Rebecca Araujo

Urban Health Today

Although annual lung cancer screening (LCS) is associated with increased cancer detection in adults at high risk for lung cancer, screening rates decline annually, according to a study in JAMA Network Open. These findings underscore the importance of adherence as a quality metric for cancer screening initiatives.Lung cancer screening with low-dose CT is recommended for adults at high risk for lung cancer by the US Preventative Services Task Force. However, according to study authors Roger Y. Kim, MD, MSCE, and colleagues, &ldquo;to realize the benefit of LCS in clinical practice, health care systems must establish programs capable of not only identifying and screening eligible adults&nbsp;but also ensuring that screened individuals continue to receive annual LCS.&rdquo;The retrospective cohort study analyzed data from 5 healthcare systems on annual LCS adherence among adults aged 55 to 75 years who currently or formerly smoked. The primary outcome was screening adherence in 2 rounds: T1 (&gt;12 to 24 months after baseline) and T2 (&gt;24 to 36 months after baseline). Other outcomes were annual incident lung cancer diagnoses and cancer stage distribution.Overall, 10,170 individuals received baseline LCS. There was a 61.2% (95% CI, 60.2%-62.2%) adherence rate to screening in round T1 and a 50.5% (95% CI, 49.5%-1.4%) adherence rate during round T2. Adherence in round T1 was significantly associated with T2 adherence (adjusted relative risk, 2.40; 95% CI, 2.06-2.79).Over 36 months of follow-up, 2.7% of participants were diagnosed with lung cancer. The incident rates of lung cancer diagnosis were&nbsp;1.3% (95% CI, 1.1%-1.6%), 0.7% (95% CI, 0.5%-0.8%), and 0.8% (95% CI, 0.6%-0.9%) at baseline and during rounds T1 and T2, respectively.Notably, &ldquo;A greater proportion of early-stage lung cancers were diagnosed among individuals adherent to screening at T2 compared with those who were not,&rdquo; the authors wrote. The proportion of early-stage cancer diagnosis was 73% (46 of 63) in the adherent group versus 25% (3 of 12) in the nonadherent group (P=0.006).In addition, among individuals who missed a T1 screening but did receive a T2 screening, the incident lung cancer detection rate was 2.1%. Adherence during round T1 was not independently associated with increased incident lung cancer diagnosis in round T2, &ldquo;emphasizing the importance of each round of annual LCS after baseline screening,&rdquo; the authors noted.Based on these results, the authors concluded, &ldquo;The finding that annual LCS adherence rates decreased across subsequent rounds of screening supports the use of annual adherence as a quality metric for LCS programs seeking to maximize the benefits of LCS for early lung cancer detection and, ultimately, reduced lung cancer-related deaths.&rdquo;Source: <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831670" target="_blank" rel="noopener">JAMA Network Open</a>

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More early-stage lung cancers were diagnosed in individuals with a history of smoking who were adherent to annual screening. 

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