Importance:Significant incidental findings (SIFs) not related to lung cancer have been widely reported in patients undergoing lung cancer screening with low-dose computed tomography (LDCT). It is unclear whether SIFs are associated with extrapulmonary cancer diagnoses. Objective:To examine the association between an SIF considered to be potentially indicative of extrapulmonary cancer (cancer SIF) detected at LDCT lung cancer screening and diagnosis of an extrapulmonary cancer within 1 year of the screen. Design, Setting, and Participants:This retrospective cohort study analyzed data from National Lung Screening Trial (NLST) participants. The NLST participants were randomly assigned to either LDCT or chest radiography to determine whether LDCT was associated with a reduction in lung cancer mortality compared with chest radiography alone. Participants aged 55 to 74 years were recruited between August 2002 and April 2004. They received up to 3 rounds of screening and were followed up for 5 to 7 years. The study concluded December 31, 2009. This analysis was restricted to participants in the LDCT arm and was conducted between June and December 2025. Exposure:Detection of a cancer SIF (ie, SIF potentially indicative of a cancer) at any lung cancer screening round in the NLST. Main Outcomes and Measures:The primary outcome was diagnosis of an extrapulmonary cancer within 1 year of a screening round. Extrapulmonary cancers were classified using Surveillance, Epidemiology, and End Results (SEER) Program organ system categories. Cancer SIFs were mapped to specific SEER cancer categories. Multilevel logistic regression was used to assess the association between detection of a cancer SIF and diagnosis of an extrapulmonary cancer. Results:The study included 75 104 LDCT screening rounds performed in 26 445 participants (mean [SD] age, 61.4 [5.0] years; 59.0% male). Cancer SIFs were reported for 2265 screening rounds (3.0%) in 1807 participants (6.8%) across the 3 screening rounds. An extrapulmonary cancer was diagnosed following a screening round with a cancer SIF (n = 2265) for 67 participants (3.0%). The marginal risk difference, after covariates and participant-specific adjustments, was 13.89 (95% confidence limit [CL], 7.03-20.75) per 1000 participants. The marginal risk differences were significantly higher for urinary cancers (17.03 [95% CL, 8.55-25.50] per 1000 participants) and other SEER cancer categories, including lymphoma and leukemia (13.83 [95% CL, 3.46-24.21] per 1000 participants). Conclusions and Relevance:This cohort study found that cancer SIFs were associated with an increased risk of an extrapulmonary cancer diagnosis in the year following an LDCT lung cancer screening examination. These findings suggest that certain SIFs should be evaluated as potential indicators of undiagnosed cancers.

Purpose Although lung cancer screening (LCS) with low-dose chest CT (LDCT) is recommended for high-risk populations, little is known about how clinical screening compares with research trials. We compared Lung CT Screening Reporting and Data System (Lung-RADS) scores between a nationally screened population from the ACR’s LCS Registry (LCSR) and the National Lung Screening Trial (NLST). Methods This retrospective study included baseline LDCT examinations from the LCSR and NLST. Patient characteristics (age, gender, smoking status, pack-years, and body mass index) were obtained. NLST LDCT results were recoded to Lung-RADS version 1.1. A multivariable multinomial logistic model was used to examine variations in Lung-RADS scores by screening group (LCSR versus NLST) and patient characteristics. Results In all, 686,011 and 26,432 participants from the LCSR and NLST, respectively, were included. Compared with the NLST, the LCSR population was older (mean age [SD]: 64.0 [5.4] versus 61.4 [5.0] years); P < .001) and included more female patients (47.9% versus 40.9%; P < .001), and its patients were more likely to be currently smoking (61.5% versus 48.1%; P < .001). After adjusting for age, gender, smoking history, and body mass index, the LCSR population was more significantly likely to have higher Lung-RADS scores than the NLST (adjusted odds ratio and 95% confidence interval > 1 for Lung-RADS scores 2, 3, 4A, 4B, 4X relative to Lung-RADS 1). Conclusions Lung-RADS scores in clinical LCS are higher than in the NLST, even after adjusting for known confounders such as age and smoking. This would imply higher rates of follow-up testing after LCS and potentially higher cancer rates in the clinically screened population than the NLST.

BACKGROUND:To plan cessation services and advance health equity, understanding factors related to cessation readiness and differences among patients presenting for lung cancer screening (LCS) is imperative. METHODS:We recruited smoking patients, ages 55 to 77 years, presenting for LCS in 26 community-based imaging clinics participating in an NCI Community Oncology Research Program site-randomized trial (WF-20817CD, UG1CA189824). We collected outcomes of smoking cessation readiness to change and quitting self-efficacy immediately prior to screening. Linear mixed models were constructed with site random effects to assess associations of outcomes and baseline characteristics. RESULTS:Participants (N = 1,094; age = 63.7; 81.9% White, 13.3% Black, 2.6% Hispanic, 2.3% American Indian, 20.2% nonmetro) were even by gender (50.8% women) and educational attainment (51.1% ≤ high school education). Participants smoked an average of 17.2 cigarettes per day (SD = 9.6), with a mean pack-year of 46.1 (SD = 25.0). Predictors of increased cessation readiness included the following: being a man, increased worry about lung cancer, increased perceived benefits of quitting, a quit attempt within the past year, and smoking ≤10 cigarettes per day. Predictors of increased quitting self-efficacy included the following: non-White race/ethnicity, men, less education, no use of other tobacco products, increased perceived benefits of quitting, a quit attempt within the past year, and smoking ≤10 cigarettes per day. CONCLUSIONS:To support cessation among patients undergoing LCS, imaging clinics and health systems should recognize that prescreening readiness to quit varies by population subgroups. Imaging clinics may benefit from a tailored approach that works with patients "where they are." IMPACT:These findings suggest that gender, race, and ethnicity are associated with smoking cessation readiness and quitting self-efficacy.

"Variability in Reporting of Incidental Findings Detected on Lung Cancer Screening." Annals of the American Thoracic Society, 20(4), pp. 617–620

BACKGROUND: One-half of all people who undergo lung cancer screening (LCS) currently use tobacco. However, few published studies have explored how to implement effective tobacco use treatment optimally during the LCS encounter.RESEARCH QUESTION: Was the Optimizing Lung Screening intervention (OaSiS) effective at reducing tobacco use among patients undergoing LCS in community-based radiology facilities?STUDY DESIGN AND METHODS: The OaSiS study (National Cancer Institute [NCI] Protocol No.: WF-20817CD) is an effectiveness-implementation hybrid type II cluster randomized trial of radiology facilities conducted in partnership with the Wake Forest National Cancer Institute Community Oncology Research Program research base. We randomly assigned 26 radiology facilities in 20 states to the intervention or usual care group. Staff at intervention facilities implemented a variety of strategies targeting the clinic and care team. Eligible patient participants were aged 55 to 77 years undergoing LCS and currently using tobacco. Of 1,094 who completed a baseline survey (523 intervention group, 471 control group) immediately before the LCS appointment, 956 completed the 6-month follow-up (86% retention rate). Fifty-four percent of those who reported not using tobacco at 6 months completed biochemical verification via mailed cotinine assay. Generalized estimating equation marginal models were used in an intention-to-treat analysis to predict 7-day tobacco use abstinence.RESULTS: The average self-reported abstinence among participants varied considerably across facilities (0%-27%). Despite a significant increase in average cessation rate over time (0% at baseline to approximately 13% at 6 months; P < .0001), tobacco use did not differ by trial group at 14 days (OR, 0.96; 95% CI, 0.46-1.99; P = .90), 3 months (OR, 1.17; 95% CI, 0.691.99; P = .56), or 6 months (OR, 0.97; 95% CI, 0.65-1.43; P = .87).INTERPRETATION: The OaSiS trial participants showed a significant reduction in tobacco use over time, but no difference by trial arm was found.

IMPORTANCE Low-dose computed tomography (LDCT) lung screening has been shown to reduce lung cancer mortality. Significant incidental findings (SIFs) have been widely reported in patients undergoing LDCT lung screening. However, the exact nature of these SIF findings has not been described. OBJECTIVE To describe SIFs reported in the LDCT arm of the National Lung Screening Trial and classify SIFs as reportable or not reportable to the referring clinician (RC) using the American College of Radiology's white papers on incidental findings. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective case series study of 26 455 participants in the National Lung Screening Trial who underwent at least 1 screening examination with LDCT. The trial was conducted from 2002 to 2009, and data were collected at 33 US academic medical centers.MAIN OUTCOMES AND MEASURES Significant incident findings were defined as a final diagnosis of a negative screen result with significant abnormalities that were not suspicious for lung cancer or a positive screen result with emphysema, significant cardiovascular abnormality, or significant abnormality above or below the diaphragm.RESULTS Of 26 455 participants, 10 833 (41.0%) were women, the mean (SD) age was 61.4 (5.0) years, and there were 1179 (4.5%) Black, 470 (1.8%) Hispanic/Latino, and 24123 (91.2%) White individuals. Participants were scheduled to undergo 3 screenings during the course of the trial; the present study included 75126 LDCT screening examinations performed for 26 455 participants. A SIF was reported for 8954 (33.8%) of 26 455 participants who were screened with LDCT. Of screening tests with a SIF detected, 12 228 (89.1%) had a SIF considered reportable to the RC, with a higher proportion of reportable SIFs among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]). The most common SIFs reported included emphysema (8677 [43.0%] of 20156 SIFs reported), coronary artery calcium (2432 [12.1%]), and masses or suspicious lesions (1493 [7.4%]). Masses included kidney (647 [3.2%]), liver (420 [2.1%]), adrenal (265 [1.3%]), and breast (161 [0.8%]) abnormalities. Classification was based on free-text comments; 2205 of 13 299 comments (16.6%) could not be classified. The hierarchical reporting of final diagnosis in NLST may have been associated with an overestimate of severe emphysema in participants with a positive screen result for lung cancer.CONCLUSIONS AND RELEVANCE This case series study found that SIFs were commonly reported in the LDCT arm of the National Lung Screening Trial, and most of these SIFs were considered reportable to the RC and likely to require follow-up. Future screening trials should standardize SIF reporting.

Supplementary Table 1. Items Assessing Lung Cancer Screening Guideline Knowledge

This article does not include an abstract.Please see the accompanying Point by Jeffrey P. Kanne.

The ACR created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.

BackgroundOne-half of all people who undergo lung cancer screening (LCS) currently use tobacco. However, few published studies have explored how to implement effective tobacco use treatment optimally during the LCS encounter.Research QuestionWas the Optimizing Lung Screening intervention (OaSiS) effective at reducing tobacco use among patients undergoing LCS in community-based radiology facilities?Study Design and MethodsThe OaSiS study (National Cancer Institute [NCI] Protocol No.: WF-20817CD) is an effectiveness-implementation hybrid type II cluster randomized trial of radiology facilities conducted in partnership with the Wake Forest National Cancer Institute Community Oncology Research Program research base. We randomly assigned 26 radiology facilities in 20 states to the intervention or usual care group. Staff at intervention facilities implemented a variety of strategies targeting the clinic and care team. Eligible patient participants were aged 55 to 77 years undergoing LCS and currently using tobacco. Of 1,094 who completed a baseline survey (523 intervention group, 471 control group) immediately before the LCS appointment, 956 completed the 6-month follow-up (86% retention rate). Fifty-four percent of those who reported not using tobacco at 6 months completed biochemical verification via mailed cotinine assay. Generalized estimating equation marginal models were used in an intention-to-treat analysis to predict 7-day tobacco use abstinence.ResultsThe average self-reported abstinence among participants varied considerably across facilities (0%-27%). Despite a significant increase in average cessation rate over time (0% at baseline to approximately 13% at 6 months; P < .0001), tobacco use did not differ by trial group at 14 days (OR, 0.96; 95% CI, 0.46-1.99; P = .90), 3 months (OR, 1.17; 95% CI, 0.69-1.99; P = .56), or 6 months (OR, 0.97; 95% CI, 0.65-1.43; P = .87).InterpretationThe OaSiS trial participants showed a significant reduction in tobacco use over time, but no difference by trial arm was found.Trial RegistryClinicalTrials.gov; No.: NCT03291587; URL: www.clinicaltrials.gov One-half of all people who undergo lung cancer screening (LCS) currently use tobacco. However, few published studies have explored how to implement effective tobacco use treatment optimally during the LCS encounter. Was the Optimizing Lung Screening intervention (OaSiS) effective at reducing tobacco use among patients undergoing LCS in community-based radiology facilities? The OaSiS study (National Cancer Institute [NCI] Protocol No.: WF-20817CD) is an effectiveness-implementation hybrid type II cluster randomized trial of radiology facilities conducted in partnership with the Wake Forest National Cancer Institute Community Oncology Research Program research base. We randomly assigned 26 radiology facilities in 20 states to the intervention or usual care group. Staff at intervention facilities implemented a variety of strategies targeting the clinic and care team. Eligible patient participants were aged 55 to 77 years undergoing LCS and currently using tobacco. Of 1,094 who completed a baseline survey (523 intervention group, 471 control group) immediately before the LCS appointment, 956 completed the 6-month follow-up (86% retention rate). Fifty-four percent of those who reported not using tobacco at 6 months completed biochemical verification via mailed cotinine assay. Generalized estimating equation marginal models were used in an intention-to-treat analysis to predict 7-day tobacco use abstinence. The average self-reported abstinence among participants varied considerably across facilities (0%-27%). Despite a significant increase in average cessation rate over time (0% at baseline to approximately 13% at 6 months; P < .0001), tobacco use did not differ by trial group at 14 days (OR, 0.96; 95% CI, 0.46-1.99; P = .90), 3 months (OR, 1.17; 95% CI, 0.69-1.99; P = .56), or 6 months (OR, 0.97; 95% CI, 0.65-1.43; P = .87). The OaSiS trial participants showed a significant reduction in tobacco use over time, but no difference by trial arm was found. ClinicalTrials.gov; No.: NCT03291587; URL: www.clinicaltrials.gov FOR EDITORIAL COMMENT, SEE PAGE 292Take-home PointsStudy Question: Are radiology facilities able to promote tobacco use cessation effectively among individuals who undergo lung cancer screening using provider- and systems-level implementation of tobacco use treatment?Results: Thirteen percent of participants who smoke in the Optimizing Lung Screening Trial quit using tobacco at 6 months after implementation (P < .0001), but tobacco use did not differ by trial group at 14 days, 3 months, or 6 months.Interpretation: Radiology facilities varied widely in their adoption and sustainability of evidence-based tobacco use treatment, and this heterogeneity may have influenced site-level variation in quit rates among patients undergoing lung cancer screening. FOR EDITORIAL COMMENT, SEE PAGE 292 Study Question: Are radiology facilities able to promote tobacco use cessation effectively among individuals who undergo lung cancer screening using provider- and systems-level implementation of tobacco use treatment? Results: Thirteen percent of participants who smoke in the Optimizing Lung Screening Trial quit using tobacco at 6 months after implementation (P < .0001), but tobacco use did not differ by trial group at 14 days, 3 months, or 6 months. Interpretation: Radiology facilities varied widely in their adoption and sustainability of evidence-based tobacco use treatment, and this heterogeneity may have influenced site-level variation in quit rates among patients undergoing lung cancer screening. Lung cancer accounts for almost 25% of cancer deaths in the United States.1American Cancer SocietyKey statistics for lung cancer: how common is lung cancer? American Cancer Society website.https://www.cancer.org/cancer/lung-cancer/about/key-statistics.htmlGoogle Scholar In 2011, the US National Lung Screening Trial (NLST) demonstrated that annual low-dose CT imaging reduced lung cancer mortality by 20% compared with chest radiography.2Aberle D.R. Adams A.M. Berg C.D. et al.Reduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (7397) Google Scholar Lung cancer screening (LCS) has the greatest public health benefit when coupled with tobacco use cessation.3Tanner N.T. Kanodra N.M. Gebregziabher M. et al.The association between smoking abstinence and mortality in the National Lung Screening Trial.Am J Respir Crit Care Med. 2016; 193: 534-541Crossref PubMed Scopus (140) Google Scholar,4Meza R. Cao P. Jeon J. et al.Impact of joint lung cancer screening and cessation interventions under the new recommendations of the US Preventive Services Task Force.J Thorac Oncol. 2022; 17: 160-166Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Offering moderately effective tobacco use treatments (TUTs) at the time patients who use tobacco undergo LCS could lead to 13% of individuals quitting,5Evans W.K. Gauvreau C.L. Flanagan W.M. et al.Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model.CMAJ Open. 2020; 8: e585-e592Crossref PubMed Scopus (18) Google Scholar with an additional 1.2% reduction in lung cancer incidence and more life-years saved vs screening alone.6Cadham C.J. Cao P. Jayasekera J. et al.Cost-effectiveness of smoking cessation interventions in the lung cancer screening setting: a simulation study.J Natl Cancer Inst. 2021; 113: 1065-1073Crossref PubMed Scopus (31) Google Scholar Meza et al4Meza R. Cao P. Jeon J. et al.Impact of joint lung cancer screening and cessation interventions under the new recommendations of the US Preventive Services Task Force.J Thorac Oncol. 2022; 17: 160-166Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar further demonstrated that TUT with low-dose CT screening substantially reduces lung cancer deaths and increases life-years. For example, adding a cessation intervention of modest effectiveness (15%) to low-dose CT screening results in life-year gains that are comparable with increasing screening uptake from 30% to 100%. In 2015, the Centers for Medicare and Medicaid Services (CMS) required that all patients who use tobacco and undergo LCS receive information on the importance of tobacco use cessation and TUT.7Tammemägi M.C. Berg C.D. Riley T.L. Cunningham C.R. Taylor K.L. Impact of lung cancer screening results on smoking cessation.J Natl Cancer Inst. 2014; 106: dju084Crossref PubMed Scopus (158) Google Scholar CMS also advised that TUT be offered at a shared decision-making visit to discuss screening and at the time of screening. In 2022, CMS removed the requirement that radiology facilities make tobacco use cessation interventions available to those who use tobacco. Nonetheless, LCS serves as an excellent opportunity to expand reach of TUT, given that one-half of all those who undergo LCS currently use tobacco. Few published studies have explored how to optimize the implementation and effectiveness of cessation support during the LCS encounter. The Optimizing Lung Screening Intervention (OaSiS) Trial is a cluster randomized trial to reduce tobacco use among participants undergoing LCS at community-based radiology facilities affiliated with the National Cancer Institute Community Oncology Research Program (NCORP).8Foley K.L. Miller Jr., D.P. Weaver K. et al.The OaSiS trial: a hybrid type II, national cluster randomized trial to implement smoking cessation during CT screening for lung cancer.Contemp Clin Trials. 2020; 91105963Crossref PubMed Scopus (8) Google Scholar This trial is part of the Smoking Cessation at Lung Examination Collaboration.9Joseph A.M. Rothman A.J. Almirall D. et al.Lung cancer screening and smoking cessation clinical trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration.Am J Respir Crit Care Med. 2018; 197: 172-182Crossref PubMed Scopus (90) Google Scholar,10National Cancer InstituteSmoking cessation at lung examination: the SCALE Collaboration. National Cancer Institute website.https://cancercontrol.cancer.gov/brp/tcrb/scale-collaborationGoogle Scholar The Smoking Cessation at Lung Examination Collaboration is an effort combining eight federally funded research studies targeting how best to support tobacco use treatment for patients undergoing LCS. The OaSiS study (Identifier: WF-20817CD) is an effectiveness-implementation hybrid (type II) cluster randomized trial of radiology facilities conducted in partnership with the Wake Forest NCORP Research Base.8Foley K.L. Miller Jr., D.P. Weaver K. et al.The OaSiS trial: a hybrid type II, national cluster randomized trial to implement smoking cessation during CT screening for lung cancer.Contemp Clin Trials. 2020; 91105963Crossref PubMed Scopus (8) Google Scholar A hybrid type II design was chosen because it places equal value on examining effectiveness and implementation outcomes in a single trial. Given that TUT is an evidence-based strategy that has not yet been tested rigorously and repeatedly in the LCS environment, this design gave us the opportunity to asses whether it works in a new setting and under what conditions.11Curran G.M. Bauer M. Mittman B. Pyne J.M. Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.Med Care. Mar. 2012; 50: 217-226Crossref PubMed Scopus (1936) Google Scholar We sent all NCORP community site principal investigators and cancer care delivery research leaders an e-mail outlining eligibility for the trial and soliciting their potential interest. Twenty-eight NCORP community sites with radiology facilities completed a brief survey that assessed LCS volume, the racial and ethnic composition of LCS participants, and availability of tobacco cessation support services within the radiology facility. Cancer care delivery research leaders obtained information from the director of the radiology facility and from health system leaders and data from the electronic health record to complete the survey. To be included in the trial, radiology facilities: (1) had to report an LCS volume of at least 50 screenings within the prior 6 months, (2) had to be willing to be randomized, and (3) had to be able to identify a champion(s) who would serve as the study liaison and organize each facility's efforts to promote tobacco use cessation. Radiology facilities were not excluded from eligibility based on existing cessation support services. A health system with more than one radiology facility chose one location to participate in this trial. This study was approved by the National Cancer Institute Cancer Prevention and Control CIRB on December 10, 2019. Within facilities, we included patients who were referred for LCS and: (1) were aged 55 to 77 years per Medicare reimbursement guidelines for LCS at the time the trial was initiated, (2) self-reported as using tobacco every day or some days at baseline, and (3) had not received tobacco dependence treatment within the last 30 days unless using bupropion for depression. We excluded individuals with any of the following criteria: prior 30-day use of a tobacco dependence treatment, (2) use of e-cigarettes only (dual e-cigarette and cigarette users were eligible), (3) presence of a cognitive or physical impairment that would prevent the person from completing surveys, and (4) did not speak English. Of the 28 NCORP community sites that initially expressed interest and were eligible for the OaSiS trial, 26 radiology facilities per protocol sample size requirements were selected randomly from 20 states. They predominantly were privately owned (88.5%), were urban (73.1%), and had been in operation for an average of 4 years, and one-half of the sites had a lung screening coordinator or navigator who performed shared decision-making for LCS.12Bellinger C. Foley K.L. Dressler E.V. et al.Organizational characteristics and smoking cessation support in community-based lung cancer screening programs.J Am Coll Radiol. 2022; 19: 529-533Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar No differences were found across intervention and control sites regarding these characteristics (Table 1). Radiology facilities were matched in pairs based on lung screening volume and racial and ethnic diversity, and then were assigned randomly to the intervention or usual care group. Facilities were expected to recruit up to 50 eligible participants for the trial. Table 1 provides site-level data on facility ownership (private, public, or university), payor mix of patients seeking LCS (eg, Medicare, Medicaid), duration of the LCS program, number of new LCS screenings in the prior 6 months, and American College of Radiology designation for LCS. Table 2 provides self-reported cessation services offered by the radiology facility (eg, referral to quit line, pharmacotherapy, counseling) at baseline. Champions served as a study liaison and organizer of efforts to promote tobacco use cessation services at the radiology facility. Sites could choose more than one representative to fill these roles. They included LCS program coordinators, lung nodule nurse practitioners, CT scan imaging leaders and technicians, physicians (radiologic medical director, pulmonary), tobacco use cessation counselors, research nurses, and NCORP personnel.Table 1Baseline Characteristics of Radiology Facilities Participating in the OaSiS TrialVariableOverall (N = 26)Control (n = 13)Intervention (n = 13)P ValueHealth system ownership.99 Private23 (88.5)11 (84.6)12 (92.3) Public2 (7.7)1 (7.7)1 (7.7) University1 (3.9)1 (7.7)0 (0.0)LCS program duration, y4.0 (3.0–5.0)3.8 (3.0–4.5)4.0 (3.0–5.5).55No. of LCSs in the prior 6 mo230 (144–442)296 (147–485)230 (139–429).78Type of navigator for SDM.15 Registered nurse8 (30.8)3 (23.1)5 (38.5) Nurse practitioner3 (11.5)3 (23.1)0 (0.0) Medical doctor1 (3.9)1 (7.7)1 (7.7) Research technician1 (3.9)0 (0.0)0 (0.0)Payor mix of patient undergoing LCS Medicare54.0 (36.0–65.0)52.5 (35.0–64.0)56.0 (40.0–65.0).82 Medicaid7.5 (4.5–14.5)10.0 (7.0–20.0)5.0 (0.9–8.0).06 Private30.0 (20.0–39.0)26.0 (20.0–40.0)30.0 (20.0–39.0).82 No insurance0.0 (0.0–2.0)0.0 (0.0–18.0)0.0 (0.0–0.0).20 Other insurance0.0 (0.0–2.5)0.0 (0.0–1.0)0.0 (0.0–3.0).47American College of Radiology designation for LCS11 (42.3)7 (53.8)4 (30.8).43Current tobacco use, %59.5 (50.0–70.0)63.0 (50.0–72.0)54.0 (50.0–60.0).40Data are presented as No. (%) or median (interquartile range), unless otherwise indicated. LCS = lung cancer screening; OaSiS = Optimizing Lung Screening Trial; SDM = shared decision-making. Open table in a new tab Table 2Self-reported Tobacco Use Treatment Services Offered by Radiology Facilities in the OaSiS Trial at BaselineVariableOverall (N = 26)Control (n = 13)Intervention (n = 13)P ValueIndividual provider discussion about tobacco use cessation tailored to the LCS context16 (57.7)9 (69.2)7 (53.8).34Individual provider discussion about tobacco use cessation not tailored to the LCS context15 (55.6)7 (53.8)8 (61.5).50Group tobacco use cessation classes or support at the clinic7 (26.9)3 (23.1)4 (30.8).50Group tobacco use cessation classes or support outside of the clinic10 (38.5)6 (46.2)4 (30.8).34Individual tobacco use cessation classes or support at the clinic14 (53.8)5 (38.5)9 (69.2).12Individual tobacco use cessation classes or support outside of the clinic11 (42.3)6 (46.2)5 (38.5).50Fax referral to state quit line9 (34.6)4 (30.8)5 (38.5).50E-referral to state quit line11 (42.3)5 (38.5)6 (46.2).50Pamphlet or brochure given on quit line20 (76.9)12 (92.3)8 (61.5).08Online tobacco use cessation classes or support5 (19.2)2 (15.4)3 (23.1).50Referral to text-to-quit or other text messaging services to help patients quit using tobacco6 (23.1)2 (15.4)4 (30.8).32Enrollment in text-to-quit or other text messaging services to help patients quit using tobacco3 (11.5)1 (7.7)2 (15.4).50Referral to online, web-based apps to help patients quit using tobacco5 (19.2)1 (7.7)4 (30.8).16Enrollment in online, web-based apps to help patients quit using tobacco3 (11.5)0 (0.0)3 (23.1).11Other4 (16.0)2 (15.4)2 (15.4).67Sum of services by site5.0 (2.8–7.3)5.0 (2.5–6.5)6.0 (3.0–8.0).56Data are presented as No. of sites (%) or median (interquartile range), unless otherwise indicated. LCS = lung cancer screening; OaSiS = Optimizing Lung Screening Trial. Open table in a new tab Data are presented as No. (%) or median (interquartile range), unless otherwise indicated. LCS = lung cancer screening; OaSiS = Optimizing Lung Screening Trial; SDM = shared decision-making. Data are presented as No. of sites (%) or median (interquartile range), unless otherwise indicated. LCS = lung cancer screening; OaSiS = Optimizing Lung Screening Trial. Participants were screened for eligibility before the LCS appointment via telephone or in person on the same day but before the LCS examination. Eligible patients were invited to participate, administered a written informed consent form, and completed an in-person baseline survey immediately before the LCS scan. Participants were contacted by telephone within 14 days and approximately 3 and 6 months after the LCS examination for follow-up surveys. We previously published a description of the intervention strategies.8Foley K.L. Miller Jr., D.P. Weaver K. et al.The OaSiS trial: a hybrid type II, national cluster randomized trial to implement smoking cessation during CT screening for lung cancer.Contemp Clin Trials. 2020; 91105963Crossref PubMed Scopus (8) Google Scholar In brief, the strategies included: (1) virtual training for LCS staff and leadership on the 5As of tobacco cessation counseling (Ask, Advise, Assess, Assist, and Arrange), and pharmacotherapy,13Fiore M.C. Jaen C.R. Baker T.B. et al.A clinical practice guideline for treating tobacco use and dependence: 2008 update—a US public health service report.Am J Prev Med. 2008; 35: 158-176Abstract Full Text Full Text PDF PubMed Scopus (894) Google Scholar shared decision-making and lung screening, motivational interviewing, and the role of CT scan imaging technicians in promoting tobacco use cessation; (2) an in-person strategic planning session on the opportunities and barriers to implementing cessation support; (3) codevelopment of an action plan to implement cessation support into the LCS workflow; (4) performance coaching and audit and feedback to support implementation of cessation support during the LCS visit; and (5) provision of health promotion materials for patients and the clinic. Team members from the radiology facilities in the intervention arm participated in all of the intervention activities. We required that a tobacco cessation champion and members of the imaging team participate in strategies 1, 2, 3, and 4. However, other individuals who participated in these strategies varied by site based on personnel and resources at the radiology facility and health system. Other participants included, for example, lung navigators and centralized tobacco cessation, pharmacy, and marketing personnel. Radiology facilities in the usual care arm were offered all implementation activities after data collection was completed. Receipt of the strategies was voluntary for usual care clinics and not an expectation of trial participation. The primary outcome was self-reported past-7-day tobacco use at the 6-month follow-up survey. Participants who indicated not using tobacco for the past 7 days at the 6-month telephone follow-up were mailed a saliva collection kit (SalivaBio Oral Swab; Salimetrics, Inc.) to validate self-report biochemically. Cotinine levels were determined using the high-sensitivity Salivary Cotinine Quantitative Enzyme Immunoassay kit (item number 1-2002; Salimetrics, Inc.), a competitive immune assay kit with a determination range from 0.8 to 200 ng/mL. Saliva samples were analyzed in duplicate without dilution. Salivary cotinine levels of < 15 ng/mL were deemed consistent with no tobacco use for the prior 7 days. Secondary outcomes included self-reported tobacco use at 14 days and 3 months, quit attempts at 3 and 6 months, and the self-reported number of cessation services received at baseline and 14 days. Participants received $10 gift cards for completion of each survey and a $20 gift card for returning the saliva kit. Sociodemographic characteristics included sex (male, female, or nonbinary), age (55-64 years, 65-74 years, or ≥ 75 years), race or ethnicity (White/non-Hispanic, Black/non-Hispanic, American Indian/non-Hispanic, or Hispanic/all races), residence (metropolitan or nonmetropolitan according to the Rural-Urban Commuting Area coding system), household income (< $15,000, $15,000-$34,999, $35,000-$64,999, or ≥ $65,000), household income or poverty status (≤ 200% vs > 200% of the 2019 US Department of Health and Human Services poverty guidelines), marital status (married or not married), employment status (working, retired, disabled, or not employed for pay), and health insurance coverage (private, Medicaid, Medicare, dual-enrollment in Medicaid and Medicare, military, or not available).14United States Human Resources and Services AdministrationDefining rural population. Human Resources and Services Administration website.https://www.hrsa.gov/rural-health/about-us/what-is-ruralGoogle Scholar Participants self-rated their health as poor or fair, good, or very good or excellent. They also indicated whether they had a family history (yes or no) or personal history (yes or no) of cancer. Participants rated their worry about lung cancer developing (not at all, a little, somewhat, or extremely) and their perceived impact of tobacco use treatment on lung cancer risk (none, a little, somewhat, or very much).15Park E.R. Ostroff J.S. Rakowski W. et al.Risk perceptions among participants undergoing lung cancer screening: baseline results from the National Lung Screening Trial.Ann Behav Med. 2009; 37: 268-279Crossref PubMed Scopus (85) Google Scholar Other tobacco-related measures included a single, validated item for nicotine dependence from the Fagerstrom test for nicotine dependence (smokes one cigarette within the first 30 min of waking: yes or no); cigarettes per day; pack-years smoked; another tobacco user in the household (yes or no); use of other tobacco products in the past 30 days; readiness to quit tobacco use (scale of 1-10, with 10 being the highest readiness); and self-efficacy to quit tobacco use (scale of 1-10, with 10 being the highest).16Heatherton T.F. Kozlowski L.T. Frecker R.C. Fagerstrom K.O. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire.Br J Addict. 1991; 86: 1119-1127Crossref PubMed Scopus (8655) Google Scholar, 17Apodaca T.R. Abrantes A.M. Strong D.R. Ramsey S.E. Brown R.A. Readiness to change smoking behavior in adolescents with psychiatric disorders.Addict Behav. 2007; 32: 1119-1130Crossref PubMed Scopus (26) Google Scholar, 18Latimer-Cheung A.E. Fucito L.M. Carlin-Menter S. et al.How do perceptions about cessation outcomes moderate the effectiveness of a gain-framed smoking cessation telephone counseling intervention?.J Health Commun. 2012; 17: 1081-1098Crossref PubMed Scopus (13) Google Scholar, 19Biener L. Abrams D.B. The contemplation ladder: validation of a measure of readiness to consider smoking cessation.Health Psychol. 1991; 10: 360-365Crossref PubMed Scopus (898) Google Scholar A sample size of 836 participants (26 sites with 32 participants each, assumed intraclass correlation of 0.03) yielded 80% power to detect a 10% difference in self-reported 7-day tobacco use abstinence at 6 months between arms, assuming a 10% abstinence rate in the control arm. To allow for 25% loss to follow-up at 6 months, we planned to enroll 1,114 participants. Sociodemographic, health- and tobacco-related characteristics, and receipt of cessation services were summarized using mean ± SD and No. (%) for continuous and categorical variables, respectively. To account for the nested cluster structure within participants and within facilities, we used generalized estimating equation marginal models in an intention-to-treat analysis as well as sensitivity analyses to predict 7-day tobacco use abstinence. A binomial distribution with logit link was specified with group, time, and the interaction of group by time included as factors while allowing intercept and time to vary by participants within facility with an exchangeable working correlation matrix designation. Sensitivity analysis assessed robustness to missing responses. Restricted maximum likelihood estimation was used to impute missing responses under a missing-at-random assumption via a data augmentation algorithm combined with Markov chain Monte Carlo method with 500 imputations. The variables group, age, sex, marital status, employment, and time were included. After imputation, generalized estimating equation models were performed as described above in each imputed dataset. Results were pooled to obtain summary estimates. Cotinine-verified tobacco use abstinence sensitivity analyses included three models that build on prior generalized estimating equation model assumptions: (1) 6-month self-reported tobacco use abstinence with intervention group as a single factor; (2) with facility clustering, changing participants with cotinine values of > 15 ng/mL without disclosed nicotine replacement therapy (NRT) to still using tobacco at 6 months with all other responses unchanged; and (3) reclassifying participants who self-reported tobacco use abstinence who did not return a sample (or one that could not be processed) as still using tobacco at 6 months. Twenty-six radiology facilities were randomized either to the intervention or to the usual care arm. One control radiology facility withdrew from the study after randomization, but before participant recruitment; the facility was not replaced. One intervention radiology facility withdrew after accruing one participant to the trial and did not obtain any follow-up data after baseline assessments. Therefore, 25 radiology facilities were included in the analysis with 24 having follow-up data (Table 3). Of 1,550 participants assessed for eligibility, 450 were excluded (Fig 1, Consolidated Standards of Reporting Trials diagram). Of the 1,100 participants enrolled, 1,094 eligible participants completed the baseline survey (523 in the intervention arm, 471 in the control arm); 956 completed 6-month surveys for an 86% retention rate.Table 3Demographic Characteristics of Participants in the OaSiS Trial Undergoing LCSVariableOverall (N = 1,094)Control (n = 571)Intervention (n = 523)Adjusted P ValueaAdjusted for correlation within site.Sex.69 Male530 (48.8)281 (49.6)249 (47.9) Female552 (50.8)283 (49.9)269 (51.7) Nonbinary5 (0.5)3 (0.5)2 (0.4)Age, y.10 55-64619 (56.6)333 58.3)286 (54.7) 65-74433 (39.6)220 (38.5)213 (40.7) 75+42 (3.8)18 (3.2)24 (4.6)Race or ethnicity.66 White, non-Hispanic875 (81.9)452 (80.4)423 (83.4) Black, non-Hispanic142 (13.3)74 (13.2)68 (13.4) Hispanic, all races28 (2.6)23 (4.1)5 (1.0) American Indian, non-Hispanic24 (2.3)13 (2.3)11 (2.2)Residence.06 Nonmetropolitan220 (20.2)165 (29.1)55 (10.5) Metropolitan870 (79.8)403 (71.0)467 (89.5)Education.17 < HS, HS, or HS Equivalency555 (51.1)307 (54.1)248 (47.7) Some after HS or college graduate532 (48.9)260 (45.9)272 (52.3)Household income/y.18 < $15,000232 (21.2)137 (24.2)94 (18.1) $15,000-34,999246 (22.5)133 (23.5)113 (21.7) $35,000-64,999234 (21.3)116 (20.5)116 (22.3) $65,000+227 (20.7)109 (19.2)117 (22.5) Unknown155 (14.2)72 (12.7)80 (15.4)Poverty level.46 Yes248 (22.7)145 (25.4)103 (19.7) No686 (62.6)349 (61.1)337 (64.4) Unknown160 (14.

After the National Lung Screening Trial demonstrated that annual lung cancer screening (LCS) with chest CT can reduce lung cancer mortality by 20% [1], CMS released beneficiary screening eligibility as age 55 to 77 years, asymptomatic for lung cancer, smoking history of at least 30 pack-years, and current smoker or a quit time of less than 15 years for former smokers. In addition, screening was to be performed in conjunction with a LCS shared decision making (SDM) visit (to include counseling on the importance of smoking cessation or continued abstinence from smoking for former smokers) and imaging facilities performing LCS were to offer smoking cessation interventions [2].

PURPOSE:The US Preventive Services Task Force has recommended lung cancer screening (LCS) with low-dose CT (LDCT) in high-risk individuals since 2013. Because LDCT encompasses the lower neck, chest, and upper abdomen, many incidental findings (IFs) are detected. The authors created a quick reference guide to describe common IFs in LCS to assist LCS program navigators and ordering providers in managing the care continuum in LCS.METHODS:The ACR IF white papers were reviewed for findings on LDCT that were age appropriate for LCS. A draft guide was created on the basis of recommendations in the IF white papers, the medical literature, and input from subspecialty content experts. The draft was piloted with LCS program navigators recruited through contacts by the ACR LCS Steering Committee. The navigators completed a survey on overall usefulness, clarity, adequacy of content, and user experience with the guide.RESULTS:Seven anatomic regions including 15 discrete organs with 45 management recommendations were identified as relevant to the age of individuals eligible for LCS. The draft was piloted by 49 LCS program navigators from 32 facilities. The guide was rated as useful and clear by 95% of users. No unexpected or adverse experiences were reported in using the guide. On the basis of feedback, relevant sections were reviewed and edited.CONCLUSIONS:The ACR Lung Cancer Screening CT Incidental Findings Quick Reference Guide outlines the common IFs in LCS and can serve as an easy-to-use resource for ordering providers and LCS program navigators to help guide management.

Introduction:The National Cancer Institute Smoking Cessation at Lung Examination (SCALE) Collaboration includes eight clinical trials testing smoking cessation interventions delivered with lung cancer screening (LCS). This investigation compared pooled participant baseline demographic and smoking characteristics of seven SCALE trials to LCS-eligible smokers in three U.S. nationally representative surveys. Methods:Baseline variables (age, sex, race, ethnicity, education, income, cigarettes per day, and time to the first cigarette) from 3614 smokers enrolled in SCALE trials as of September 2020 were compared with pooled data from the Tobacco Use Supplement-Current Population Survey (2018-2019), National Health Interview Survey (2017-2018), and Population Assessment of Tobacco and Health (wave 4, 2016-2017) using the U.S. Preventive Services Task Force 2013 (N = 4803) and 2021 (N = 8604) LCS eligibility criteria. Results:SCALE participants have similar average age as the U.S. LCS-eligible smokers using the 2013 criteria but are 2.8 years older using the 2021 criteria (p < 0.001). SCALE has a lower proportion of men, a higher proportion of Blacks, and slightly higher education and income levels than national surveys (p < 0.001). SCALE participants smoke an average of 17.9 cigarettes per day (SD 9.2) compared with 22.4 (SD 9.3) using the 2013 criteria and 19.6 (SD 9.7) using the 2021 criteria (p < 0.001). The distribution of time to the first cigarette differs between SCALE and the national surveys (p < 0.001), but both indicate high levels of nicotine dependence. Conclusions:SCALE participants smoke slightly less than the LCS-eligible smokers in the general population, perhaps related to socioeconomic status or race. Other demographic variables reveal small but statistically significant differences, likely of limited clinical relevance with respect to tobacco treatment outcomes. SCALE trial results should be applicable to LCS-eligible smokers from the U.S. population.

Cancer survivors are at higher risk than the general population for development of a new primary malignancy, most commonly lung cancer. Current lung cancer screening guidelines recommend low-dose chest CT for high-risk individuals, including patients with a history of cancer and a qualifying smoking history. However, major lung cancer screening trials have inconsistently included cancer survivors, and few studies have assessed management of lung nodules in this population. This narrative review highlights relevant literature and provides expert opinion for management of pulmonary nodules detected incidentally or by screening in oncologic patients. In patients with previously treated lung cancer, a new nodule most likely represents distant metastasis from the initial lung cancer or a second primary lung cancer; CT features such as nodule size and composition should guide decisions regarding biopsy, PET/CT, and CT surveillance. In patients with extrapulmonary cancers, nodule management requires individualized risk assessment; smoking is associated with increased odds of primary lung cancer, whereas specific primary cancer types are associated with increased odds of pulmonary metastasis. Nonneoplastic causes, such as infection, medication toxicity, and postradiation or postsurgical change, should also be considered. Future prospective studies are warranted to provide evidence-based data to assist clinical decision-making in this context.

ImportanceWhile cholinergic receptor nicotinic alpha 5 (CHRNA5) variants have been linked to lung cancer, chronic obstructive pulmonary disease (COPD) and smoking addiction in case–controls studies, their corelationship is not well understood and requires retesting in a cohort study.ObjectiveTo re-examine the association between the CHRNA5 variant (rs16969968 AA genotype) and the development of lung cancer, relative to its association with COPD and smoking.MethodsIn 9270 Non-Hispanic white subjects from the National Lung Screening Trial, a substudy of high-risk smokers were followed for an average of 6.4 years. We compared CHRNA5 genotype according to baseline smoking exposure, lung function and COPD status. We also compared the lung cancer incidence rate, and used multiple logistic regression and mediation analysis to examine the role of the AA genotype of theCHRNA5variant in smoking exposure, COPD and lung cancer.ResultsAs previously reported, we found the AA high-risk genotype was associated with lower lung function (p=0.005), greater smoking intensity (p<0.001), the presence of COPD (OR 1.28 (95% CI 1.10 to 1.49) p=0.0015) and the development of lung cancer (HR 1.41, (95% CI 1.03 to 1.93) p=0.03). In a mediation analyses, the AA genotype was independently associated with smoking intensity (OR 1.42 (95% CI 1.25 to 1.60, p<0.0001), COPD (OR 1.25, (95% CI 1.66 to 2.53), p=0.0015) and developing lung cancer (OR 1.37, (95% CI 1.03 to 1.82) p=0.03).ConclusionIn this large-prospective study, we found the CHRNA5 rs 16 969 968 AA genotype to be independently associated with smoking exposure, COPD and lung cancer (triple whammy effect).

OBJECTIVE:Coronary artery calcification (CAC) is a marker of atherosclerotic cardiovascular disease (ASCVD), the leading cause of death in individuals receiving lung cancer screening (LCS) with low-dose CT. Our purpose was to determine the proportion of the LCS population eligible for primary ASCVD preventive statin therapy by American College of Cardiology/American Heart Association guidelines, assess statin prescription rates among statin-eligible individuals, and determine associations of CAC on downstream statin prescribing within 90 days of LCS.METHODS:Individuals receiving LCS between January 1, 2016, and December 31, 2018, across three centers were retrospectively enrolled. Statin eligibility in individuals without pre-existing ASCVD was determined by 2013 American College of Cardiology/American Heart Association guidelines: (1) low-density lipoprotein ≥190 mg/dL, (2) diabetes, or (3) ASCVD risk score ≥7.5%. CAC presence and severity (mild, moderate, heavy) were extracted from LCS reports. Variation in statin prescription rates and associations between CAC and statin prescription were determined using mixed-effects logistic regression.RESULTS:Of 5,495 individuals receiving LCS, 31.4% (1,724 of 5,495) had pre-existing ASCVD. Of the remaining 3,771 individuals, 73.6% were statin eligible (2,777 of 3,771). However, most lacked statin prescription (60.5%, 1,681 of 2,777). CAC was associated with downstream statin prescribing (adjusted odds ratio = 2.60, 95% confidence interval: 1.12-6.02), with a higher likelihood of statin prescribing with increasing CAC severity (adjusted odds ratio = 2.21, 95% confidence interval: 1.35-3.60).CONCLUSION:Although most of the LCS population is eligible for guideline-directed statin therapy, statins are underprescribed in this group. Radiologist reporting of CAC at LCS reflects a potential opportunity to raise awareness of ASCVD risk and improve preventive statin prescribing.

Beyond the AJR: To Expand the Population-Level Benefit of Lung Cancer Screening, Expand Access to Racially Diverse PopulationsCaroline Chiles, MD1 and Raymond U. Osarogiagbon, MBBS2Audio Available | Share

Abstract Purpose: Many patients presenting for lung cancer screening are current smokers; screening may be a teachable moment for cessation. The objective of the current analysis is to compare cessation readiness among lung screening patients by rural/urban residence and race/ethnicity to identify populations who may benefit from tailored support. Methods: We enrolled 1,095 current smokers presenting for low dose CT lung cancer screening at 24 NCI Community Oncology Research Program (NCORP) imaging clinics as part of the OaSiS trial (WF 20817CD). Prior to screening, we collected data regarding perceived risk and worry about lung cancer, perceived impact of cessation on lung cancer risk, cessation readiness, and quitting self-efficacy (both 1-10 Likert type scales). We classified participants as rural vs urban using the zip-code-based definitions of the Federal Office of Rural Health Policy. We summarized group differences using chi-square analyses. Results: Participants were 50.2% female; average age 64 years (range 55-79); 81.9% non-Hispanic White (NHW), 13.3% non-Hispanic Black (NHB), 2.6% Hispanic, 2.2% American Indian; 20.2% rural residence). The median cigarettes smoked per day was 20 and the median pack years smoked was 44. NHW participants were less likely than other groups to report being “extremely” worried about lung cancer [15.5% vs NHB (31.4%), Hispanic (35.7%), and American Indian (25%), p<.0001]. When queried about their perceived risk of developing lung cancer, NHB (21.8%), Hispanic (14.3%), and American Indian (12.5%) participants were also more likely to report that they didn’t know, compared to NHW participants (9.7%, p <.0001). NHB participants were more likely to believe that quitting smoking would “very much” reduce their risk of lung cancer (52.1%), compared to NHW (36.3%), Hispanic (35.7%), and American Indian (37.5%) participants (p<.001). NHWs reported lower cessation readiness compared to NHB, Hispanic, and American Indian participants (p<.001). NHB and Hispanic participants also reported high quitting self-efficacy compared to NHW and American Indian participants (p<.0001). With regard to rural/urban differences, compared to urban residents, rural residents reported lower or unknown perceived impact of cessation on lung cancer risk (9.5 vs 6.8% no impact & 13.2 vs 6.9% unknown, p<.01). There were no other differences in cessation readiness factors by rural-urban residence. Conclusions: To advance health equity, it is important to understand cessation readiness, among patients presenting to community-based imaging clinics for lung cancer screening. Evidence-based cessation treatment for racial/ethnic minorities within these settings may be enhanced by tailoring for higher cessation readiness. Rural and racial/ethnic minority patients may benefit from enhanced education regarding lung cancer risk and the impact of cessation. This work was supported by the National Cancer Institute (R01CA207158 & UG1CA189824). Citation Format: Kathryn E. Weaver, Erin L. Sutfin, Emily Dressler, Christina Bellinger, David P. Miller, Caroline Chiles, W. J. Petty, Glenn Lesser, Kristie L. Foley. Rural/urban and race differences in factors related to cessation readiness among cigarette smokers presenting for lung cancer screening in community settings [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-009.

PURPOSE:To provide evidence-based recommendations to practicing clinicians on radiographic imaging and biomarker surveillance strategies after definitive curative-intent therapy in patients with stage I-III non-small-cell lung cancer (NSCLC) and SCLC.METHODS:ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, radiology, primary care, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2019. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.RESULTS:The literature search identified 14 relevant studies to inform the evidence base for this guideline.RECOMMENDATIONS:Patients should undergo surveillance imaging for recurrence every 6 months for 2 years and then annually for detection of new primary lung cancers. Chest computed tomography imaging is the optimal imaging modality for surveillance. Fluorodeoxyglucose positron emission tomography/computed tomography imaging should not be used as a surveillance tool. Surveillance imaging may not be offered to patients who are clinically unsuitable for or unwilling to accept further treatment. Age should not preclude surveillance imaging. Circulating biomarkers should not be used as a surveillance strategy for detection of recurrence. Brain magnetic resonance imaging should not be used for routine surveillance in stage I-III NSCLC but may be used every 3 months for the first year and every 6 months for the second year in patients with stage I-III small-cell lung cancer who have undergone curative-intent treatment.