Lung Cancer Screening in a Safety-Net Hospital: Rare Harms Inform Decision Making

Lynde K. Lutzow, Jessica Magarinos, Chandra Dass, Grace X. Ma, Cherie P. Erkmen

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Lung cancer screening (LCS) with low-dose computed tomography (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 results, false-negative procedure from a false-positive result, 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: Among the 995 patients who underwent screening, 54.9% were African American, 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 result. Five patient cases highlight challenges, namely (1) false-positive result resulting in operation, (2) false-negative result, (3) incidental finding, (4) delay in diagnosis, and (5) death 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. Although 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.

Original languageEnglish
Pages (from-to)1168-1175
Number of pages8
JournalAnnals of Thoracic Surgery
Volume114
Issue number4
DOIs
StatePublished - Oct 2022

Keywords

  • Decision Making
  • Decision Making, Shared
  • Early Detection of Cancer/methods
  • Humans
  • Lung Neoplasms/diagnosis
  • Mass Screening
  • Prospective Studies
  • Safety-net Providers

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