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Original Research: Lung Cancer |

Effects of Implementation of Lung Cancer Screening at One Veterans Affairs Medical Center

Ikenna C. Okereke, MD; Maria F. Bates, MD; Matthew D. Jankowich, MD; Sharon I. Rounds, MD; Brian A. Kimble, MD; Janelle V. Baptiste, MD; Thomas T. Ng, MD; Linda L. Nici, MD
Author and Funding Information

FUNDING/SUPPORT: This study was supported in part by P20 GM103652 (to S. I. R.) and by VA Merit Review awards (to S. I. R. and M. D. J.).

aDivision of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX

bDepartment of Surgery, Warren Alpert Medical School of Brown University, Providence, RI

cDepartment of Medicine, Warren Alpert Medical School of Brown University, Providence, RI

dProvidence Veterans Affairs Medical Center, Providence, RI

CORRESPONDENCE TO: Ikenna Okereke, MD, Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(5):1023-1029. doi:10.1016/j.chest.2016.08.1431
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Background  Lung cancer screening recommendations have been developed, but none are focused on veterans. We report the results of the lung cancer screening program at our Veterans Affairs medical center and compare them with historic results.

Methods  All veterans between 55 and 74 years who were current smokers or quit within the past 15 years and had at least a 30-pack-year smoking history were invited to receive an annual low-dose chest CT scan beginning in December 2013. Demographics, CT scan results, and pathologic data of screened patients were recorded retrospectively. Overall results during the screening period were compared with results in veterans who received diagnoses from January 2011 to December 2013 (prescreening period).

Results  From December 2013 through December 2014 (screening period), 1,832 patients obtained a screening CT scan. Their mean age was 65 years. A lung nodule was present in 439 of 1,832 patients (24%). Lung cancer was diagnosed in 55 of 1,832 screened patients (3.0%). During the prescreening period, 37% of every lung cancer detected at our center (30 of 82) was stage I or stage II. After implementation of the screening program that percentage rose to 60% (52 of 87; P < .01). During the screening period, 55 of the 87 diagnosed lung cancers (63%) were detected through the screening program. The number of lung cancers detected per month rose from 2.4 to 6.7 after implementation of the screening program (P < .01).

Conclusions  Implementation of lung cancer screening in the veteran population leads to detection of an increased number and proportion of early-stage lung cancers. Lung cancer screening in veterans may also increase the rate of lung cancer diagnoses in the immediate postimplementation period.

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