Eligibility for lung cancer screening in Greece: a retrospective study

Background: Screening for lung cancer has resulted in significant improvement in disease-specific and overall survival in large prospective studies. Aims and objectives: To assess the coverage of lung cancer screening programs in the Greek population. Methods: We performed a retrospective chart review of patients with lung cancer diagnosed at Sotiria General Hospital for Chest Diseases, Athens, Greece, between January 2016 and May 2019. Descriptive statistics were utilized to calculate the proportion of patients that would be eligible for lung cancer screening and chi-squared test to assess for associations between baseline patient characteristics and lung cancer screening criteria. All hypothesis testing was conducted at a two-sided significance level of α=0.05. Results: 878 patients were included in the analysis. The median age at diagnosis was 67 years (range 34-93). 72.4%, 21.6%, and 5.9% of patients were current, former, and never smokers, respectively. The proportion of patients eligible for lung cancer screening at the time of diagnosis ranged according to the screening criteria applied (NLST: 59.5%, USPSTF: 77.9%, NELSON: 63.7%). Baseline characteristics associated with the NLST eligibility criteria were squamous (OR, 2.04; 95% CI, 1.48-2.83; p=0.00001) and small cell (OR, 2.13; 95% CI, 1.42-3.25; p=0.002) histology as well as lack of targetable driver alterations (OR, 2.79; 95% CI, 1.39-5.96; p=0.004). Conclusions: The majority of patients with lung cancer qualify for screening at the time of diagnosis. Baseline characteristics directly linked with smoking are associated with screening eligibility; more personalized screening approaches are needed for light- or never-smokers.