Proportion of Non–Small-Cell Lung Cancer Patients that Would Have Been Eligible for Lung Cancer Screening

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Abstract

Micro-Abstract

Lung cancer screening is recommended, but there is limited evidence on the efficacy of existing criteria. We retrospectively applied screening criteria to an institutional cohort of 2030 lung cancer patients to evaluate the utility of current guidelines. Our findings suggest that a significant proportion of former smokers are excluded from screening and that prospective evaluation of existing criteria is warranted.

Background:

Lung cancer screening is recommended for current smokers (CS) and former smokers (FS) who meet specific age and smoking criteria. We used existing criteria to estimate the proportion of non–small-cell lung cancer (NSCLC) patients that would have been screening-eligible.

Methods:

We identified 2030 NSCLC patients at our institution from 1994 to 2014 and recorded their cigarette smoking status and history. Using criteria from the United States Preventative Services Task Force (USPSTF) and from other organizations, we ascertained the proportions of screening-eligible patients. Associations among smoking status, gender, race/ethnicity, and insurance type were assessed using Chi-Square test.

Results:

In our cohort, 31.0% (n = 630) were CS, 43.0% (n = 873) were FS, and 26.0% (n = 527) were never smokers. There were 698 patients (34.4%) who met all USPSTF screening criteria. Among 1503 CS and FS, 77.5% (n = 1165) were between age 55 and 80 years, and 67.9% (n = 1021) had smoked ≥ 30 pack-years. Among FS, 50.4% (n = 440) had quit within 15 years of diagnosis. Median pack-years smoked was 40 (interquartile range, 20-55 pack-years). CS were more likely to meet screening criteria than FS (67.5% vs. 31.3%; P < .0001). Significant differences were found among individuals meeting criteria by gender, race/ethnicity, and insurance type.

Conclusion:

Only a third of patients diagnosed with NSCLC were eligible for lung cancer screening based on USPSTF criteria. FS were less likely to meet all screening criteria due to only half meeting the quit-time criterion. Additional evidence is needed to evaluate the utility of restricting screening among FS to those who quit within 15 years.

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