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Reassessing Efficacy: Understanding Failures in Lung Cancer Screening Despite Low-Dose CT Protocol Adherence.

About this Publication
Title
Reassessing Efficacy: Understanding Failures in Lung Cancer Screening Despite Low-Dose CT Protocol Adherence.
Pubmed ID
40446891 (View this publication on the PubMed website)
Digital Object Identifier
Publication
Ann Thorac Surg. 2025 May 28
Authors
Wu VS, Boutros C, Bassiri A, Jiang B, Sinopoli J, Tapias-Vargas L, Linden PA, Towe CW
Affiliations
  • Department of Surgery, Brigham and Women's Hospital, Boston, MA.
  • Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
  • Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
  • Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH. Electronic address: christopher.towe@uhhospitals.org.
Abstract

BACKGROUND: Despite substantial benefits of low-dose CT screening (LDCT), some patients still die of lung cancer despite screening. Factors contributing to LDCT screening "failures" remain unclear. We hypothesize specific clinical and demographic factors increase screening failure risk.

METHODS: We retrospectively analyzed 16,081 National Lung Screening Trial patients undergoing LDCT screening with an initial negative scan. Screening success was defined as no lung cancer diagnosis or surviving lung cancer treatment. Screening failure included (1) three negative scans followed by death from lung cancer, (2) a stage 4 lung cancer diagnosis during the study, or (3) a positive scan with subsequent death from lung cancer. Logistic regression analyses assessed factors associated with screening failure.

RESULTS: Of 15,775 patients (98.1%) with negative screenings who remained cancer-free, 306 cancer cases occurred. Among them, 102 (33.3%) had successful screenings, while 204 (66.6%) experienced screening failure. Failure was more common among men, those over 65, and current smokers, with no significant differences by race, ethnicity, or marital status. Multivariable analysis identified higher failure risk associated with age over 70 (OR=2.65; 95% CI: 1.66-4.12), male sex (OR=1.56; 95% CI: 1.13-2.17), current smoking (OR=2.03; 95% CI: 1.52-2.73), chronic obstructive pulmonary disease (OR=2.20; 95% CI: 1.35-3.46), emphysema (OR=1.94; 95% CI: 1.27-2.88), sarcoidosis (OR=7.99; 95% CI: 1.24-29.0), and firefighting (OR=2.14; 95% CI: 0.99-4.07).

CONCLUSIONS: LDCT screening does not prevent all adverse outcomes. Factors like age, male sex, smoking, chronic obstructive pulmonary disease, emphysema, sarcoidosis, and firefighting increase failure risk. Targeted interventions may enhance effectiveness and reduce mortality.

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