Impact of Low-dose Chest CT Screening on the Association Between Rurality and Lung Cancer Outcomes.

INTRODUCTION: Lung cancer mortality is higher among rural United States populations compared with nonrural ones. Little is known about screening low-dose chest computed tomography (LDCT) outcomes in rural settings. MATERIALS AND METHODS: This retrospective cohort study examined all patients (n=1805) who underwent screening LDCT in a prospective registry from March 1, 2015, through December 31, 2019, in a majority-rural health care system. We assessed the proportion of early-stage lung cancers (American Joint Committee on Cancer stage I-II) diagnosed among LDCT-screened patients, and analyzed overall survival after early-stage lung cancer diagnosis according to residency location. RESULTS: The screening cohort had a median age of 63 and median 40-pack-year smoking history; 62.4% had a rural residence, 51.2% were female, and 62.7% completed only 1 LDCT scan. Thirty-eight patients were diagnosed with lung cancer (2.1% of the cohort), of which 65.8% were early-stage. On multivariable analysis, rural (vs nonrural) residency was not associated with a lung cancer diagnosis (adjusted hazard ratio 1.59; 95% CI, 0.74-3.40; P =0.24). At a median follow-up of 37.1 months (range, 3.3 to 67.2 months), 88.2% of rural versus 87.5% of nonrural patients with screen-diagnosed early-stage lung cancer were alive ( P =0.93). CONCLUSIONS: In a majority-rural United States population undergoing LDCT, most screen-detected lung cancers were early-stage. There were no significant differences observed between rural and nonrural patients in lung cancer diagnosis rate or early-stage lung cancer survival. Increased implementation of LDCT might blunt the historical association between rural United States populations and worse lung cancer outcomes.

Lung cancer in women--an unrecognized epidemic.

Lung cancer claims the lives of more women in the United States than breast cancer. The overall 5-year survival rate for lung cancer-15%-has not changed much in the past 50 years. By contrast, the 5-year survival rate for breast cancer in women is 86%. In Minnesota, the number of lung cancer deaths among women started exceeding deaths from breast cancer in 1992. This article looks at the explanations behind the phenomenon and ways to reduce deaths from lung cancer among women.

Preventing cardiovascular disease in women: an intervention-control randomized study.

This 1-year, group-randomized, intervention-control study looked at the effectiveness of a primary prevention, community-based program for reducing cardiovascular (CV) risk factors in women. Women between the ages of 20 and 50 were recruited through community contacts, including religious and academic institutions, health clinics, and large local employers in the Duluth, Minnesota, and Superior, Wisconsin, area. All study activities took place in neighborhood places of worship. Screenings at baseline and 12 months included physical and laboratory measurements addressing CV risk factors and assessment of the women's knowledge about CV disease in women. All participants received an individualized review of their CV risk factors and recommendations for modifying them, along with educational literature about CV disease in women. The control group had limited follow-up compared with the intervention group, who participated in general CV health classes and received a follow-up phone call and information about health resources. The study showed that education and one-on-one follow-up significantly change behavior. Comprehensive community-based screening and individualized review decrease women's risk for CV disease.