In the prospective observational DELUGE study reported in the Journal of Clinical Oncology, researchers in the Baptist Memorial Health Care Corporation (BMHCC) found that programs for low-dose computed tomography (CT) screening and for management of incidentally detected lung nodules were complementary in the early detection of lung cancer.
The BMHCC is a community-based health-care system serving residents in areas of Arkansas, Mississippi, Tennessee, Kentucky, Missouri, and Alabama. The study population was defined as the Mississippi Delta cohort. From 2015 to 2021, 22,886 patients were enrolled in the study, including 5,659 in the low-dose CT and 15,461 in the lung nodule early detection programs. An additional 1,766 were enrolled on the basis of a thoracic oncology multidisciplinary care program that held weekly meetings to evaluate patients with suspicion of lung cancer who were not enrolled in either of the early detection programs.
Key Findings
Lung cancer was diagnosed in 150 patients in the low-dose CT program, 698 in the lung nodule program, and 1,010 in the multidisciplinary care program. Among these, 61%, 60%, and 44% were diagnosed at clinical stage I or II, and 19%, 20%, and 29% were diagnosed at stage IV (overall P = .0005).
Curative-intent surgery was performed in 47%, 42%, and 32% of patients, respectively (overall P < .0001). Aggregate 3-year overall survival rates were 80% (95% confidence interval [CI] = 73%–88%), 64% (95% CI = 60%–68%), and 49% (95% CI = 46%–53%), respectively; 5-year overall survival rates were 76% (95% CI = 67%–87%), 60% (95% CI = 56%–65%), and 44% (95% CI = 40%–48%), respectively (overall P < .001).
Among the 1,858 patients diagnosed with lung cancer, 46% would have been deemed eligible for low-dose CT by U.S. Preventive Services Task Force (USPSTF) 2013 criteria and 54% would have been eligible by USPSTF 2021 criteria. If all eligible patients by USPSTF 2021 criteria had been enrolled into the low-dose CT program, the lung nodule program would have detected 20% of the stage I and II lung cancers in the entire cohort.
The investigators concluded, “Low-dose CT and lung nodule programs are complementary, expanding access to early lung cancer detection and curative treatment to different-risk populations. Implementing lung nodule programs may alleviate emerging disparities in access to early lung cancer detection.”
Raymond U. Osarogiagbon, MBBS, of the Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by a Patient-Centered Outcomes Research Institute (PCORI) Award and others. For full disclosures of the study authors, visit ascopubs.org.
