ABSTRACT
INTRODUCTION: We have previously published the outcome of a community-based lung cancer screening program. We now report on the 5-year follow-up of this study and include both patients with and without airflow obstruction. MATERIALS AND METHODS: One thousand two hundred fifty-six patients completed questionnaires in the office of their primary care physicians, and 430 of this group were assessed to be at high risk for lung cancer. These patients then underwent spirometry, and 88 of 126 patients with airflow obstruction consented to lung cancer screening test. TESTING METHODS: Complete screening testing included spirometry, two-view chest radiograph, chest CT scan, and sputum cytology examinations. RESULTS: Eight lung cancers were found in the high-risk group with airflow obstruction. No more cancers were found in the tested group in the 5 years since the earlier report. Ten cancers were found in the 304 patients with normal airflow, not previously reported. In all, 18 lung cancers were found in 430 patients deemed at risk by a simple one-page questionnaire (4.2%). CONCLUSIONS: A questionnaire, self-administered in a primary care office setting, helps identify patients at high risk of lung cancer. If upcoming results of randomized controlled trials show a benefit of lung screening, this tool could be of help to select patients for screening.
Subject(s)
Ambulatory Care/methods , Lung Neoplasms/diagnosis , Outcome Assessment, Health Care , Primary Health Care/methods , Pulmonary Disease, Chronic Obstructive/etiology , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Colorado/epidemiology , Female , Follow-Up Studies , Humans , Lung Neoplasms/complications , Lung Neoplasms/mortality , Male , Middle Aged , Prognosis , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/mortality , Respiratory Function Tests , Retrospective Studies , Risk Factors , Survival Rate/trends , Time FactorsABSTRACT
INTRODUCTION: This prospective study describes a community-based lung cancer identification project focusing on high-risk patients who receive general care in a primary care outpatient practice. Within 1 calendar year, a simple questionnaire was completed in 1,296 patients > 50 years old to identify 430 patients at high risk of lung cancer (smoking, family history of aerodigestive tract cancer, or occupational exposures). Spirometric abnormalities were found in 126 of these patients. METHODS: Chest posteroanterior radiographs, thoracic CT scans, and sputum cytology were offered to subjects with airflow obstruction (n = 126). Eighty-eight patients underwent all tests. Thirty-eight patients refused or could not consent in a timely fashion. RESULTS: Six cancers were found in the screened group, and all were treated. Two more cancers were found in the nonscreened patients with airflow obstruction. Both were treated by surgical resection or radiation therapy. Costs per cancer found were $11,925 per patient. CONCLUSIONS: Case finding in high-risk patients in a primary care population can be accomplished at a relatively low cost.
