Lung Cancer Screening in a Safety-Net Hospital: Rare Harms Inform Decision Making.
Publication/Presentation Date
10-1-2022
Abstract
BACKGROUND: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) decreases lung cancer mortality; however, screening benefits and harms are poorly described in minority populations. Our purpose is to report benefits and harms of LCS implemented in a safety-net institution. Because harms are rare, there is a paucity of clinical experience guiding shared decision making (SDM) with diverse populations.
METHODS: We conducted a prospective, observational study of patients undergoing LCS between September 2014 and March 2019 with 2-year follow-up. LDCT results, lung cancer diagnosis, stage, treatment, false-positive results, false-negative procedure from a false-positive result, complication from procedures, and death were recorded. Patient cases highlighting the challenges of delivering LCS to an underserved population were evaluated in the context of current evidence.
RESULTS: Among the 995 patients who underwent screening, 54.9% were African American, with 2.9% receiving a cancer diagnosis, a false-positive rate of 9.4% and a 0.7% rate of procedures resulting from a false-positive result. Five patient cases highlight challenges, namely (1) false-positive result resulting in operation, (2) false-negative result, (3) incidental finding, (4) delay in diagnosis, and (5) death from cause other than lung cancer.
CONCLUSIONS: LCS of a predominantly African American population with 2-year follow-up demonstrates early detection and treatment of lung cancer with few harms. Although rare, harms must be clearly described with population-specific evidence. We report clinical perspective of rare harms that can provide guidance to providers and patients.
Volume
114
Issue
4
First Page
1168
Last Page
1175
ISSN
1552-6259
Published In/Presented At
Lutzow, L. K., Magarinos, J., Dass, C., Ma, G. X., & Erkmen, C. P. (2022). Lung Cancer Screening in a Safety-Net Hospital: Rare Harms Inform Decision Making. The Annals of thoracic surgery, 114(4), 1168–1175. https://doi.org/10.1016/j.athoracsur.2021.07.102
Disciplines
Medicine and Health Sciences
PubMedID
34516963
Department(s)
Fellows and Residents
Document Type
Article