Background: Lung cancer is the leading cause of cancer-related deaths in the US In 2011, the National Lung Screening Trial (NLST) showed a 1.1% incidence of lung cancer in low-dose CT (LDCT) screened patients and a 20% relative risk reduction in mortality through LDCT screening. An estimated 900,000 out of 6.7 million veterans meet lung cancer screening criteria; therefore, an effective model to ensure proper screening is critical.
Methods: From December 2015 to May 2018, Salisbury VA Medical Center (SBYVAMC), Kernersville Health Care Center (KHCC), and Charlotte Health Care Center (CHCC) primary care providers screened and referred veterans to a centralized Lung Cancer Screening Program. Patients
were seen by providers in the Lung Cancer Screening Program and participated in shared decision making. Providers sought to ensure guidelines established by NLST and the Center for Medicare and Medicaid Services (CMS) for LDCT screening were met. Each patient’s age, sex, race, smoking history, LDCT date, results, and follow-up plan were recorded in a secured database. Data were queried for these patient characteristics and the appropriateness for LDCT screening was evaluated. Cases of cancer found on LDCT were clinically verified through a VA EMR review.
Results: Of 1124 screened, 1,104 (98.2%) veterans received an appropriate LDCT, according to strict CMS criteria. By NLST inclusion criteria, 1,088 of 1124 (96.8%) met strict criteria. Tumors were detected in 14 SBYVAMC patients (2.92%), 13 KHCC patients (3.05%), and 7 CHCC patients (3.21%). In total, 34 veterans (3.02%) had a tumor detected by LDCT. Of the 34, 27 veterans had primary lung cancer (79.4%) and 22 of these veterans had stage 1 lung cancer (64.7%).
Conclusions/Implications: This model of lung cancer screening demonstrates a high rate of appropriate LDCT screenings. Appropriate screening is critical to reducing unnecessary costs and potential harms to veterans. Additionally, a nearly three-fold higher incidence of cancer was found in this veteran population compared to the NLST trial.