First round of lung cancer screening among patients with atheromatous cardiovascular disease exposed to tobacco: a prospective cohort study.

INTRODUCTION Identification of populations eligible for lung cancer screening (LCS) is a priority question in this field. The primary objective of this study was to quantify lung cancer prevalence after a first round of LCS among patients with history of atheromatous cardiovascular disease (aCVD) and tobacco exposure.

Methods

We performed a prospective bi-centric descriptive quantification of lung cancer prevalence among patients aged 45-75 years old with minimal history of 10 years of daily smoking and aCVD who underwent a chest computed tomography (CT) in an intend to screen. We also described lung cancer stage at diagnosis and treatments, we evaluated the eligibility of our population to the National Lung Screening Trial (NLST) and the Dutch-Belgian randomized controlled trial (NELSON) and described main quality metrics of LCS clinical path.

Results

Among 505 participants who underwent a chest CT 159/505 (31%) did not met NLST nor NELSON eligibility criteria, 19/505 (3.8%) participants presented a positive screening. We diagnosed 16 cancers in 15 patients resulting in a LC prevalence of 2.97% (15/505). Among 16 lung cancers, 11 were stage I or II (75%). All patients with lung cancer received specific treatments including 12 surgeries alone, 2 surgeries with adjuvant systemic therapy, 1 radiation with systemic therapy and one systemic therapy alone; there was no postoperative severe morbidity (i.e. Clavien Dindo ≥ 3).

Conclusions

Our exploratory descriptive prospective study suggests that age 45-75 years-old, daily smoking for 10 years and aCVD may be evaluated in future studies as additional LCS eligibility criteria to existing LCS eligibility criteria.