Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study

Abstract

Objective To determine the effect of the introduction of low dose computed tomography screening in 2013 on lung cancer stage shift, survival, and disparities in the stage of lung cancer diagnosed in the United States. Design Quasi-experimental study using Joinpoint modeling, multivariable ordinal logistic regression, and multivariable Cox proportional hazards modeling. Setting US National Cancer Database and Surveillance Epidemiology End Results program database. Participants Patients aged 45-80 years diagnosed as having non-small cell lung cancer (NSCLC) between 1 January 2010 and 31 December 2018. Main outcome measures Annual per cent change in percentage of stage I NSCLC diagnosed among patients aged 45-54 (ineligible for screening) and 55-80 (potentially eligible for screening), median all cause survival, and incidence of NSCLC; multivariable adjusted odds ratios for year-to-year changes in likelihood of having earlier stages of disease at diagnosis and multivariable adjusted hazard ratios for changes in hazard of death before versus after introduction of screening. Results The percentage of stage I NSCLC diagnosed among patients aged 55-80 did not significantly increase from 2010 to 2013 (from 27.8% to 29.4%) and then increased at 3.9% (95% confidence interval 3.0% to 4.8%) per year from 2014 to 2018 (from 30.2% to 35.5%). In multivariable adjusted analysis, the increase in the odds per year of a patient having one lung cancer stage lower at diagnosis during the time period from 2014 to 2018 was 6.2% (multivariable adjusted odds ratio 1.062, 95% confidence interval 1.048 to 1.077; P<0.001) higher than the increase in the odds per year from 2010 to 2013. Similarly, the median all cause survival of patients aged 55-80 did not significantly increase from 2010 to 2013 (from 15.8 to 18.1 months), and then increased at 11.9% (8.9% to 15.0%) per year from 2014 to 2018 (from 19.7 to 28.2 months). In multivariable adjusted analysis, the hazard of death decreased significantly faster after 2014 compared with before 2014 (P<0.001). By 2018, stage I NSCLC was the predominant diagnosis among non-Hispanic white people and people living in the highest income or best educated regions. Non-white people and those living in lower income or less educated regions remained more likely to have stage IV disease at diagnosis. Increases in the detection of early stage disease in the US from 2014 to 2018 led to an estimated 10 100 averted deaths. Conclusions A recent stage shift toward stage I NSCLC coincides with improved survival and the introduction of lung cancer screening. Non-white patients and those living in areas of greater deprivation had lower rates of stage I disease identified, highlighting the need for efforts to increase access to screening in the US.

Comparison of perioperative outcomes with or without routine chest tube drainage after video-assisted thoracoscopic pulmonary resection: A systematic review and meta-analysis

“…Lung cancer is the fastest-growing malignancy worldwide in morbidity and mortality, the most common cause of cancer death in men and the second leading cause of cancer death in women ( 1 ). Due to the popularization of low-dose computed tomography (CT) screening, the rate of detection of small pulmonary nodules (especially ground-glass nodules) has significantly increased in recent years, which makes early diagnosis and treatment of lung cancer more challenging ( 2 , 3 ). With the rapid development of minimally invasive techniques, traditional thoracotomy has been transformed into video-assisted thoracoscopic surgery (VATS) with less risk to patients ( 4 , 5 ).…”

Lung cancer screening associated with earlier diagnosis and improved survival

“…A new study has found that low‐dose computed tomography lung cancer screening can lead to increases in the early detection of lung cancer and improvements in survival at the population level 1 . The results are encouraging because they demonstrate the potential for the widespread adoption of lung cancer screening to save lives.…”

Screening high risk populations for lung cancer

“…In this context, the linked study by Potter and colleagues (doi:10.1136/bmj-2021-069008) provides key evidence supporting the beneficial effect for lung cancer screening in people at high risk in the US despite the poor state of implementation 8. Using a quasi-experimental observational design, Potter and colleagues analyzed data from two large comprehensive US cancer registries—the National Cancer Database and the Surveillance Epidemiology End Results (SEER) program database.…”