Do Veterans Receive Lung Cancer Screening at Recommended Intervals?

A study of lung cancer screening in veterans found less than 30% received the 3 annual consecutive screenings that are recommended. Results of the veterans study were recently presented at the American Thoracic Society (ATS) International Conference 2022, held in San Francisco, CA, May 13 to 18.

The National Lung Screening Trial has shown a decline in lung cancer mortality of 20% when patients have 3 annual lung cancer screening (LCS) examinations at 10-to-15-month intervals. To determine how well this recommendation is followed in real world practice, investigators conducted a large retrospective study of US veterans across the Veterans Affairs health system nationally to determine how often they received the 3 annual rounds of lung cancer screening.

The researchers compiled a national retrospective cohort of veterans who began LCS between 2015 and 2018 at any Veterans Affairs facility. Participants were identified by the presence of  chest computed tomography (CT), along with a report including a Lung CT Screening Reporting & Data System (Lung-RADS) code. The authors followed the cohort prospectively, looking for the presence of a second and third LCS examination. Disqualifying events included high-risk LCS findings (eg, Lung-RADS categories 3 and 4) for which closer follow-up is advised, lung cancer diagnosis, age older than 80 years, or death before the subsequent annual LCS examination. The proportion of veterans who underwent a total of 3 annual LCS examinations spaced at 10-to-15-month intervals (primary analysis) was calculated. As a sensitivity analysis, the proportion was recalculated to include any CT chest examinations received at the proper intervals, not just those having Lung-RADS findings.

In all, 20160 veterans undergoing an initial LCS had low-risk findings (Lung-RADS categories 1 and 2). A total of 1314 veterans experiencing disqualifying events were excluded. In the primary analysis, the percentage of veterans getting a second annual LCS examination was 38.6%, and only 18.9% received both second and third examinations during the recommended time. The sensitivity analysis showed that 59.9% of veterans received a second annual examination and 35.3% received both second and third examinations in the time period advised.

“To attain the mortality benefits seen in clinical trials, it is critical to optimize timely receipt of annual screening,” investigators concluded. “Future work should target identifying and addressing barriers to receiving timely annual lung cancer screening,” they added.

Reference

Nunez ER, Caverly TJ, Zhang S, et al. Timely Receipt of Guideline Recommended Annual Lung Cancer Screening Across Three Rounds Among US Veterans. Presented at: the American Thoracic Society (ATS) 2022 International Conference; May 13-18, 2022; San Francisco, CA. Session A13.