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J.A. Howell
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P2.06 - Poster Session/ Screening and Early Detection (ID 219)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.06-001 - Community-Based Low-Dose Computed Tomography (LDCT) Lung Cancer Screening in the Histoplasmosis Belt of the United States (ID 2688)
09:30 - 09:30 | Author(s): J.A. Howell
- Abstract
Background:
LDCT lung cancer screening has been incorporated into most major American medical societies' screening guidelines and has recently been approved for reimbursement by the Centers for Medicare and Medicaid Services. However, its performance in a non-tertiary care community setting with a high prevalence of fungal infections has not been sufficiently studied.
Methods:
Beginning in April 2013, high-risk adults ages 55-80 with at least a 30 pack-year smoking history, including former smokers who had quit within the previous 15 years, were prospectively evaluated with an LDCT scan performed at our community hospital (Unity Point Health Medical Center in Quad Cities, Illinois). Standard National Lung Screening Trial exclusion criteria were followed with the exception of previous chest CTs being allowed up to 12 months rather than 18 months prior to study entry and extension of age of the studied population to 80 years. An oncology nurse navigator contacted and monitored all participants. The CTs were interpreted by a local radiology group with two radiologists spearheading the program and ensuring consistent interpretations.
Results:
As of April 2015, we have evaluated 176 participants, 86 of whom were men (49%). Median age of the studied population was 64 years (range 55 - 80). Screening adherence was 97% with a total of 36 participants (20%) having at least one follow-up LDCT. 40 participants (23%) had a positive baseline screening test. 1 patient had a baseline screening test positive for pneumonia and was subsequently diagnosed with stage IV non-small cell lung cancer (NSCLC). 135 patients (77%) had a negative baseline screening test. Benign appearing calcified granulomas were detected in 60 participants (34%) with a nearly identical relative distribution between those with negative and positive screening tests. Only seven follow-up PET-CT scans were necessary. One was performed for staging purposes after a histologically proven cancer diagnosis. Six were performed for evaluation of lesions felt to be highly suspicious on LDCT. Four of the six PET-CTs were positive and led to a diagnosis of malignancy. A total of five malignancies (2.8%) were detected as a direct result of the screening. Four were NSCLC, of which three were stage I and one was stage IV. One participant was diagnosed with Marginal Zone Non-Hodgkin Lymphoma of the lung. All biopsies that were performed were positive for malignancy. No unnecessary biopsies were performed. No biopsy-related complications occurred. Four out of five patients with detected malignancies are still alive and doing well. Two patients (1%) died during the follow-up. One patient died secondary to an advanced NSCLC detected by the screening program; the other death was due to an unrelated cause, pneumonia.
Conclusion:
To our knowledge, this is the first community hospital-based study evaluating the results of LDCT lung cancer screening in an area of the United States endemic for both Histoplasmosis and Blastomycosis. LDCT cancer screening in such a setting can be done effectively without significant false positive results due to fungal infections. A significant number of early stage lung cancers were detected without excessive testing or complications.
