Lung Cancer Screening at Appalachian VA Medical Center Versus the National Lung Screening Trial

The National Lung Screening Trial (NLST) previously reported the prevalence of lung cancer in high-risk individuals at 1%, and that screening these individuals with low-dose helical computed tomography (LDCT) saves lives. Results of a lung screening program implemented for individuals meeting US Preventive Services Task Force criteria in a vulnerable rural Appalachian Veterans Health Administration medical center (VAMC) population were presented at the 2023 North America Conference on Lung Cancer.

The researchers utilized electronic chart reminders to refer eligible patients during a VAMC visit. The patients had several socioeconomic disadvantages, including lower income and education, unemployment, and rural living, along with military exposures. The researchers reviewed charts of 1375 participants screened in the first 16 months of the program using the Lung Imaging Reporting and Diagnostic System (Lung RADS). Categories 3 and 4 were considered positive findings, and demographic and disease criteria were collected on these patients.

Results showed that among 1375 scans, 156 (11%) were Lung RADS category 4; 242 (18%) were category 3; and 977 (71%) were category 1 and 2. Of the 1375 participants, 35 (2.5%) had lung cancer, which was significantly higher than 1.1% during the first year of the NLST (P<.001). A majority (66%) were detected in early stages, and the clinical workup time from LDCT to diagnosis/treatment was very short, usually within 1 month. In addition, 43% had Agent Orange exposure and 26% had signs of interstitial lung disease.

“In our veteran population we found a significantly higher lung cancer prevalence of 2.5% (compared with 1.1% in the NLST),” the researchers said. “This study justifies LDCT screening, especially in high-risk regions and populations, especially veterans with additional exposure risks. The stage shift to earlier-detected lung cancers (66%) should lead to better overall survival and less morbidity. Our program provided short intervals from LDCT to diagnosis/treatment by utilizing a case management approach streamlining scheduling and workup.”

Source: Partlow J, Thomas D, Carter S, Ragina C, Schroeder C. Appalachian veterans lung cancer screening program. Abstract of a poster presented at the 2023 North America Conference on Lung Cancer; December 1-3, 2023; Chicago, Illinois.