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Lutzow LK , Magarinos J , Dass C , Ma GX , Erkmen CP
Lung Cancer Screening in a Safety-Net Hospital: Rare Harms Inform Decision-Making
Ann Thorac Surg. 2021 Sep 10
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Abstract
BACKGROUND: Lung cancer screening (LCS) with Low-Dose CT (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, false-negative procedure from a false-positive, 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: 995 patients underwent screening, of which the majority were African American (54.9%), 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. Five patient cases highlight challenges namely 1) false-positive resulting in surgery, 2) false-negative,3) incidental finding, 4) delay in diagnosis, and 5) mortality 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. Though 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.
Notes
Lutzow, Lynde K Magarinos, Jessica Dass, Chandra Ma, Grace X Erkmen, Cherie P eng U54 CA221704/CA/NCI NIH HHS/ U54 CA221705/CA/NCI NIH HHS/ Netherlands Ann Thorac Surg. 2021 Sep 10. pii: S0003-4975(21)01559-9. doi: 10.1016/j.athoracsur.2021.07.102.