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Purpose Our aim was to develop a novel approach for lung cancer screening among a diverse population that integrates the Centers for Medicare and Medicaid Services (CMS) recommended components including shared decision making (SDM), low-dose CT (LDCT), reporting of results in a standardized format, smoking cessation, and arrangement of follow-up care. Methods Between October of 2015 and March of 2018, we enrolled patients, gathered data on demographics, delivery of SDM, reporting of LDCT results using Lung-RADS, discussion of results, and smoking cessation counseling. We measured adherence to follow-up care, cancer diagnosis, cancer treatment, and smoking cessation at 2 years after initial LDCT. Results We enrolled 505 patients who were 57% African American, 30% Caucasian, 13% Hispanic, < 1% Asian, and 61% were active smokers. All participants participated in SDM, 88.1% used a decision aid, and 96.1% proceeded with LDCT. Of 496 completing LDCT, all received a discussion about results and follow-up recommendations. Overall, 12.9% had Lung-RADS 3 or 4, and 3.2% were diagnosed with lung cancer resulting in a false-positive rate of 10.7%. All 48 patients with positive screens but no cancer diagnosis adhered to follow-up care at 1 year, but only 35.4% adhered to recommended follow-up care at 2 years. The annual follow-up for patients with negative lung cancer screening results (Lung-RADS 1 and 2) was only 23.7% after one year and 2.8% after 2 years. All active smokers received smoking cessation counseling, but only 11% quit smoking. Conclusion The findings show that an integrated lung cancer screening program can be safely implemented in a diverse population, but adherence to annual screening is poor.

Lung cancer is the leading cause of cancer deaths in the United States representing about 25% of all cancer deaths. The risk from smoking has increased over time with racial/ethnic minorities and disadvantaged populations having higher smoking rates and experiencing greater burden of lung cancer compared to other populations. Rural populations, in particular, experience higher rates of tobacco usage associated with increased incidence of lung cancer. National efforts to identify lung cancer in its early stage would greatly benefit high-risk populations, consequently reducing advanced cancers and potentially decreasing smoking rates. In 2013, lung cancer screening with low-dose computed tomography was recommended by the US Preventive Services Task Force for early detection of lung cancer. These guidelines were developed after the results of the National Lung Screening Trial. The National Lung Screening Trial study showed a 20% reduction in deaths of participants who were current or former heavy smokers who were screened with low-dose computed tomography versus those screened by chest X-ray. In response to this evidence and using state lung cancer burden data and local smoking rates as a guide, Michigan implemented a lung cancer screening awareness campaign in the rural northern, lower peninsula. Awareness of lung cancer screening was increased through the use of a variety of media including gas station/convenience store small media, digital media, radio broadcast media, and the use and marketing of a website that provided lung cancer screening information and resources.

AbstractAnnual lung cancer screening (LCS) is recommended for individuals at high risk for lung cancer. However, primary care provider–initiated discussions about LCS and referrals for screening are low overall, particularly among Black or African Americans and other minoritized racial and ethnic groups. Disparities also exist in receiving provider advice to quit smoking. Effective methods are needed to improve provider knowledge about LCS and tobacco-related disparities, and to provide resources to achieve equity in LCS rates. We report the feasibility and impact of pairing a self-directed Lung Cancer Health Disparities (HD) Web-based course with the National Training Network Lung Cancer Screening (LuCa) course on primary care providers’ knowledge about LCS and the health disparities associated with LCS. In a quasi-experimental study, primary care providers (N = 91) recruited from the MedStar Health System were assigned to complete the LuCa course only vs. the LuCa + HD courses. We measured pre-post–LCS-related knowledge and opinions about the courses. The majority (60.4%) of providers were resident physicians. There was no significant difference between groups on post-test knowledge (p > 0.05). However, within groups, there was an improvement in knowledge from pre- to post-test (LuCa only (p = 0.03); LuCa + HD (p < 0.001)). The majority of providers (81%) indicated they planned to improve their screening and preventive practices after having reviewed the educational modules. These findings provide preliminary evidence that this e-learning course can be used to educate providers on LCS, smoking cessation, and related disparities impacting patients.

Abstract Background African American individuals experience disparities in the burden of lung cancer compared to other racial or ethnic groups. Yet, African Americans are less likely than White patients to have provider-initiated discussions about lung cancer screening (LCS). In addition to provider-level barriers, predictors of racial disparities include patient-level knowledge barriers and medical mistrust. This study assessed the feasibility and acceptability of provider- and patient-oriented approaches to increase uptake of LCS in a majority African American primary care clinic setting. Methods In Phase 1, we conducted surveys (N = 22) and usability testing with providers (N = 7) to develop a previsit planning message, a type of clinician reminder. The clinician reminder is sent via the electronic health record ahead of scheduled visits with screening-eligible participants to promote LCS discussion. We partnered with a primary care clinic (N = 5 providers; N = 399 patients 50–80 years old with a documented smoking history, no prior lung cancer diagnosis) to evaluate the impact of the reminder on LCS referral rates. In Phase 2, we conducted a pretest-posttest study (N = 16) to pilot a previsit phone-based patient education session. Patient-level LCS knowledge was assessed using 10 true/false items and a single item measured screening intentions. Results In Phase 1, LCS referrals increased from 6 6-months prepilot to 49 during the 6-month pilot period. The majority (89.8%) of the orders placed had a clinician reminder. In Phase 2, from pretest to posttest, there was improvement in LCS knowledge (mean percent correct: 63.3% to 76.7%; P = .013) and screening intentions (43.8% to 82%; P = .05). Conclusions In a diverse clinical setting, we developed a feasible and acceptable multilevel approach aimed at increasing LCS equitably. Clinical Trial information The Clinical Trials Registration #NCT04675476. We developed a feasible and acceptable multilevel approach aimed at increasing lung cancer screening among African Americans in the primary care setting. Lay Summary Lung cancer is the leading cause of cancer death in the United States. African Americans are less likely to be diagnosed early with lung cancer. People who take part in lung cancer screening can lower their chances of dying from lung cancer. Lung cancer screening is recommended for older adults with a history of smoking. However, many African Americans who are eligible for lung screening do not get the test. There are several health system, provider, and patient barriers that stand in the way of people getting the test. This study developed a provider reminder and patient education intervention to promote lung cancer screening. In this pilot study, the provider reminder increased provider referrals for lung cancer screening and the patient education intervention increased patient knowledge about screening. In a future study, we will test the provider reminder and patient education together to increase lung cancer screening among African American patients. Graphical Abstract Graphical Abstract

Background/Objectives: Despite recent lung cancer screening (LCS) studies proving significant mortality reduction, comorbidities are a prominent issue affecting cost effectiveness, which is holding back national implementation. Incidental findings (IFs) of comorbidities make a significant contribution to delayed diagnoses and raise discussions about optimal management plans. This is particularly relevant to national lung cancer screening (NLCS), as the high-risk population qualifying for the screening often have increased likelihood for comorbidities due to their smoking history. Methods: The Early Detection of Cancer of the Lung Scotland (ECLS) (ClinicalTrials.gov identifier NCT01925625) study showcases a targeted approach to NLCS by implementing the blood-based biomarker EarlyCDT-Lung test. Firstly, this paper explored the ECLS dataset for comorbidities present within the screening population at baseline A chi-square analysis was then undertaken to investigate the relationship of cohort allocation and incidence of new comorbidities over the five-year follow-up period. Results: High prevalence conditions were cardiovascular (38.5%), neurological/psychiatric (33.9%), gastrointestinal (29.8%), and respiratory (19.2%). While 20.3% of the total patient cohort showed a newly discovered comorbidity, there was no significant variation in new incidences between the intervention and control cohort. Conclusions: When considering these results alongside the all-cause mortality reduction shown in previous analyses, they indicate that this targeted approach to LCS might help improve the benefit–harm ratio through the introduction of biomarkers. Further refining selection criteria for low-dose CT screening might contribute to minimising the risk of overdiagnosis and overtreatment.

Lung cancer is the leading cause of cancer-related death worldwide, with 1.8 million deaths annually. Early detection is vital for improving patient outcomes; however, survival rates remain low due to late-stage diagnoses. Accumulating data supports the idea that screening methods are useful for improving early diagnosis in high-risk patients. However, several barriers limit the application of lung cancer screening in real-world settings. The widespread diffusion of artificial intelligence (AI), radiomics, and machine learning has dramatically changed the current diagnostic landscape. This review explores the potential of AI and biomarker-driven methods, particularly liquid biopsy, in enhancing early lung cancer detection. We report the findings of major randomized controlled trials, cohort studies, and research on AI algorithms that use multi-modal imaging (e.g., CT and PET scans) and liquid biopsy to identify early molecular alterations. AI algorithms enhance diagnostic accuracy by automating image analysis and reducing inter-reader variability. Biomarker-driven methods identify molecular alterations in patients before imaging signs of cancer are evident. Both AI and liquid biopsy show the potential to improve sensitivity and specificity, enabling the detection of early-stage cancers that traditional methods, like low-dose CT (LDCT) scans, might miss. Integrating AI and biomarker-driven methods offers significant promise for transforming lung cancer screening. These technologies could enable earlier, more accurate detection, ultimately improving survival outcomes. AI-driven lung cancer screening can achieve over 90% sensitivity, compared to 70–80% with traditional methods, and can reduce false positives by up to 30%. AI also boosts specificity to 85–90%, with faster processing times (a few minutes vs. 30–60 min for radiologists). However, challenges remain in standardizing these approaches and integrating them into clinical practice. Ongoing research is essential to fully realize their clinical benefits and enhance timely interventions.

Background Low-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20–24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3–20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization. Methods Guided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50–80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled ( N  = 184 for implementation clinics, N  = 184 for comparison clinics; total N  = 368). Provider participants will include those practicing at the partner clinics ( N  = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity). Discussion The study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates. Trial registration ClinicalTrials.gov, NCT04675476. Registered December 19, 2020.

Lung cancer is the leading cause of cancer-related deaths. Screening eligible high-risk individuals for lung cancer with a low-dose computed tomography scan is evidence based. A nurse practitioner centralized screening process was initiated to evaluate the impact on patient volume, follow-up compliance, and the length of time from diagnosis to treatment intervention. The implementation of a centralized lung cancer screening program standardization of practice resulted in a statistically significant improvement with follow-up recommendations and patient compliance compared with the established lung cancer screening process. •Screening individuals at higher risk of developing lung cancer with a low-dose computed tomography scan (LDCT) is evidence based.•Lung-screening LDCT scans are underutilized.•Centralized screening programs may improve compliance with follow-up.•Delays initiating lung cancer treatment influence patient survival.

Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer deaths. Lung cancer screening (LCS) reduces NSCLC mortality; however, a lack of diversity in LCS studies may limit the generalizability of the results to marginalized groups who face higher risk for and worse outcomes from NSCLC. Identifying sources of inequity in the LCS pipeline is essential to reduce disparities in NSCLC outcomes. The authors searched 3 major databases for studies published from January 1, 2010 to February 27, 2020 that met the following criteria: 1) included screenees between ages 45 and 80 years who were current or former smokers, 2) written in English, 3) conducted in the United States, and 4) discussed socioeconomic and race- based LCS outcomes. Eligible studies were assessed for risk of bias. Of 3721 studies screened, 21 were eligible. Eligible studies were evaluated, and their findings were categorized into 3 themes related to LCS dis-parities faced by Black and socioeconomically disadvantaged individuals: 1) eligibility; 2) utilization, perception, and utility; and 3) postscreening behavior and care. Disparities in LCS exist along racial and socioeconomic lines. There are several steps along the LCS pipeline in which Black and socioeconomically disadvantaged individuals miss the potential benefits of LCS, resulting in increased mortality. This study identified potential sources of inequity that require further investigation. The authors recommend the implementation of prospective trials that evaluate eligibility criteria for underserved groups and the creation of inter-ventions focused on improving utilization and follow- up care to decrease LCS dis-parities.

BackgroundRandomized controlled trials have evaluated the efficacy of low-dose CT (LDCT) lung cancer screening on lung cancer (LC) outcomes.ObjectiveMeta-analyze LDCT lung cancer screening trials.MethodsWe identified studies by searching PubMed, Google Scholar, the Cochrane Registry, ClinicalTrials.gov, and reference lists from retrieved publications. We abstracted data on study design features, stage I LC diagnoses, LC and overall mortality, false positive results, harm from invasive diagnostic procedures, overdiagnosis, and significant incidental findings. We assessed study quality using the Cochrane risk-of-bias tool. We used random-effects models to calculate relative risks and assessed effect modulators with subgroup analyses and meta-regression.ResultsWe identified 9 studies that enrolled 96,559 subjects. The risk of bias across studies was judged to be low. Overall, LDCT screening significantly increased the detection of stage I LC, RR = 2.93 (95% CI, 2.16–3.98), I2 = 19%, and reduced LC mortality, RR = 0.84 (95% CI, 0.75–0.93), I2 = 0%. The number needed to screen to prevent an LC death was 265. Women had a lower risk of LC death (RR = 0.69, 95% CI, 0.40–1.21) than men (RR = 0.86, 95% CI, 0.66–1.13), p value for interaction = 0.11. LDCT screening did not reduce overall mortality, RR = 0.96 (95% CI, 0.91–1.01), I2 = 0%. The pooled false positive rate was 8% (95% CI, 4–18); subjects with false positive results had < 1 in 1000 risk of major complications following invasive diagnostic procedures. The most valid estimates for overdiagnosis and significant incidental findings were 8.9% and 7.5%, respectively.DiscussionLDCT screening significantly reduced LC mortality, though not overall mortality, with women appearing to benefit more than men. The estimated risks for false positive results, screening complications, overdiagnosis, and incidental findings were low. Long-term survival data were available only for North American and European studies limiting generalizability.