LDCT Screening Detects High Lung Cancer Rates in Underserved Area

Carsten Schroeder, MD, PhD

free program to screen high-risk individuals for lung cancer showed triple the number of overall cancer incidence than reported in the National Lung Screening Trial (NLST).

Carsten Schroeder, MD, PhD, Director of the Cancer Center Thoracic Surgery Service and Associate Professor of Surgery, and resident Erika Simmerman, MD, both at the Medical College of Georgia at Augusta University, will report on the findings during Monday’s General Thoracic Session: Lung Cancer I—Diagnosis and Staging, which will be held from 1:30 p.m. to 3:30 p.m. in Room 120A.

“In the NLST, they found 1 in 100 cancers. We found 1 in 32 cancers,” said Dr. Schroeder, adding that the NLST was done throughout the United States, while the Augusta trial was conducted in an underserved area in the Southeast.

The NLST randomly assigned participants to undergo three annual screenings with either low-dose computed tomography (LDCT) (26,722 participants) or single-view chest X-ray (26,732).

The men and women were ages 55 to 74 with at least 30 pack-years of smoking and were either current smokers or had quit within the past 15 years.

Results from the NLST, which were published in 2011, found a 20% reduction in lung cancer mortality among patients screened with LDCT, compared to patients screened with plain chest radiography.

As a result of the NLST findings, the National Comprehensive Cancer Network recommended that high-risk individuals undergo annual LDCT screenings.

In February 2015, the Centers for Medicare & Medicaid Services released a final National Coverage Determination that provides coverage of LDCT lung cancer screening in certain high-risk patients.

Georgia Screening

The researchers conducted their thoracic surgery-driven 1-year LDCT trial beginning in June 2014 at the major academic hospital in Augusta, Georgia. The trial had two screening groups of people ages 55 to 80. (See modified screening criteria below.)

Augusta, a 2-hour drive from Atlanta, has about 200,000 residents, with the metro area totaling about 545,000. A 2014 Brookings Institution report found that between 2008 and 2012, 63.9% of Augusta’s poor lived in the suburbs.

Of the 255 patients screened, four had pathologically proven malignancies, four had a clinical diagnosis of cancer, seven had equivocal findings for workups, four were false positives, and four chose to avoid intervention and instead underwent serial imaging surveillance.

“Early detection of lung cancer is important because if we don’t detect it early, it is not operable,” Dr. Schroeder said. “Once an individual starts coughing up blood or has pain, it’s normally too late because you are already in stage 3 or 4. If we can detect lung cancer early, we can offer patients longer survival, if not a cure.”

Screening Criteria

Group 1

  • 55−80 years old
  • Currently a smoker or have quit within the past 15 years
  • Smoked at least a pack of cigarettes a day for 30-plus years

Group 2

  • 50−80 years old
  • Smoked at least a pack of cigarettes a day for 20-plus years
  • Have at least one of the following additional lung cancer risks:
    • Personal cancer history (lung, head and neck, and/or lymphoma)
    • Family history of lung cancer (parent, sibling, or child)
    • Emphysema or chronic bronchitis
    • Chronic obstructive pulmonary disease
    • Long-term exposure to asbestos
    • Asbestos-related lung disease or pulmonary asbestosis
    • Long-term exposure to silica, cadmium, arsenic, beryllium, chromium, diesel fumes, nickel, radon, uranium, or coal smoke and soot