Are we casting the net wide enough? Applying the proposed lung cancer screening criteria in single centre lung cancer resections.

Abstract

8066 Background: The Australian National Lung Cancer Screening Program (NLCSP) commences in July 2025. Thoracic surgery is a key treatment option in screen-detected early-stage lung cancers. St. John of God Subiaco Hospital is a private hospital in Western Australia (WA) and is part of the Australian and New Zealand Thoracic Clinical Quality Registry (ANZTHOR) collaborative database as one of the inaugural sites. We examined the resected primary lung cancers at our centre to assess if our cohort aligned with the characteristics of the targeted at-risk patient population as defined by the NLCSP proposed screening criteria. Methods: Demographic patient data was retrieved from ANZTHOR at our centre who underwent surgical resection for primary lung cancer between March 2023 to November 2024. Retrospective data analysis was then conducted on the mode and symptoms at time of diagnosis, age and smoking history. The NLCSP criteria for screening (aged 50-70 years, history of ≥30 pack-years smoking in current smokers or ex-smokers who quit within the last 10 years) was then applied to this cohort of privately insured primary lung cancer patients to evaluate the proportion of patients that would have been eligible/ineligible for screening. Results: Of the 107 patients, median age was 71 (range 42-87) and 67 (63%) were females. 96 (90%) patients were asymptomatic and 98 (92%) were early-stage cancers (Stage 2 and below). 58 (54%) patients were >70 years old and 34 (32%) were never-smokers. Conclusions: A substantial proportion (86%) of this cohort of asymptomatic resected lung cancer patients would not have been identified via lung cancer screening by NLCSP screening criteria. This is likely in part related to the different demographics of patients attending private hospitals but nonetheless raises the possibility that the current screening criteria is overly stringent and will miss many primary lung cancer presentations. Supplementary methods (i.e. blood biomarker testing) may improve screen detection rates of lung cancer and enable better identification of at-risk groups. Total patients (n=107) Asymptomatic patients (n=96) Ineligibility based on age 61 (57%) 56 (58%) Ineligibility based on smoking history 73 (68%) 67 (70%) Ineligibility based on full NLCSP criteria 91 (85%) 83 (86%)