ASPO Abstracts
Evaluating harms following lung cancer screening across diverse community-based healthcare systems
Category: Early Detection & Risk Prediction
Conference Year: 2021
Abstract Body:
Purpose of the study: Lung cancer screening (LCS) with low-dose CT imaging has been
shown to reduce lung cancer mortality in high-risk individuals. However, LCS can lead to
potential harms, including false positive results, follow-up imaging and invasive diagnostic
procedures, and downstream complications. Assessing the rate and distribution of these
potential harms is key to evaluating effectiveness and determining if benefits outweigh
harms for LCS in community-based care settings and across populations.
Methods: We used electronic health record data on LCS delivery, results, and follow-up
care, joined with tumor registry data, to establish a longitudinal cohort of patients who
underwent LCS January 2014-September 2018 in the five health systems participating in
the NCI-funded Lung Population-Based Research to Optimize the Screening Process
(PROSPR) Consortium. False positives were defined as scans with findings of Lung-
RADS scores of 3 or 4 with no lung cancer diagnosed within 12 months. Diagnostic
procedures and complications were identified via diagnosis and procedure codes.
Covariates of interest include demographics, comorbidities, smoking history, and area-
level social indicators. A matched control group was assembled from underlying health
system patient populations to assist with attribution of potential harms to lung cancer
screening
Results: Over 18,000 patients aged 55-80 years received LCS, of which 3% were
Asian/Pacific Islander, 5% Hispanic, 10% Black, 76% White, and 45% female. In
preliminary analysis, 22% received at least one non-screening chest CT in the 12-month
interval following screening, while 5% received a PET scan, and 26% received a chest x-
ray. About 2% received a bronchoscopy, and 1% had a thoracotomy or other thoracic
surgery.
Conclusions: A substantial proportion of patients undergoing LCS have additional imaging
or other diagnostic procedures during the following year. Additional analyses underway on
false positive rates and post-procedure complications, along with control group
comparisons, will provide a more comprehensive assessment of the occurrence and
distribution of attributable post-screening harms that should be considered alongside
benefits when evaluating the effectiveness of LCS in routine care.
Keywords: lung cancer screening harms