Screening criteria evaluation for expansion in pulmonary neoplasias (screen)

• Published in: Canadian Journal of Surgery 2022-11, Vol.65, p.S57-S58
• Main Authors: Huo, Bright, Manos, Daria, Xu, Zhaolin, Matheson, Kara, Chun, Samuel, Fris, John, Wallace, Alison, French, Daniel
• Format: Article
• Language: English
• Subjects: Lung cancer; Medical screening
• ISSN: 0008-428X; 1488-2310

Background: Low-dose computed tomography (LDCT) screening is recommended for heavy smokers (HS), but 15%40% of lung cancer patients are light-or-never smokers (LONS). The SCREEN study investigated whether survival differs between lung cancer patients who were eligible (HS) and ineligible (LONS) for LDCT screening to establish whether expanded screening criteria should be studied. SCREEN is a retrospective cohort study of 917 lung cancer cases from 2005 to 2020 at a tertiary Canadian institution. Methods: Proportional-hazards models were used to compare mortality risk between HS and LONS, defined by the National Lung Screening Trial (NSLT) criteria and sepa- rately by the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial criteria. One-year and 5-year survival rates were also compared between HS and LONS. Results: The median follow-up was 2.9 years. The cohort comprised 36.9% (NLST, n = 338) and 56.3% (NELSON, n = 516) HS. LONS had a higher proportion of stage 1 cancer than HS (NELSON: 58.7% [n = 216] v. 51.8% [n = 244], p = 0.047). The 5-year overall survival rate was similar between LONS and HS using NLST criteria (55.2% [n = 338] v. 58.5% [n = 529], p = 0.408; hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.80-1.40, p = 0.704) and NELSON criteria (57.6% [n = 401] v. 56.9% [n = 516], p = 0.855; HR 1.02, 95% CI 0.73-1.42, p = 0.925). Multivariate analysis showed males were at increased risk of mortality compared females in both the NLST (HR 2.00, 95% CI 1.57-2.54, p < 0.001) and NELSON models (HR 2.00, 95% CI 1.58-2.54, p < 0.001). Conclusion: Survival did not differ between HS and LONS, but there was a higher proportion of stage 1, potentially curable lung cancers among LONS. Smoking status and age alone may be insufficient predictors of lung cancer risk. Additional research is needed to refine lung cancer screening eligibility criteria through expanded risk factor analysis to ensure that screening is effective and equitable.