Mobile low-dose computerized tomography (LDCT): Three-year follow up of solution for early diagnosis of lung cancer in under-served populations.

Abstract

6507 Background: Randomized trials have proven that screening high-risk patients with LDCT of chest reduces lung cancer mortality compared to screening with chest x-ray. Under-served patients lack access to this test due to geographic and socio-economic factors. We hypothesized that a mobile screening unit would improve access and increase survival in this group, which is most at risk of lung cancer deaths. Methods: We installed a BodyTom portable 32 slice low-dose CT scanner (Samsung Inc) into a 35 foot coach (Frazier Inc), reinforced to avoid equipment damage during road travel. It includes waiting area, high speed wireless internet connection for rapid image transfer, and electronic tablets to deliver smoking cessation and health education programs and shared decision-making video aids. We used LUNG RADS approach to lesion classification, yielding high sensitivity and specificity in assessment. All films were reviewed by a central panel. This is certified as a lung cancer screening Center of Excellence by the Lung Cancer Alliance. Protocol was approved by Advarra IRB. Medicare pts excluded as insurance covered them for LDCT, although this reduced potential number of cases diagnosed as this is highest risk population. Results: We screened 1200 uninsured or under-insured subjects, mean age 61 years (range 55-64), with average pack year history of 47.8 (30-150); 61% male; 18% Black, 3% Hispanic/Latino; 78% rural. We found 97 pts with LUNG RADS 4 lesions, 30 lung cancers (2.5%), including 15 at stage I-II treated with curative intent; 5 incidental non-lung cancers (renal CA 2, head & neck CA 1, pancreas CA 2); more than 50% with cardiovascular disease or COPD seen on LDCT. Of eligible first-screen subjects (J. Clin. Oncol., 2019, 37, 383S), 440 attended Year 1 repeat LDCT and 161 attended Year 2 LDCT. Only one pt with surgically resected CA lung has relapsed to date. Conclusions: Mobile LDCT yields higher screening rate for under-served pts than prior international studies, with strong protocol adherence and paucity of early cancer deaths in high-risk population with traditionally poor compliance.