Patient Adherence to Lung CT Screening Reporting &amp; Data System–Recommended Screening Intervals in the United States: A Systematic Review and Meta-Analysis

Lin, Yannan; Fu, Mingzhou; Ding, Ruiwen; Inoue, Kosuke; Jeon, Christie Y.; Hsu, William; Aberle, Denise R.; Prosper, Ashley

doi:10.1016/j.jtho.2021.09.013

Cited by 49 publications

(31 citation statements)

References 41 publications

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“…Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination Differences in how studies define adherence (ACR Lung-RADS recommended follow-up time vs extended time interval vs any follow-up during an observed time interval) to recommended follow-up either with repeat imaging or biopsy after the screening LDCT has led to substantial variability in the reporting of adherence rates. 19 In a recent study by Kim et al, 23 the overall adherence rate for recommended follow-up after a positive LDCT was 69.9%. The authors used a follow-up timeline from the index LDCT of 4 to 9 months for Lung-RADS 3, 1 to 5 months for Lung-RADS 4A, and within 5 months for Lung-RADS 4B or 4X.…”

Section: Jama Network Open | Oncologymentioning

confidence: 95%

Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination

et al. 2022

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ImportanceMaximizing benefits of lung cancer screening requires timely follow-up after a positive screening test. The American College of Radiology (ACR) Lung CT Screening Reporting and Data System (Lung-RADS) recommends testing and follow-up timing based on the screening result.ObjectiveTo determine rates of and factors associated with recommended follow-up after a positive lung cancer screening examination by Lung-RADS category.Design, Setting, and ParticipantsThis prospective cohort study of lung cancer screening examinations performed from January 1, 2015, through July 31, 2020, with follow-up through July 31, 2021, was conducted at 5 academic and community lung cancer screening sites in North Carolina. Participants included 685 adults with a positive screening examination, Lung-RADS categories 3, 4A, 4B, or 4X. Statistical analysis was performed from December 2020 to March 2022.ExposuresIndividual age, race, sex, smoking exposure, year of lung cancer screening examination, chronic obstructive pulmonary disease, body mass index, referring clinician specialty, rural or urban residence.Main Outcomes and MeasuresAdherence, defined as receipt of recommended follow-up test or procedure after the positive screen per ACR Lung-RADS timeframes: 6 months for Lung-RADS 3 and 3 months for Lung-RADS 4A. For Lung-RADS 4B or 4X, adherence was defined as follow-up care within 4 weeks, as ACR Lung-RADS does not specify a timeframe.ResultsAmong the 685 individuals included in this study who underwent lung cancer screening with low-dose computed tomography, 416 (60.7%) were aged at least 65 years, 123 (18.0%) were Black, 562 (82.0%) were White, and 352 (51.4%) were male. Overall adherence to recommended follow-up was 42.6% (292 of 685) and varied by Lung-RADS category: Lung-RADS 3 = 30.0% (109 of 363), Lung-RADS 4A = 49.5% (96 of 194), Lung-RADS 4B or 4X = 68.0% (87 of 128). Extending the follow-up time increased adherence: Lung-RADS 3 = 68.6% (249 of 363) within 9 months, Lung-RADS 4A = 77.3% (150 of 194) within 5 months, and Lung-RADS 4B or 4X = 80.5% (103 of 128) within 62 days. For Lung-RADS 3, recommended follow-up was less likely among those currently smoking vs those who quit (adjusted odds ratio [aOR], 0.48; 95% CI, 0.29-0.78). In Lung-RADS 4A, recommended follow-up was less likely in Black individuals vs White individuals (aOR, 0.35; 95% CI, 0.15-0.86). For Lung-RADS 4B or 4X, recommended follow-up was more likely in female individuals vs male individuals (aOR, 2.82; 95% CI, 1.09-7.28) and less likely in those currently smoking vs those who quit (aOR, 0.31; 95% CI, 0.12-0.80).Conclusions and RelevanceIn this cohort study, adherence to recommended follow-up after a positive screening examination was low but improved among nodules with a higher suspicion of cancer and after extending the follow-up timeline. However, the association of extending the follow-up time of screen-detected nodules with outcomes at the population level, outside of a clinical trial, is unknown. These findings suggest that studies to understand why recommended follow-up is lower in Black individuals, male individuals, and individuals currently smoking are needed to develop strategies to improve adherence.

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Section: Jama Network Open | Oncologymentioning

confidence: 95%

Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination

et al. 2022

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“…High costs, radiation exposure, and a high false-positive rate hinder the application of LDCT for large-scale screening. 2 , 5 A highly accurate and non-invasive tool for lung cancer screening is urgently warranted.…”

Section: Introductionmentioning

confidence: 99%

Identification of lung cancer breath biomarkers based on perioperative breathomics testing: A prospective observational study

et al. 2022

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“…The BTS guideline applies to individuals over 18 years old regardless of their previous cancer status, although previous cancer is a factor which should be considered in baseline assessment. Despite the availability of these guidelines, clinicians' awareness of the guidance is poor (38), and low levels of adherence has been observed at both patient and clinician level (39).…”

Section: Diagnostic Strategies To Manage Pulmonary Nodulesmentioning

confidence: 99%

The Use of Imaging Tests for the Diagnosis and Management of Lung Nodules

Lumbreras,

Chilet-Rosell,

Parker

2022

Metastasis

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Imaging tests have a central role in the diagnosis and management of lung cancer. Because of the increasing sensitivity of the current diagnostic imaging tests, and the implementation of screening programs, pulmonary nodules are more frequently detected in clinical practice. In addition, early detection of lung cancer and improvements in treatment have led to improved survival rates. As smoking was in the past more common among men, lung cancer has traditionally been considered as a male disease, particularly for older male smokers. However, this stereotype is no longer valid. A large number of studies point to a higher risk sensitivity in women than men for major lung cancer types. In this chapter, we describe the different clinical pathways in the management of solitary pulmonary nodules.

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Patient Adherence to Lung CT Screening Reporting & Data System–Recommended Screening Intervals in the United States: A Systematic Review and Meta-Analysis

Cited by 49 publications

References 41 publications

Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination

Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination

Identification of lung cancer breath biomarkers based on perioperative breathomics testing: A prospective observational study

The Use of Imaging Tests for the Diagnosis and Management of Lung Nodules

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