A retrospective cohort study investigating factors affecting recommendation for continued low-dose computed tomography lung cancer screening in the national lung cancer screening trial

Abstract

Objective

To analyze trends in recommending continuation of lung cancer screening across different risk factors and demographic groups using data from the National Lung Screening Trial (NLST).

Methods

This retrospective cohort study utilized de-identified NLST data from August 2002 to April 2004 and follow-up data collected through December 31, 2009, with 24,924 participants. Multivariable logistic regression was performed to assess the odds of continued low-dose computed tomography (LDCT) screening based on variables such as alcohol consumption, age, sex, race, ethnicity, education, diagnosis of chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, or pneumonia, occupational history, family history of lung cancer, and a previous cancer diagnosis for another type of cancer. Participants receiving chest X-rays, a previous diagnosis of lung cancer, or those with incomplete data were excluded from the analysis.

Results

Participants who consumed five or more alcoholic drinks per day (OR = 2.19), identified as Asian (OR = 3.59) or Native American, Alaskan Native, or Pacific Islander (OR = 2.37), and multiracial participants (OR = 2.15) had significantly higher odds of the reporting radiologist to recommend continued screening compared to Caucasians, while Black participants had lower odds (OR = 0.85). Factors such as family history of lung cancer or respiratory diseases like chronic bronchitis, COPD, and emphysema reduced the odds of the reporting radiologist recommending continued screening.

Conclusions

The study highlights differences in lung cancer screening recommendations among demographic groups at the time the NLST data were collected. Given the evolving guidelines and practices for LDCT screening, further research is needed to understand how these patterns compare to current trends. It is noted that global lung cancer screening programs vary in their approach, offering comparisons with lung cancer prevention worldwide.