New research shows that the adoption of a Lung Nodule Program (LNP) can significantly enhance the detection of early lung cancer among individuals not meeting the age eligibility criteria for traditional lung cancer screening. LNPs are often set up as a way to follow up with patients when lung nodules are identified during a routine imaging for reasons other than suspected lung cancer or for lung cancer screening
The study, published in the Journal of Thoracic Oncology, was led by Dr. Raymond U. Osarogiagbon, chief scientist for Baptist Memorial Health Care in Memphis, TN. The prospective observational study compared lung cancer diagnosis risks, characteristics, and overall survival among participants undergoing low-dose CT (LDCT) screening and those involved in an LNP. It compared the two-year cumulative risk of lung cancer, lung cancer characteristics, and overall survival (OS) among patients undergoing LDCT in patients 50 to 80 years of age, and LNP patients from 35 to 50 years and older than 80 years of age.
LDCT screening for lung cancer has demonstrated a reduction in mortality of up to 20%. Annual LDCT screening for lung cancer is recommended by the United States Preventive Services Task Force for patients with a 20-pack year smoking history and are still smoking or have quit fewer than 15 years ago.
While that age range was lowered from 55 to 50, the majority of persons diagnosed with lung cancer are ineligible for this lung cancer screening method. LNPs, however, which use the Fleischner Society lung nodule management guidelines, expand access to early lung cancer detection to a more diverse population, though using this method to identify patients at risk had not yet been rigorously estimated.
“Our findings indicate that our Lung Nodule Program modestly benefitted individuals deemed too young or too old for traditional screening,” says Osarogiagbon. “The observed differences in clinical characteristics and outcomes strongly suggest variations in the biological characteristics of lung cancer in these distinct patient cohorts.”
The study revealed that individuals 50 to 80 years of age enrolled in an LNP had a higher risk of lung cancer diagnosis within two years compared to those undergoing LDCT screening. Importantly, the demographic, socio-economic characteristics, and risk factor profiles of individuals diagnosed with lung cancer through the LNP differed notably from the screened cohort. This suggests that LNPs, utilizing Fleischner Society lung nodule management guidelines, expand access to early lung cancer detection across a more diverse population.
The study spanned from 2015 to 2022 and included 329 (3.43%) LDCT, 39 (1.07%) young, and 172 (6.87%) elderly LNP patients. Strikingly, the two-year cumulative incidence rates were 3.0% for LDCT, 0.79% for young LNP, and 6.5% for elderly LNP. The lung cancer diagnosis risk was found to be similar between young LNP and certain LDCT categories, while elderly LNP risk exceeded that of specific LDCT categories.
The research also identified significant differences in the stage at which cancer was diagnosed, with a higher percentage of LDCT cases diagnosed at stage I/II compared to young and elderly LNP cohorts. Moreover, the five-year overall survival rates varied among the groups, with LDCT cases showing higher rates than both young and elderly LNP cases.
