Women who undergo mammography to screen for breast cancer can be reviewed and recommended for additional lung cancer screening, thereby increasing enrollment, according to the results of a study published in the Journal of the American College of Radiology. The study, called Coordinate a Lung Screening With Mammography (CALM), resulted in a significant increase in lung cancer screening examinations in women.
“For years, we have recognized that many women screened for breast cancer are, in fact, dying from lung cancer. This study allowed us the opportunity to inform women and their referring providers of lung [cancer] screening eligibility and to facilitate lung screening exams,” said study corresponding author and co-principal investigator Kim Sandler, MD, Professor of Radiology and Radiological Sciences at Vanderbilt University Medical Center and Director of the Vanderbilt Lung Screening Program.
Background and Study Methods
Rates for lung cancer screenings among the eligible population in the United States are far below that of breast cancer screenings. A prior study showed that 58% of women eligible for lung cancer screening had undergone a mammogram within 2 years, but only 7.9% had underwent lung cancer screening. Additionally, women have proved less likely to discuss lung cancer screening with health-care providers than men.
The researchers considered that mammography screening could be used as a teachable moment to improve rates of screenings for lung cancer as well.
The CALM study assessed women who had undergone mammography (n = 32,165) between November 2019 and December 2022 at two academic hospitals for their potential eligibility for lung cancer screening. Then, they reached out to eligible women and their referring providers to offer lung cancer screening. Women who were already enrolled in lung cancer screening or who had metastatic malignancies were excluded from the study. Targeted outreached was performed for 1 year at each of the two sites.
Key Findings
A total of 4.9% of women who had undergone mammography were found to be eligible for lung cancer screening by chart review. Sixty-nine percent of these women had not undergone prior screenings for lung cancer.
Total lung cancer screening examinations among eligible women significantly increased during the study period at both hospitals. Baseline lung cancer screening exams in women started at 12 and 28 scans per month at each institution prior to the study period, and increased during the study period to 18 and 38 scans per month, respectively (P = .0038 and P = .0125, respectively).
Target enrollment for the study was 200 new patients for lung cancer screening at one institution and 322 at the other; the study resulted in 214 and 445 patients enrolled, respectively.
No significant corresponding changes were observed in baseline lung cancer screening exams among men at either site during the study period.
“It has been more than 10 years since annual screening for lung cancer was recommended, and screening rates [are still] disappointingly low. There are many reasons for these low rates, but mostly identifying eligible individuals is challenging in the primary care setting, and there is evidence showing a surprising lack of awareness about lung cancer screening among eligible individuals," said study co-principal investigator Robert Smith, PhD, Senior Vice President and Director of the American Cancer Society Center for Early Cancer Detection. “The CALM model demonstrates we can successfully recruit eligible women through mammography screening. Perhaps we also will be able to enlist them to encourage eligible family members to have a conversation about lung cancer screening with their health-care providers. There is enormous potential here.”
Disclosure: The study was funded by the American Cancer Society and the National Lung Cancer Roundtable. For full disclosures of the study authors, visit sciencedirect.com.
