- Resource Type:
16. Evaluating the Lung Cancer Screening Eligibility of Patients Undergoing Lung Cancer Operations: An Analysis of the Southern Community Cohort Study
May 6, 2023
Sandra Starnes , Invited Discussant , University of Cincinnati Medical Center
Alexandra Potter , Abstract Presenter , University of California, Berkeley
103rd Annual Meeting, the Los Angeles Convention Center, Los Angeles, CA, USA
Los Angeles Convention Center, 408A
Objective: The goal of lung cancer screening with low-dose computed tomography (LDCT) is to identify lung cancer at an earlier stage when it is amenable to surgical treatment. We sought to evaluate the proportion of lung cancer patients undergoing surgery who would have been eligible for lung cancer screening using data from the Southern Community Cohort Study (SCCS).
Methods: Patients who underwent surgery for lung cancer from 2002-2020 in the SCCS-a prospective cohort study of nearly 85,000 predominately low-income Black and White adults from 12 states in the southeastern United States-were identified for analysis. The proportions of patients who would have been eligible for LDCT screening under the 2013 and 2021 United States
Preventive Services Task Force (USPSTF) guidelines were compared using the McNemar test. Using data from the National Cancer Database, we calculated the proportion of breast and colon cancer patients who underwent surgery and who would have been eligible for breast and colon cancer screening, respectively; these proportions were then compared to the proportion of patients who underwent lung cancer operations in SCCS that would have been eligible for LDCT screening using a chi-square test.
Results: A total of 314 lung cancer patients underwent surgical treatment. The proportion of patients who would have been eligible for screening increased by 69.5% (from 32.5% to 55.1%, P<0.001) under the 2013 vs. 2021 USPSTF lung cancer screening guidelines. However, 45% of lung cancer patients undergoing surgery would have still been ineligible for LDCT screening under the 2021 USPSTF guidelines-in comparison, only 22% of patients undergoing colon cancer surgery and 15% of patients undergoing breast cancer surgery would have been ineligible for colorectal cancer and breast cancer screening, respectively (P<0.001). Of patients with a smoking history who underwent lung cancer operations and were ineligible for screening, 70.9% had fewer than 20 pack-years, 32.7% had quit smoking more than 15 years prior, 14.6% were too young, and 2.7% were too old (Figure).
Conclusions: Even though lung cancer screening is intended to identify lung cancers at earlier stages when they are amenable to surgical treatment, we found that 45% of patients undergoing lung cancer operations would have been ineligible for lung cancer screening, highlighting the need for further revision to the USPSTF lung cancer screening guidelines.
Alexandra Potter (1), Maha Yehia (1), Meghan McCarthy (1), Camille Mathey-Andrews (1), Linda Martin (2), Chi-Fu Jeffrey Yang (1), (1) Massachusetts General Hospital, Boston, MA, (2) University of Virginia Health System, Charlottesville, ID
Dr. Starnes is a Professor of Srugery and tthe John B. Flege Chair of Cardiothoracic Surgery at the University of Cincinnati She is also the Program Director for the Integrated Thoracic Surgery Residency.
She is a general thoracic surgeon wtih expertise in thoracic malignancies, including lung cancer, esophageal cancer and mediastinal tumors, with a focus on minimally-invasive and complex thoracic procedures. She is the Director of the University of Cincinnati Lung Cancer Center.
She has been active in multiple national organizations. She has served as President of the Thoracic Surgey Directors Assocation. She has been a quest examiner for the American Board of Thoracic Surgery since 2013 and currently serves on the Thoracic Surgery Residency Review Committee.
Alexandra Potter is a research assistant at Masshachusetts General Hospital. Her research focus is in the field of thoracic oncology, with a specific focus on lung cancer screening.