary cancer center. METHODS Patients with a previous history of malignancy, a life expectancy ≥ 5 years referred for CT lung cancer screening between May 2, 2011, and November 28, 2018, were included. Demographics regarding risk factors including smoking history and prior history of thoracic radiation were collected. CT scan features assessed nodule size, morphologic features, and number. The Lung-CT Reporting and Data System (Lung-RADS) scoring system was retrospectively applied to studies performed before October 2014 and prospectively applied to remainder of studies. Data was collected in a Health Insurance Portability and Accountability Act (HIPAA)-compliant manner. RESULTS A total of 543 patients were studied (mean age of 66 years). All had a previous history of cancer, most commonly breast cancer 205 (38%), head and neck cancer 105 (19%), and lung cancer 87 (16%). Of screening CTs performed, 17.5% were positive screening study results as per Lung-RADS scoring system. SPLC was diagnosed in 35 patients (6.4%) with 21 prevalence cancers detected and 14 interval cancers detected in subsequent screening rounds. CONCLUSIONS The rate of screen-detected SPLC in patients with prior malignancy is higher than reported rates seen in historical prospective screening studies. Our study suggests the need for prospective research to evaluate any mortality benefit that screening may have in this population. KEY POINTS • The rate of screen-detected second primary lung cancer in patients with prior malignancy is higher than reported rates seen in historical prospective randomized lung cancer screening studies in a general screened population. • Patients with a prior malignancy undergoing lung cancer screening have higher rates of positive screening studies and higher rates of invasive diagnostic procedures than those reported in a general screening population. • Prospective research is required to evaluate if screening offers a mortality benefit in this population.
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Affiliation(s)
- Elisabeth O'Dwyer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Darragh F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Park JS, Kang B, Park Y, Park SJ, Cheon JH, Jung M, Beom SH, Shin SJ, Hur H, Min BS, Baik SH, Lee KY, Ahn JB, Kim NK, Kim TI. Screening for Lung Cancer Using Low-dose Chest Computed Tomography in Korean Long-term Colorectal Cancer Survivors. J Cancer Prev 2019; 24:48-53. [PMID: 30993095 PMCID: PMC6453590 DOI: 10.15430/jcp.2019.24.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/23/2019] [Indexed: 11/04/2022] Open
Abstract
Background The National Lung Screening Trial (NLST) and NELSON trial showed that low-dose chest computed tomography (LDCT) screening significantly reduced the mortality form lung cancer. Although cancer survivors are known to have high risk for second malignant neoplasm (SMN), the usefulness of LDCT screening for lung cancer in cancer survivors is not clear. Methods Between August 2016 and August 2017, 633 long-term colorectal cancer (CRC) survivors visited the survivorship clinic in Cancer Prevention Center, Yonsei Cancer Center, Seoul, Republic of Korea. We surveyed the smoking status and recommended LDCT screening to ever-smoking CRC survivors aged 55–80 years. The participants were classified into three risk groups: risk group 1 (RG1) who met the NLST criteria (Age 55–74 years, ≥ 30 pack-years of smoking, smoking cessation < 15 years); risk group 2 (RG2) who would not meet the NLST criteria but were at increased 6-year risk of lung cancer (PLCOM2012 ≥ 0.0151); risk group 3 (RG3) who did not meet any of the criteria above. Results Among 176 ever-smoking CRC survivors, 173 (98.3%) were male, 32 (18.2%) were current-smoker, and median age was 66 years (range, 55–79 years). We found 38 positive findings (non-calcified nodule ≥ 4 mm), 8 clinically significant findings, 66 minor abnormalities, and 64 negative findings on LDCT. Positive findings were identified in 15 of 79 (19.0%) of RG1, in 9 of 36 (25%) of RG2, and in 14 of 61 (23.0%) of RG3. Second primary lung cancers were found in 2 patients of RG2, and in 1 patient of RG3. SMN was most frequently found in RG2 (11 of 36 patients, 30.6%), compared with RG1 (12.7%) or RG3 (9.8%) (P = 0.016). Conclusions LDCT screening for lung cancer in Korean CRC survivors is feasible. Well-designed clinical trial for defining high risk patients for lung cancer among CRC survivors is needed.
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Affiliation(s)
- Ji Soo Park
- Cancer Prevention Center, Yonsei Cancer Center, Seoul, Korea.,Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yehyun Park
- Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Seung Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Hyuk Hur
- Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyuk Baik
- Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Nam Kyu Kim
- Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Cancer Prevention Center, Yonsei Cancer Center, Seoul, Korea.,Colorectal Cancer Center, Yonsei Cancer Center, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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