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A4424 - Screening High-Risk Patients with Low-Dose Chest CT (LDCT) Scans Over a Four-Year Period Provided a Relatively Safe and Effective Approach for Early Detection of Lung Cancers in a Veterans Health Administration Medical Center
Author Block: T. K. Rubenstein1, J. Demp2, B. Giang2, B. Elicker3, M. Arjomandi4, N. Trivedi4, J. K. Brown5; 1Nursing, San Francisco VA, San Francisco, CA, United States, 2Research, San Francisco VA, San Francisco, CA, United States, 3Radiology, UC-San Francisco, San Francisco, CA, United States, 4Univ of California San Francisco, San Francisco, CA, United States, 5Pulmonary, San Francisco VA Med Ctr, San Francisco, CA, United States.
Rationale: Prior to use of LDCT scans for screening, only 15% of newly detected lung cancers in the US were localized to the primary site (Stage 1). In this group, 5-year survivals ranged from 58-73% compared to only 6% for those detected with Stage 4 disease. The National Lung Cancer Screening Trial (NLST), in which enrollees underwent 3 rounds of annual LDCT scans and were followed for 6 years, demonstrated early-stage detection and a 20% reduction in lung cancer-associated mortality. In the VA’s Demonstration Project (JAMA Intern Med 2017:177:399), only 1.5 % of screening CT’s ultimately led to a lung cancer diagnosis but screening in these Veterans was carried out for a short time. Our goal was to describe findings from a VA-based lung cancer screening program that has been sustained for 4 years. Methods: We conducted a retrospective review of all Veterans who participated in the San Francisco VA’s Lung Cancer Screening Program from November 2013 to October 2017. Enrollees all met US Preventative Services Task Force criteria: age 55-80 years, >30 pack years, and active smoking or quit within last 15 years. Annual LDCT scans were scored by radiologists, mostly using Lung-RADS criteria. High-risk nodules (Lung-RADS 4b or higher) were reviewed by a multidisciplinary team with representatives from pulmonary, radiation oncology, thoracic radiology, thoracic surgery, and oncology. Patients were selected for diagnostic evaluations including PET/CT and tissue sampling. Results: 1,010 Veterans enrolled in the program. 428 (42%) had small nodules requiring imaging follow up, usually by annual LDCT scans as already required for screening. 49 (4.8%) were found to have high-risk nodules. Among the 1010 patients, only 37 invasive procedures (9 CT-guided biopsies, 12 bronchoscopies, 1 endoscopic ultrasound, and 15 surgical procedures) were required for diagnosis and treatment. Three patients with >90% pretest probability for lung cancer, but poor surgical candidacy, were referred directly for targeted radiation therapy. A total of 33 (3.3 %) lung cancers were treated, of which 30 were non-small cell and 3 small cell. The staging of the non-small lung cancers was Stage I, 70%; II, 10%; III, 10%; and IV, 10%. Conclusions: These findings indicate that an effective lung cancer screening program using LDCT scans can be undertaken using relatively few invasive procedures in a well-staffed academic VHA medical center. In this sustained program, cancer detection rates were similar to those of NLST and the majority of cancers detected were early stage.