TY - JOUR
T1 - Quantifying Benefits and Harms of Lung Cancer Screening in an Underserved Population
T2 - Results From a Prospective Study
AU - Erkmen, Cherie P.
AU - Randhawa, Simran
AU - Patterson, Freda
AU - Kim, Rachel
AU - Weir, Mark
AU - Ma, Grace X.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Lung cancer screening with annual low-dose computed tomography reduces lung cancer death by 20–26%. However, potential harms of screening include false-positive results, procedures from false positives, procedural complications and failure to adhere to follow-up recommendations. In diverse, underserved populations, it is unknown if benefits of early lung cancer detection outweigh harms. We conducted a prospective observational study of lung cancer screening participants in an urban, safety-net institution from September 2014 to June 2020. We measured benefits of screening in terms of cancer diagnosis, stage, and treatment. We measured harms of screening by calculating false-positive rate, procedures as a result of false positive screens, procedural complications, and failure to follow-up with recommended care. Of patients with 3-year follow up, we measured these same outcomes in addition to compliance with annual screening. Of 1509 participants, 55.6% were African American, 35.2% White, 8.1% Hispanic, and 0.5% Asian. Screening resulted in cancer detection and treatment in 2.8%. False positive and procedure as a result of a false positive occurred in 9.2% and 0.8% of participants, respectively with no major complications from diagnostic procedures or treatment. Adherence to annual screening was low, 18.7%, 3.7%, and 0.4% at 1, 2, and 3 years after baseline screening respectively. Multidisciplinary lung cancer screening in a safety-net institution can successfully detect and treat lung cancer with few harms of false-positive screens, procedure after false-positive screens and major complications. However, adherence to annual screening is poor.
AB - Lung cancer screening with annual low-dose computed tomography reduces lung cancer death by 20–26%. However, potential harms of screening include false-positive results, procedures from false positives, procedural complications and failure to adhere to follow-up recommendations. In diverse, underserved populations, it is unknown if benefits of early lung cancer detection outweigh harms. We conducted a prospective observational study of lung cancer screening participants in an urban, safety-net institution from September 2014 to June 2020. We measured benefits of screening in terms of cancer diagnosis, stage, and treatment. We measured harms of screening by calculating false-positive rate, procedures as a result of false positive screens, procedural complications, and failure to follow-up with recommended care. Of patients with 3-year follow up, we measured these same outcomes in addition to compliance with annual screening. Of 1509 participants, 55.6% were African American, 35.2% White, 8.1% Hispanic, and 0.5% Asian. Screening resulted in cancer detection and treatment in 2.8%. False positive and procedure as a result of a false positive occurred in 9.2% and 0.8% of participants, respectively with no major complications from diagnostic procedures or treatment. Adherence to annual screening was low, 18.7%, 3.7%, and 0.4% at 1, 2, and 3 years after baseline screening respectively. Multidisciplinary lung cancer screening in a safety-net institution can successfully detect and treat lung cancer with few harms of false-positive screens, procedure after false-positive screens and major complications. However, adherence to annual screening is poor.
KW - African American
KW - False positive
KW - Harms of lung cancer screening
KW - Implementation
KW - Lung cancer screening
KW - Underserved populations
KW - Unnecessary procedures
UR - http://www.scopus.com/inward/record.url?scp=85108842398&partnerID=8YFLogxK
U2 - 10.1053/j.semtcvs.2021.04.055
DO - 10.1053/j.semtcvs.2021.04.055
M3 - Article
C2 - 34091014
SN - 1043-0679
VL - 34
SP - 691
EP - 700
JO - Seminars in Thoracic and Cardiovascular Surgery
JF - Seminars in Thoracic and Cardiovascular Surgery
IS - 2
ER -