Background: LDCT lung cancer screening has been incorporated into most major American medical societies' screening guidelines. However, its performance in a non-tertiary care community setting with a high prevalence of fungal infections has not been sufficiently studied. Methods: Beginning in April 2013, high-risk adults ages 55-80 with at least a 30 pack-year smoking history, including former smokers who had quit within the previous 15 years, were prospectively evaluated with an LDCT scan performed at our community hospital (UnityPoint Health Medical Center in Quad Cities, Illinois). Standard National Lung Screening Trial exclusion criteria were followed with minor modifications. All participants' scans were evaluated using Lung-RADS version 1.0 assessment categories. An oncology nurse navigator contacted and monitored all participants. CTs were interpreted by a local radiology group, with two radiologists spearheading the program and ensuring consistent interpretations. Results: As of June 2016, we present data on 466 evaluable participants (compared to 176 from one year ago), 234 of whom were men (50%). The median age of the studied population remains 64 years (range 55-80). Screening adherence has dropped from 97% to 91%, with 40 participants lost to followup. 27 participants have completed all required phases of the screening. 192 participants (41%) had positive baseline screening tests. 26 of those participants (6% of the total population) required further evaluation with PET scans. 15 of these PET scans were followed by invasive procedures, including lung biopsy. 13 biopsy-proven malignancies (3%) were detected as a direct result of the screening. 12 malignancies were NSCLCs, of which 9 were early-stage (stages I-II). The thirteenth malignancy, a stage I Marginal Zone Non-Hodgkin Lymphoma of the lung, was confirmed by a lung wedge biopsy. Of the other two participants requiring invasive diagnostic procedure, one had a biopsy "negative for malignancy" and the other was diagnosed with histoplasmosis. No biopsy-related complications occurred. Twelve of thirteen participants with biopsy-proven malignancies are still alive and doing well. One participant died secondary to an advanced NSCLC detected by the screening program. Conclusion: This report represents an update on, to our knowledge, the first community hospital-based study evaluating the results of LDCT lung cancer screening in an area of the United States endemic for both histoplasmosis and blastomycosis. Only one case of histoplasmosis has been confirmed by invasive diagnostic procedure. A significant number of early stage lung cancers were detected without excessive testing or complications.
Porubcin, E., Howell, J., & Cremer, S. (2017). P1.03-047 Community-Based Low-Dose Computed Tomography (LDCT) Lung Cancer Screening in the US Histoplasmosis Belt: One Year Followup. Journal of Thoracic Oncology, 12(1), S571. https://doi.org/10.1016/j.jtho.2016.11.718