Longitudinal evaluation of a multidisciplinary lung cancer early detection program.

Abstract

e20707 Background: Lung cancer remains the leading cause of cancer-related mortality in the United States and globally. Multiple clinical trials have demonstrated reduced mortality and stage shift among participants of low-dose CT lung screening (CTLS). Although real-world studies suggest similar trends following screening adoption, longitudinal evaluations that integrate CTLS, incidental pulmonary nodule (IPN) management, and symptomatic presentation across diagnostic pathways remain limited. In 2015, our community-based teaching hospital established a multidisciplinary lung cancer early detection program, which integrates CTLS, IPN, and symptomatic presentation of lung cancers. Methods: We conducted a retrospective analysis of lung cancers diagnosed through this quality improvement program from 2015 to 2024. Cancers were classified by CTLS-, IPN-, or symptomatic-detection. Changes in the diagnostic pathway distribution were assessed using chi-squared testing. Among CTLS-eligible patients, multivariable logistic regression estimated the odds of symptomatic diagnosis in 2024 versus 2015, adjusting for age, sex, and race. Results: Over the study period, 825 lung cancers were diagnosed through the integrated program. Comparison of cancers diagnosed in 2015 (n = 90) and 2024 (n = 85) demonstrated a significant redistribution of diagnostic pathways (χ² p < 0.001), with symptomatic presentation declining from 54.4% to 21.2% alongside increases in IPN-detected and CTLS- detected cancers. Twice as many cancers were detected via the IPN pathway as compared to CTLS. Among screening-eligible patients, the adjusted odds of symptomatic diagnosis in 2024 were markedly lower than in 2015 (OR 0.063, 95% CI 0.014-0.291; p < 0.001). Notably, there was a significantly higher proportion of patients who reported never using tobacco as the program matured (8.9% in 2015 compared with 23.5% in 2024, p=0.039). Conclusions: Over a decade, implementation of a multidisciplinary integrated lung cancer early detection program was associated with a substantial reduction in symptomatic presentation among screen-eligible patients and a significant stage shift to earlier stage disease, and a significantly higher percent of patients with no tobacco use history. These data support the role of organized and integrated lung screening and structured follow-up of pulmonary nodules in improving early detection of lung cancer. Program characteristics by year of diagnosis. Variable 2015 (n=90) 2024 (n=85) p-value / OR (95% CI) Age, mean (SD) 69.5 (8.8) 71.3 (9.7) - Male sex, n (%) 42 (46.7) 36 (42.4) p=0.67 No prior cigarette use, n (%) 8 (8.9) 20 (23.5) p=0.039 Screening-eligible, n (%) 30 (33.3) 32 (37.6) - Screening-detected, n (%) 13 (14.4) 24 (28.2) p<0.001 Incidental, n (%) 28 (31.1) 43 (50.6) p<0.001 Symptomatic, n (%) 49 (54.4) 18 (21.2) p<0.001 Symptomatic upon diagnosis (screen eligible) 18 (60.0) 4 (12.5) OR 0.063 (0.014-0.291)