Lung Cancer Screening in a Safety-Net Hospital: Rare Harms Inform Decision-Making

Abstract Background Lung cancer screening (LCS) with Low-Dose CT (LDCT) decreases lung cancer mortality; however, screening benefits and harms are poorly described in minority populations. Our purpose is to report benefits and harms of LCS implemented in a safety-net institution. Because harms are rare, there is a paucity of clinical experience guiding Shared Decision Making (SDM) with diverse populations. Methods We conducted a prospective, observational study of patients undergoing LCS between September 2014 and March 2019 with 2-year follow-up. LDCT results, lung cancer diagnosis, stage, treatment, false-positive, false-negative procedure from a false-positive, complication from procedures, and death were recorded. Patient cases highlighting the challenges of delivering LCS to an underserved population were evaluated in the context of current evidence. Results 995 patients underwent screening, of which the majority were African American (54.9%), with 2.9% receiving a cancer diagnosis, a false-positive rate of 9.4% and a 0.7% rate of procedures resulting from a false-positive. Five patient cases highlight challenges namely 1) false-positive resulting in surgery, 2) false-negative,3) incidental finding, 4) delay in diagnosis, and 5) mortality from cause other than lung cancer. Conclusions LCS of a predominantly African American population with 2-year follow-up demonstrates early detection and treatment of lung cancer with few harms. Though rare, harms must be clearly described with population-specific evidence. We report clinical perspective of rare harms that can provide guidance to providers and patients.