Results of Lung Cancer Screening in a Rural Setting: A Retrospective Cohort Study

Background In this study, we aimed to determine the performance of the lung cancer screening (LCS) program using low-dose computed tomography (LDCT) in a rural community. Methodology We conducted a retrospective cohort study of patients who underwent LCS at a rural healthcare institution from September 1, 2016, through December 31, 2019, to determine the utilization of screening, rate of positivity, rate of cancer detection, and patient compliance. Results A total of 1,474 patients underwent initial LCS, and 1,776 LCS examinations were performed using LDCT. Of 1,776 tests performed, 375 (21.1%) were categorized as positive (Lung CT Screening Reporting and Data System III or higher), with 215 of the 375 (57.6%) being lost to follow-up. A total of 29 malignancies were identified (in 1.6% of all LCS tests) during the study period, with 23 (82.8%) malignancies being low-stage malignancies (stage I or II), 24 (79.3%) malignancies potentially surgical candidates (stage IIIA or less), and five (17.2%) malignancies being non-surgical candidates based on stage (stage IIIB or IV). A total of 28.7% of all patients eligible for repeat screening had at least one repeat annual test. Overall, 9.9% of all patients eligible for two repeat annual tests had a second repeat annual test. Conclusions LCS using LDCT is effective in detecting lung cancer in a rural setting. However, compliance with repeat annual screening and recommendations for further workup is low. This may be exacerbated by healthcare and socioeconomic issues prevalent in rural communities. The use of LCS patient coordinators and dedicated tracking software may improve compliance with repeat annual screening and compliance with recommendations when LCS tests are positive.