In a publication in Cancer, researchers conducted a retrospective analysis to explore the impact of screening among patients in the Veterans Health Administration healthcare system who were diagnosed with lung cancer from 2011 to 2018.

The authors wrote, “Despite randomized trials demonstrating a mortality benefit to low-dose computed tomography screening to detect lung cancer, uptake of lung cancer screening (LCS) has been slow, and the benefits of screening remain unclear in clinical practice.”

The authors also noted that, to their knowledge, this is the largest retrospective cohort of patients with lung cancer measuring the real-world impact of LCS among veterans—a population containing a high number of smokers at high risk of developing lung cancers.

For this retrospective analysis, researchers assessed data from 2011 to 2018 involving 57,919 veterans diagnosed with lung cancer in the national Veterans Affairs lung cancer registry and evaluated lung cancer stage at diagnosis, lung cancer–specific survival, and overall survival among patients with cancer who did and did not receive screening before diagnosis. The researchers also employed Cox regression modeling and inverse propensity weighting analyses with lead time bias adjustment to correlate LCS exposure with patient outcomes.

Of the 57,919 individuals, 2,167 (3.9%) underwent screening before diagnosis. Among the patients who underwent screening, there were higher rates of stage I diagnoses (52% vs. 27%; P ≤.0001) compared with those without screening.

The results also revealed that screened patients had improved 5-year overall survival rates (50.2% vs. 27.9%) and 5-year lung cancer–specific survival (59.0% vs. 29.7%) compared with unscreened patients. Among screening-eligible patients who underwent National Comprehensive Cancer Network guideline–concordant treatment, screening yielded considerable decreases in all-cause mortality (adjusted hazard ratio [aHR], 0.79; 95% CI, 0.67-0.92; P = .003) and lung-specific mortality (aHR, 0.61; 95% CI, 0.50-0.74; P <.001).

The authors wrote, “Despite robust randomized clinical trial data demonstrating a mortality benefit to LCS, we observed that only a small minority of veterans with lung cancer (3.9%) obtained an LDCT before their lung cancer diagnosis, similar to other reported rates.”

The authors also wrote, “Our analysis builds on and corroborates these previous studies at a patient level, and our work is unique in that we have been able not only to assess the differences in outcomes between patients with lung cancer who did and did not undergo screening but also to quantify the impact of screening among screening-eligible patients who subsequently received lung cancer-directed therapy, the most relevant population for clinical practice.”

The authors concluded that while uptake of LCS remains inadequate, screening was correlated with earlier-stage diagnoses and improved survival. Lastly, the authors noted that the findings from this large national study validate the value of LCS in clinical practice; however, efforts are required to implement this critical intervention extensively in healthcare delivery.

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