Timely adherence to follow-up after high-risk lung cancer screenings

J Med Screen. 2023 Sep;30(3):150-155. doi: 10.1177/09691413231162507. Epub 2023 Mar 14.

Abstract

Objective: To achieve the lung cancer screening (LCS) mortality benefit in clinical trials, timely, real-world follow-up of abnormal test results is necessary. Presently, annual LCS rates are lower than in trials, and adherence to follow-up after suspicious findings has not been well studied. This study examined timely adherence to follow-up recommendations after positive low-dose computed tomography (LDCT) screenings.

Methods: This retrospective study included individuals from two academic primary care practices in New York City who met United States Preventative Services Task Force LCS eligibility and had a positive LDCT scan between 2013 and 2020. They were recommended for shorter interval follow-up repeat computed tomography (CT), CT biopsy, or positron emission tomography/CT. Adherence was completion of the prescribed imaging by 15 days after the recommended 7-, 30-, and 90-day follow-up and by 30 days after the 180-day recommended follow-up.

Results: Among 106 individuals with a positive LDCT scan, 64 (60%) were adherent to follow-up recommendations. Adherence was 72%, 63%, and 42% for recommended follow-ups of 30, 90, and 180 days, respectively. Being male was a predictor of a lower adherence rate. Among 23 individuals newly diagnosed with lung cancer after a positive LDCT scan, 83% were adherent to follow-up testing and 82% of cancers were Stage 1A or limited stage.

Conclusions: There was variable adherence to the LCS follow-up recommendations despite positive screening CT, suggesting that even in a well-established screening program there may not be an efficient, systematic approach for follow-up. The delays in repeat testing potentially undermine the benefits of early detection.

Keywords: Low-dose computed tomography; adherence to follow-up; high-risk screening; lung cancer screening.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Early Detection of Cancer / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms* / diagnostic imaging
  • Lung Neoplasms* / pathology
  • Male
  • Mass Screening
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods
  • United States