Chest. 2014 Oct 1;146(4_MeetingAbstracts):593A. doi: 10.1378/chest.1994637.

Current Lung Cancer Screening Guidelines May Exclude High Risk Populations.

Ravipati HP, Mankikar R, Charaf C, Foreman M, Flenaugh E.

Abstract

SESSION TITLE:

Lung Cancer Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Lung cancer is the leading cause of mortality from cancer worldwide. Current lung screening guidelines recommend annual screening with low-dose computed tomography in 55 - 80 year old individuals with a 30 pack-year smoking history, who are currently smoking or have quit within the past 15 years. We applied the current guidelines to lung cancer cases diagnosed at an urban medical center over a 5-year time frame to determine the fraction of lung cancer cases that would be missed.

METHODS: Retrospective analysis of electronic medical record data from a tertiary teaching hospital in Georgia was used to evaluate all patients diagnosed with lung cancer between 2007 and 2012. Lung cancer cases staged IA, IB, IIA, IIB, IIIA, IIIB, IV were included.RESULTS: Of 843 lung cancer cases diagnosed in 2007 - 2012, the subjects were primarily African American and male. Racial and gender distributions are as follows: African Americans, n = 726 (86.1%) vs. 89 (10.5%) cases in non-Hispanic Whites vs. others 28 (3.3%); 338 (40.1%) females and 505 (59.9%) males. There were 5 (0.5%) lung cancer diagnoses in individuals aged 20 - 29 yrs; 16 (1.8%) diagnoses in ages 30 - 39 yrs; 93 (11%) cases in ages 40 - 49 yrs; 304 (36%) cases in ages 50-59; 272 (32.2%) cases in ages 60-69 yrs; 117 (13.8%) cases in ages 70-79 yrs; and 36 (4.2%) cases in subjects > 80 years of age. 150 (17.7%) cases would not have been captured by the current guidelines for lung cancer screening.

CONCLUSIONS: In this high-risk population, application of the current lung cancer screening guidelines would not have detected 17.7% of the cancers, as the majority (62%) occurred in 40-49 year-olds. As the mortality for lung cancer is high for African Americans, a one-size-fits-all screening policy may not be appropriate. Further research to determine screening guidelines for targeted groups, as indicated by our data, is warranted.

CLINICAL IMPLICATIONS: Early detection of lung cancer improves outcomes and the use of its screening methods can reduce mortality. Based on our data, current guidelines might have to be applicable on an individual basis so that we can incorporate factors such as race.