Incidental Lung Nodule Program Identifies Early-Stage Lung Cancer More Frequently Than Most LDCT Screening Programs

The third most-diagnosed cancer type worldwide is lung cancer.¹ It is also the most common cause of cancer-related deaths globally, as generally it is diagnosed at an advanced stage when treatment is less effective.¹ More than 2.21 million cases of lung cancer were diagnosed worldwide in 2020, with >1.8 million people dying from the disease in 2020.² In the United States, similar rates are found with approximately 25% of all cancer deaths being caused by lung cancer.³ The 5-year survival rate for lung cancer is 18.6%, which is lower than many leading cancer causes, and >50% of people with lung cancer die within a year of their diagnosis.³ If the disease is detected at an early localized stage, the 5-year survival rate increases to 56%³; however, only 16% of total cases are diagnosed at this stage.³ Advanced-stage lung cancer patients have a 5% survival rate.³ Early diagnosis through screening high-risk patients has the potential to improve survival rates. A study presented at the virtual 2021 American Society of Clinical Oncology annual meeting shared data on early lung cancer detection with the use of an incidental lung nodule program (ILNP).

The program was implemented in a community healthcare system enrolling 13,710 patients from 2015 to 2020. Patients with lung lesions were enrolled when radiologists flagged them after routine radiological studies. Patients were triaged using evidence-based guidelines, and their eligibility for low-dose computed tomography (LDCT) screening was determined using criteria from various lung cancer groups, including the National Lung Screening Trial (NLST), the US Preventive Services Task Force, and the National Comprehensive Cancer Network (NCCN) Risk Group 2, among others. The median patient age was 64 years and 42% of the patients were male.⁴ White individuals made up the majority of the patients (65%) with black individuals representing 29% of the patients.⁴ There were 667 patients diagnosed with lung cancer with the ILNP program with 39% of patients diagnosed with adenocarcinoma and 20% with squamous-cell carcinoma.⁴ The stage at diagnosis of these patients was as follows: stage I, 49%; stage II, 8%; stage III, 17%; and stage IV, 16%. Of the ILNP patients, 11% to 20% would have been eligible for LDCT.⁴ Only 33% of the ILNP patients diagnosed with lung cancer were eligible for screening using the NLST criteria.⁴ When the NCCN Risk Group 2 criteria were used, the percentage increased to 55%. Aggregated 1-year and 3-year ILNP-diagnosed lung cancer survival rates were 76% and 64% in this study, respectively.⁴

Invasive diagnostic testing was performed in 832 patients (11% having >1 invasive diagnostic test) with 50% of these patients undergoing computed tomography–guided biopsy, 30% undergoing bronchoscopy, and/or 26% undergoing endobronchial ultrasound bronchoscopy.⁴ The most common complications experienced by patients undergoing invasive diagnostic testing were pneumothorax and chest tube placement.⁴

The majority of patients with lung cancer in this study were not eligible for LDCT even though the ILNP identified early-stage lung cancer more often than most of the current LDCT programs.

References

1. Cainap C, Pop LA, Balacescu O, Cainap SS. Early diagnosis and screening in lung cancer. Am J Cancer Res. 2020;10:1993-2009.
2. World Health Organization. Cancer fact sheet. Updated March 3, 2021. www.who.int/news-room/fact-sheets/detail/cancer. Accessed June 26, 2021.
3. American Lung Association. Lung cancer fact sheet. Updated May 27, 2020. www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet#:~:text=Lung%20cancer%20is%20the%20most,1.8%20million%20deaths%20in%202018. Accessed June 26, 2021.
4. Smeltzer M, Liao W, Meadows-Taylor M, et al. Early detection of lung cancer with an incidental lung nodule program (ILNP). J Clin Oncol. 2021;39(suppl 15):8553.