Stage Migration and Lung Cancer Incidence After Initiation of Low-Dose Computed Tomography Screening

Authors

Anil Vachani
Nikki M. Carroll
Michael J. Simoff, Henry Ford HealthFollow
Christine Neslund-Dudas, Henry Ford HealthFollow
Stacey Honda
Robert T. Greenlee
Katharine A. Rendle
Andrea Burnett-Hartman
Debra P. Ritzwoller

Recommended Citation

Vachani A, Carroll NM, Simoff MJ, Neslund-Dudas C, Honda S, Greenlee RT, Rendle KA, Burnett-Hartman A, and Ritzwoller DP. Stage Migration and Lung Cancer Incidence After Initiation of Low-Dose Computed Tomography Screening. J Thorac Oncol 2022; 17(12):1355-1364.

Document Type

Article

Publication Date

12-1-2022

Publication Title

J Thorac Oncol

Abstract

INTRODUCTION: Despite evidence from clinical trials of favorable shifts in cancer stage and improvements in lung cancer-specific mortality, the effectiveness of lung cancer screening (LCS) in clinical practice has not been clearly revealed.

METHODS: We performed a multicenter cohort study of patients diagnosed with a primary lung cancer between January 1, 2014, and September 30, 2019, at one of four U.S. health care systems. The primary outcome variables were cancer stage distribution and annual age-adjusted lung cancer incidence. The primary exposure variable was receipt of at least one low-dose computed tomography for LCS before cancer diagnosis.

RESULTS: A total of 3678 individuals were diagnosed with an incident lung cancer during the study period; 404 (11%) of these patients were diagnosed after initiation of LCS. As screening volume increased, the proportion of patients diagnosed with lung cancer after LCS initiation also rose from 0% in the first quartile of 2014 to 20% in the third quartile of 2019. LCS did not result in a significant change in the overall incidence of lung cancer (average annual percentage change [AAPC]: -0.8 [95% confidence interval (CI): -4.7 to 3.2]) between 2014 and 2018. Stage-specific incidence rates increased for stage I cancer (AAPC = 8.0 [95% CI: 0.8-15.7]) and declined for stage IV disease (AAPC = -6.0 [95% CI: -11.2 to -0.5]).

CONCLUSIONS: Implementation of LCS at four diverse health care systems has resulted in a favorable shift to a higher incidence of stage I cancer with an associated decline in stage IV disease. Overall lung cancer incidence did not increase, suggesting a limited impact of overdiagnosis.

Medical Subject Headings

Humans; Early Detection of Cancer; Lung Neoplasms; Incidence; Cohort Studies; Tomography, X-Ray Computed; Mass Screening

PubMed ID

36087860

Volume

17

Issue

12

First Page

1355

Last Page

1364