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Strong support for lung-cancer screening in at-risk adults

Reuters Health - 05/04/2022 - The introduction of lung-cancer screening in the United States has led to a shift toward diagnosis of earlier-stage disease and improvement in survival, a new analysis indicates. 

Yet lung-cancer screening rates remain low overall among eligible adults and disparities in access to low-dose computed tomography (LDCT) continue to exist, the researchers say in The BMJ. 

LDCT lung-cancer screening for high-risk adults (over age 55 with a history of smoking) was introduced in the United States in December 2013. 

To gauge the "real-world" benefits of screening, researchers with Massachusetts General Hospital in Boston analyzed cancer-registry data for more than 763,000 adults diagnosed with non-small-cell lung cancer (NSCLC) between 2010 and 2018. 

After LDCT screening was introduced, there was a significant increase of 3.9% per year in detection of early (stage I) NSCLC - from 30.2% in 2014 to 35.5% in 2018. In contrast, there was no significant increase from 2010 to 2013 (from 27.8% to 29.4%), report Dr. Chi-Fu Jeffrey Yang and colleagues. 

The introduction of LDCT screening also coincided with an average increase of 11.9% per year in median all-cause survival (from 19.7 months in 2014 to 28.2 months in 2018, resulting in an estimated 10,100 averted deaths. 

By 2018, stage-I NSCLC was the predominant diagnosis among non-Hispanic white people and those living in the highest income or best educated regions. 

However, non-white individuals and those living in lower income or less educated regions remained more likely to be diagnosed with later (stage IV) disease at diagnosis. 

The researchers note that the newest U.S. Preventive Services Task Force lung cancer screening guidelines expand screening eligibility for an additional 6.5 million adults, with the greatest increases in eligibility for women and racial minorities. 

"Although the adoption of lung cancer screening has been slow and screening rates have remained low nationally, the findings of this study indicate the beneficial effect that even a small amount of screening can have on lung cancer stage shifts and survival at the population level," Dr. Yang and colleagues write. 

The findings also suggest that widespread adoption of LDCT screening "should be considered an important strategy for reducing mortality from lung cancer in the U.S. Efforts to increase utilization of screening should be prioritized to ensure equitable access to screening and to reduce disparities in the stage of lung cancer diagnosed and in survival among different patient populations with lung cancer," they say. 

The authors of an editorial say these results suggest that "even poorly implemented screening can result in a stage shift that will almost certainly lead to downstream decreases in lung cancer mortality over the longer term." 

Despite the poor state of implementation, the study should also be a "call to arms" for all stakeholders to ensure more equitable access to screening that reduces health disparities, write Dr. Anne Melzer with the University of Minnesota Medical School in Minneapolis and Dr. Matthew Triplette with Fred Hutchinson Cancer Research Center in Seattle. 

They urge researchers and policymakers to analyze not just how many people are being screened but also the "mismatch" between who is screened and who bears the greatest burden of lung cancer. 

"Through such targeted interventions, screening can realize its full potential for everyone at high risk for lung cancer," they conclude. 

SOURCE: https://bit.ly/3J1iHgr   https://bit.ly/3K0jHCM  The BMJ, online March 30, 2022. 

By Reuters Staff 

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