Rates of advanced lung cancer decline after low-dose CT guidelines, cost coverage
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CHICAGO — Analysis of the SEER database showed a significant decline of rates of advanced lung cancer following screening guidelines for low-dose chest computed tomography.
The analysis, presented at ASCO Annual Meeting, included 400,343 patients aged 55 to 80 years who were diagnosed with regional or advanced lung cancer between 2004 and 2018.
“One of the most effective ways to improve survival of patients is to promote early lung cancer diagnosis, and this was elusive until 2011 when the results of the National Lung Screening trial were reported,” Maxwell Oluwole Akanbi, MD, PhD, MS, resident physician with McLaren Flint Hospital, said during his presentation. “For the first time, we saw a randomized control trial that reported improved survival in patients who were screened for lung cancer by low-dose CT.”
Based on those findings, the U.S. Preventive Services Task Force released a recommendation for lung cancer screening with low-dose CT in 2013. In 2015, the Centers for Medicare and Medicaid also released screening guidelines for low-dose CT and worked with private insurance companies to cover the cost. The researchers compared the rates of advanced lung cancer from 2004 to 2014 (pre-low-dose CT) to rates from 2015 to 2018 (post-low-dose CT) using age-adjusted incidence rates (AAIR) and interrupted time series regression analyses stratified by sex, race and residence.
According to the abstract, there was an overall 41% decline in the AAIR of advanced lung cancer post-low-dose CT compared with pre-low-doseCT (7.6/100,000 person-years vs. 4.5/100,000 PY, P < 0.01).
The AAIR of advanced lung cancer among women was more accelerated compared with men (53% vs. 30%). When stratified by race, the annual rates declined most rapidly among non-Hispanic Blacks (55%, 9.5/100,000 PY vs. 4.7/100,000 PY, P < 0.01), while the slowest rate of decline was seen among Hispanics (41%, 4.6/100,000 PY vs. 2.7/100,000 PY, P < 0.01). Moreover, stratification by residence demonstrated a greater decline in annual rates among patients in nonmetropolitan areas (69%, 10.1/100,000 PY vs. 3.2/100,000 PY) compared with patients in metropolitan areas (37%, 7.2/100,000 PY vs. 4.5/100,000 PY, P < 0.01).
“We saw age-adjusted incidence of advanced lung cancer declined significantly from 2015 to 2018 compared to the baseline from 2004 to 2014,” Akanbi said.
He highlighted the overall benefit for patients in marginalized communities, particularly non-Hispanic Black patients, women and people who live in rural areas.
“We were unable to evaluate the impact on mortality, which I believe is very important to all of us,” Akanbi said. “We believe we will need a little bit more time to evaluate long-term data to give us a good assessment of the impact of this intervention on mortality.”
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Akanbi MO, et al. Effect of lung cancer screening on the incidence of advanced lung cancer in the United States: A SEER database analysis. Presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
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