Adopting a lung nodule program may increase the detection of early lung cancer for patients who are not eligible for lung cancer screening under existing age eligibility criteria. This is according to recent data published in the Journal of Thoracic Oncology.
Lung nodule programs are established to follow up on lung nodules that are frequently identified during routine imaging for reasons other than suspected lung cancer or lung cancer screening.
Raymond U. Osarogiagbon, MBBS, FACP, who is chief scientist for Baptist Memorial Health Care and director of the multidisciplinary thoracic oncology program and the thoracic oncology research group for Baptist Cancer Center, Memphis, Tennessee, led the prospective observational study. The team compared 2-year cumulative lung cancer diagnosis risk, lung cancer characteristics, and overall survival (OS) among 50- to 80-years old participants undergoing low-dose CT (LDCT) to lung nodule program participants who were considered too young (35 to 50 years old) or too old (80 years old) for screening based on US Preventive Services Task Force recommendations for annual screening for lung cancer with LDCT.
LDCT screening for lung cancer has been shown to reduce mortality by up to 20%. However, most people diagnosed with lung cancer in the US are ineligible for lung cancer screening. Dr. Osarogiagbon said lung nodule programs expand access to early lung cancer detection to a more diverse population.
According to the research, individuals aged 50 to 80 years enrolled in a lung nodule program were at greater risk of lung cancer diagnosis within 2 years compared to the LDCT cohort. Additionally, the demographic, socio-economic characteristics, and risk factor profile of patients diagnosed with lung cancer through the lung nodule program differed strikingly from that of the screened cohort.
Lung cancer risk in patients considered too young or too old for screening, but who have an incidentally detected lung lesion, had not previously been rigorously estimated.
Dr. Osarogiagbon said the study compared the cumulative lung cancer diagnosis risk, lesion characteristics, lung cancer characteristics, treatment, and outcomes of screening age-ineligible persons in a lung nodule program to an LDCT screening cohort.
The study, which spanned from 2015 to 2022, revealed that lung cancer was diagnosed in 329 (3.43%) LDCT screening participants, 39 (1.07%) young lung nodule program participants, and 172 (6.87%) elderly lung nodule program patients. Strikingly, the 2-year cumulative incidence rates were 3.0% for LDCT participants, 0.79% for young lung nodule program participants, and 6.5% for elderly lung nodule program participants.
Despite age differences, the lung cancer diagnosis risk was found to be similar between young lung nodule program participants and Lung-RADS 1 and 2. In contrast, elderly lung nodule program participants’ risk exceeded that of Lung-RADS 3, but was less than 4.
Moreover, the study revealed significant differences in stage at the time of cancer diagnosis, with 62.92% of LDCT cases diagnosed at stage I/II compared to 33.33% for young and 48.26% for elderly LNP cohorts. Notably, 16.72%, 41.03%, and 29.65% of LDCT, young, and elderly lung nodule program cases respectively, were diagnosed at stage IV. The 5-year overall survival rates were 57%, 55%, and 24% respectively, with statistically significant differences, persisting even after excluding individuals with any prior history of cancer.
“Our findings indicate that our Lung Nodule Program modestly benefited individuals deemed too young or too old for traditional screening,” Dr. Osarogiagbon said. “The observed differences in clinical characteristics and outcomes strongly suggest variations in the biological characteristics of lung cancer in these distinct patient cohorts.”