TOPLINE:

Among patients in a lung cancer screening registry, cancer survivors had similar outcomes as those with no prior cancer — but their rate of lung cancer detection was numerically higher.

METHODOLOGY:

• Cancer survivors face an increased risk of developing a second primary cancer, with lung cancer being the most common. Some groups recommend lung cancer screening for long-term cancer survivors, but that practice has not been widely accepted due to a lack of data on screening outcomes for this population.
• This cohort study analyzed data from 7295 individuals (mean age, 64.7 years) who underwent low-dose CT lung cancer screening at eight sites in North Carolina from 2015 to 2019; 814 had a history of cancer (most commonly breast, prostate, bladder, lung, and colorectal cancers) and 6481 had no such history.
• The primary outcome was whether lung cancer was diagnosed within a year of the first CT exam. The researchers also assessed positive CT findings (Lung-RADS 3-4X) and calculated the probability of developing lung cancer within 5 years, and the probability of death from lung cancer without screening.
• Cancer survivors were older than individuals with no prior cancer (≥ 65 years; 61.6% vs 50.4%) and had higher rates of respiratory comorbidities (39.9% vs 35%) and cardiovascular disease (64.4% vs 58.1%). Nearly all individuals in both groups were current or former smokers.

TAKEAWAY:

• Rates of positive CT findings were similar between the groups: 15.8% among survivors vs 17.0% among those without cancer (adjusted odds ratio [OR], 0.91; 95% CI, 0.74-1.12).
• Lung cancer was diagnosed in 25 cancer survivors and 118 individuals without prior cancer within 1 year of the first screening. Survivors had a numerically higher cancer detection rate, at 30.4 vs 18.2 cases per 1000 (OR, 1.69; P = .02). The difference did not reach significance after adjustment for age and demographic factors (adjusted OR, 1.51; P = .07).
• All-cause mortality rates in the year following the first screening were comparable, at 19.4 per 1000 among cancer survivors vs 17.1 per 1000 among individuals with no cancer history.
• The two groups were also similar in terms of the 5-year probability of developing lung cancer (33 cases per 1000 among survivors vs 30.2 cases per 1000 among individuals with no prior cancer) and the 5-year probability of death from lung cancer if not screened (22 vs 19.5 per 1000).

IN PRACTICE:

These findings, the authors wrote, suggest that the lung cancer detection rate with screening may be slightly higher in cancer survivors vs individuals with no such history. While age and smoking history are a “practical” way to select patients for screening, they concluded, “ consideration of clinical variables associated with increased risk of lung cancer, such as a history of cancer, should be evaluated in the context of individualized shared decision-making and assessment of net benefits and risk of [lung cancer screening].”

SOURCE:

This study, led by M. Patricia Rivera, MD, University of Rochester Medical Center, Rochester, New York, was published online on September 30 in JAMA Network Open.

LIMITATIONS:

This study was limited by being restricted to one state, small sample size of cancer survivors, possible misclassification of prior cancer history, and inability to confirm whether detected lung cancers in survivors represented second primaries or recurrences.

DISCLOSURES:

This study was funded by grants from the National Cancer Institute and the National Center for Advancing Translational Sciences of the National Institutes of Health. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.