Abstract PR006: Screening under-served populations by mobile low dose computerized tomography (LDCT) scans results in stage shift with potential cures: Time for a change in health policy?
Authors: Raghavan Derek , Doege Darcy , Wheeler Mellisa , Dungan Kia , III John Doty , Hickman Glenn , Mileham Kathryn , Carrizosa Daniel 
Published: January 2023

Abstract
Background: More than 60% of under-served patients with lung cancer first present with advanced/metastatic disease. Randomized trials have shown that LDCT of chest reduces lung cancer mortality but under-served populations have been excluded from these studies because of financial, geographic, insurance and access problems. We have tested the first mobile LDCT units and demonstrated improved access. We report a shift to earlier stage at diagnosis and potential cures in a large under-served population that includes African American, Hispanic/LatinX and Native American subjects. Methods: We developed two coaches fitted with portable 32 slice low-dose CT scanners to screen uninsured and under-served heavy smokers for lung cancer in an IRB-approved program ("The Oncologist", 2019). All films were reviewed by a central panel (using LUNG RADS protocol). Medicare patients were excluded because their insurance covers LDCT lung screening (but it should be noted that the elderly population is at increased risk for lung cancer, leading to a negative case selection bias). Results: We initially screened 1200 uninsured/under-insured subjects, mean age 61 years (range 55-64), with average pack year history of 47.8 (range 30- &gt;150); 61% male; 18% Black, 3% Hispanic/LatinX, &lt;1% Native American; 78% rural. We found 97 pts with LUNG RADS 4 (very high risk) lesions, 30 lung cancers (2.5%), including 18 at stage I-III treated with curative intent (60%); &gt;50% had intercurrent cardiovascular disease and COPD seen on LDCT. We have additionally screened 574 cases, including 51 Native Americans (in a structured assessment of one tribe). Of the Native Americans, 5 had LUNG RADS 3-4 (high risk) lesions, but no cancers have been identified to date. For the total series of 1774 subjects with age-related negative case selection bias, 42 lung cancers have been identified (2.4%), 26 of which were treated with curative intent (62%) via surgery, radiation, or chemo-radiation. Only one patient of 18 treated with curative intent in the first series of 30 lung cancers has relapsed to date (median follow up 3 years, with 5 without evidence of disease beyond 3.5 years). These data confirm a shift to detection of early-stage lung cancer in this large under-served population, with an apparent potential for cure. Conclusion: Mobile LDCT yields a higher screening rate for under-served patients than prior hallmark trials, with a consequent shift to early-stage detection of lung cancer, with sustained treatment-induced complete remissions beyond 4 years. This approach could be applied to improve national lung cancer survival in the under-served.
Citation Format: Derek Raghavan, Darcy Doege, Mellisa Wheeler, Kia Dungan, John Doty III, Glenn Hickman, Kathryn Mileham, Daniel Carrizosa. Screening under-served populations by mobile low dose computerized tomography (LDCT) scans results in stage shift with potential cures: Time for a change in health policy? [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr PR006.