J. Maxwell Chamberlain Paper for General Thoracic Surgery: Assessing Lung Cancer Screening Eligibility Among Lung Cancer Patients in the Boston Lung Cancer Study: An Analysis of 6,239 Lung Cancer Cases

A. Potter¹, Q. Guo¹, D. Srinivasan¹, M. Yang¹, M. McCarthy¹, D. Wang¹, J. Kothari², A. Shafer³, D. C.. Christiani³, C. Jeffrey. Yang^4
1Massachusetts General Hospital - Thoracic Surgery, Boston, Massachusetts ²Harvard T.H. Chan School of Public Health - Epidemiology and Environmental Health, Boston, Massachusetts ³Massachusetts General Hospital - Pulmonary and Critical Care Unit, Boston, Massachusetts ⁴Massachusetts General Hospital - Thoracic Surgery, Winchester, Massachusetts

Purpose: Current lung cancer screening eligibility criteria exclude many high-risk individuals. Modifications have been proposed to improve screening eligibility criteria, including using duration instead of pack-years and removing the 15-year since quitting (YSQ) criterion. Our objective was to assess screening eligibility using different criteria in the Boston Lung Cancer Study.

Methods: Patients newly diagnosed with lung cancer from 1992-2024 in the Boston Lung Cancer Study (BLCS), a cancer epidemiology cohort study, were identified for analysis. Detailed smoking history was collected at the time of enrollment by trained staff using a standardized questionnaire. We evaluated smoking patterns among patients who currently and formerly smoked at lung cancer diagnosis. The proportion of patients who would have qualified for screening under the United States Preventive Services Task Force (USPSTF) guideline (aged 50-80, >= 20 pack-years, currently smoke or quit < 15 years ago), 20-duration guideline (aged 50-80, >= 20 year smoking duration, currently smoke or quit < 15 years ago), American Cancer Society (ACS) guideline (aged 50-80, > 20 pack-years), NCCN guideline (aged >= 50, >= 20 pack-years), and NCCN-duration guideline (aged >= 50, >= 20 year smoking duration) were evaluated.

Results: A total of 6,239 lung cancer patients met study inclusion criteria. Of these patients, 58.9% (n=3,673) formerly smoked at diagnosis. Scatterplots of smoking pack-years vs. age at diagnosis among patients who currently smoked and smoking pack-years vs. years since quitting smoking among patients who formerly smoked are shown in Figures A-B. Notably, over 56.1% of patients who formerly smoked quit smoking >15 years ago. The proportions of lung cancer patients, stratified by smoking status, that would have qualified under each guideline are shown in Figure C. Among patients who currently smoked at diagnosis, the proportion that would have qualified under each guideline ranged from 81% to 89%. The 20-year duration guideline and NCCN-modified guideline, which use a 20-year duration cutoff instead of a 20-pack-year cutoff, led to small increases in the proportion of patients who currently smoked that would have qualified for screening. Among patients who formerly smoked at diagnosis, only 36% would have qualified under the USPSTF guideline; this proportion was increased to 65-78% under the ACS, NCCN, and NCCN-duration guidelines (all of which remove the 15-YSQ requirement).

Conclusion: In this analysis of >6,000 patients in the Boston Lung Cancer Study, 81% of patients who currently smoked and 36% of patients who formerly smoked would have met the USPSTF criteria. Using smoking duration, instead of pack-years, and removing the 15-YSQ-criterion from the USPSTF guideline would significantly increase screening eligibility.

Identify the source of the funding for this research project: None