By characterizing the demographics and comorbidities of patients screened for lung cancer in three states, a new study led by the UF Health Cancer Center lays the groundwork for a personalized approach to screening for the deadliest cancer.
The study, published Feb. 21 in JAMA Health Forum, characterized 31,000 patients screened for lung cancer using low-dose CT scans in the geographic area the UF Health Cancer Center serves in North Central Florida, as well as two health systems in California and South Carolina, over a five-year period.
“By better understanding our catchment area, we have an opportunity to develop interventions to help older patients who are eligible for lung cancer screening manage their health and target lung cancer screening to those who are the most likely to benefit,” said lead author Dejana Braithwaite, Ph.D., associate director for cancer control and population sciences at the UF Health Cancer Center.
Lung cancer presents a major burden in the region the UF Health Cancer Center serves. Most of the 23 counties in the region have a smoking rate of 20% or higher, which is well above the national rate of around 11%.
Lung cancer screening with low-dose CT scans is a vital tool to detect lung cancer early so it can be treated and cured. In 2011, the multicenter National Lung Screening Trial (NLST) found that for those at highest risk, three rounds of screening with low-dose CT scans was associated with a 20% reduction in lung cancer-related death compared with those who received chest radiography.
Participants in that trial, which was sponsored by the National Cancer Institute, were overall healthier and younger than adults who are eligible to be screened, however.
In the new cohort of patients, patients were older, with nearly double the proportion of patients ages 70 to 74 years. They also had more severe illness and were more racially and ethnically diverse than those in the NLST.
“The fact that this cohort is more racially diverse compared to the NLST is important because very little is known about the interaction between comorbidities and their effect on screening in this population,” said Gerard A. Silvestri, M.D., M.S., professor of medicine at the Medical University of South Carolina and co-investigator on the study. “Having enough data to study this will allow us to provide personalized screening recommendations for this community.”
The prevalence of chronic obstructive pulmonary disease in the new cohort was almost double that in the NLST, and the prevalence of diabetes was more than double.
Older patients and those with serious comorbidities, such as reduced heart function, or a heavy smoking history may not have the same benefits from lung cancer screening as healthier patients. They may not be healthy enough to undergo treatment like surgery, for example, or they may die from another chronic condition.
“The high prevalence of chronic conditions, frailty, and impaired cardiopulmonary function in the group of patients we studied suggests that the benefits and harms seen in the National Lung Screening Trial may not translate to the clinical setting of lung cancer screening,” said Braithwaite, a professor and chief of the Division of Population Health Sciences in the UF Department of Surgery.
Co-authors of the new study included Shama Karanth, Ph.D., and Jae Jeong (JJ) Yang, Ph.D., members of the UF Health Cancer Center’s Cancer Control and Population Sciences research program. The team included researchers at the VA Portland Health Care System and Oregon Health & Science University, Brock University, Kaiser Permanente Bernard J. Tyson School of Medicine, and the Medical University of South Carolina.
The study was funded by the National Cancer Institute and the Center to Improve Veteran Involvement in Care.
