Lung cancer screening with low-dose CT integrated with pulmonary care in a public hospital in southern Brazil: results from the first 712 patients

• Published in: Jornal brasileiro de pneumologia Vol. 48; no. 5; p. e20220146
• Main Authors: Svartman, Fábio Munhoz, Leite, Maurício Mello Roux, Sartori, Ana Paula Garcia, Gutierrez, Renato Soares, Cadore, Ana Carolina, Oliveira, Carla Tatiana Martins de, Brito, Renata Ullmann de, Andrade, Cristiano Feijó
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Pneumologia e Tisiologia 01-01-2022
• Subjects: Adolescent; Brazil - epidemiology; Early Detection of Cancer - methods; Hospitals, Public; Humans; Lung Neoplasms - pathology; Mass Screening; Middle Aged; RESPIRATORY SYSTEM; Retrospective Studies; Smoking - adverse effects; Smoking - epidemiology; Tomography, X-Ray Computed - methods; Brazil; Programas de triagem diagnóstica; Brasil; Neoplasias pulmonares; Tuberculosis; Diagnostic screening programs; Brazil; Early detection of cancer; Tuberculose; Detecção precoce de câncer; Lung neoplasms
• ISSN: 1806-3756; 1806-3756
• DOI: 10.36416/1806-3756/e20220146

To describe the performance of a pulmonologist-led lung cancer screening program using low dose CT (LDCT) in a cohort of outpatients with stable respiratory diseases in the Brazilian public health care system.
This was a retrospective analysis of the first two rounds of lung cancer screening of patients enrolled in the program. Inclusion criteria were being between 55 and 80 years of age, being a current or former smoker (smoking cessation ≤ 15 years), and having a smoking history ≥ 30 pack-years. LDCT results were interpreted in accordance with the Lung CT Screening Reporting and Data System, and those with a score of 3 or 4 were considered positive screening. Incidental pleuropulmonary findings were sought in all reports.
LDCTs were requested for 791 patients during the study period, and 712 patients (90%) met the screening criteria. The mean patient age was 63 years, and most participants were current smokers (56%) with emphysema (78.5%) and other pleuropulmonary findings on CT (64%). Screening was positive in 14.0% and 5.6% of the cases in the first and second screening rounds, respectively. Lung cancer was detected in 1.5% of the patients in both first and second rounds (positive predictive value: 11.0% and 26.6%, respectively). The rate of early-stage (TNM I or II) screen-detected non-small cell carcinoma was 64.3%. Of the patients with positive screening, 19% were lost to follow-up before investigation was complete.
The results of this screening program suggest its adequate performance in a cohort of patients with significant respiratory morbidity. The loss to follow-up rate highlights the need for constant monitoring and interventions to ensure adherence.