CT lung screening in urban, poor population feasible


Jan. 3, 2015 - A computed tomography (CT) lung cancer screening program in a diverse inner-city population was found feasible with the support of a robust infrastructure, according to a study recenlty published in the Journal of Thoracic Imaging.However, the authors determined further research is needed to determine a mortality benefit in this population.

The study evaluated a CT lung cancer-screening program for an ethnically diverse, poor, predominantly overweight, and obese patient population, which significantly differs from the National Lung Screening Trial population. The study was designed to identify the baseline characteristics and results of the initial 18 months of a clinical CT lung cancer-screening program in this socio-economically challenged group in an urban environment.  

A CT lung screening exam. Source: Duke University, Dept. of Radiology, 2013. http://radiology.duke.edu/wp-content/uploads/2013/08/NSCLC-270x300.png

The 320 patients who participated in the study met National Lung Screening Trial eligibility criteria. The program infrastructure included a standardized results report [Bronx score of 1 to 5 (modeled on BI-RADS)] for the electronic medical record and a dedicated bilingual screening coordinator. Medicare and Medicaid insured only 38% (121) of the CT screening population in this study.

Among the patients who underwent initial CT lung cancer screening from December 18, 2012 to July 3, 2014, the median pack-years was 47, and 68% (218) were current smokers. Twenty-six percent (84) were white, and 70% (223) were overweight (101) or obese (122). The lung cancer prevalence was 2.2% (7/320). Seventy-eight percent (7/9) of patients with CT findings positive for lung cancer (score 5a, 5b) had proven lung cancer; 1 had stage 1 (1B) disease, and 6 had stage IIA or higher disease. The false-positive rate for a Bronx score ≥3 was 19% (60).

The authors concluded that with strong infrastructure, a CT screening program is feasible in a diverse inner-city population.

1. Milch H1, Kaminetzky M, Pak P, et al.  Computed Tomography Screening for Lung Cancer: Preliminary Results in a Diverse Urban Population. J Thorac Imaging. 2014 Dec 19.