RSNA 2014: Study finds more lung cancers in poor, underserved area than NLST population

The introduction of a CT lung cancer screening program in a poor, underserved community of New York City using National Lung Screening Trial (NLST) standards resulted in the detection of more cancers than other studies, according to research presented last week at the annual meeting of the Radiological Society of North America in Chicago.

Montefiore Medical Center in the Bronx has been conducting a CT lung cancer screening program in its community since 2012. According to Hanna Milch, M.D., one of the study authors, the Bronx ranks as one of the unhealthiest of the 62 counties in New York state. In addition, the patients who come from the Bronx are more diverse, much older, more likely to be current smokers and have more chronic diseases than NLST study participants.

For purposes of the study, Montefiore researchers created a standardized "Bronx" lung cancer probability score modeled after BI-RADS, with a score of 5, which represented a high suspicion of malignancy. Researchers analyzed data from 320 patients who underwent low dose CT screening in the first 18 months of the program.

Of those patients, nine received Bronx scores of 5. Eight of the nine had tissue proven lung cancer, while the ninth has had a PET-CT scan highly suspicious for lung cancer, which has yet to be confirmed.

This meant that the prevalence of lung cancer in this population was 2.5 percent (and could be as high 2.8 percent if the ninth patient has a cancer diagnosis confirmed on biopsy). Of the eight patients with confirmed lung cancer, just two had adenocarcinomas (which was the dominant cancer type for the NLST trial), and only one patient had stage 1 disease.

Montefiore's screening population presented the medical center with a number of challenges, according to Milch. For example, she said, 40 percent of the patients were obese, affecting both image quality and radiation dose.

"And compliance was one of the largest challenges we faced," Milch said. For example, one 73-year-old patient had a scan that received a Bronx score of 5 and later underwent a PET-CT that was highly suspicious for malignancy, "but was later lost to follow up," she said.