Prospective cohort study of lung cancer diagnosis rates in early detection programs in the Mississippi Delta

Estimates of the impact of lung cancer screening (LCS) largely rely on the 3.97% lung cancer diagnosis rate (LCDR) from the National Lung Screening trial. A prospective cohort study of a large regional community health care system in the Mississippi Delta was carried out to estimate the LCDR in clinical LCS and incidental pulmonary nodule (IPN) programs. The study included participants who had at least one low-dose computed tomography scan (CT) for lung cancer detection or any CT scan finding an IPN diameter of 30 mm or less and no prior history of lung cancer between January 1, 2015, and June 30, 2024. The primary outcome was aggregate LCDRs. Among 40 612 participants, 15 754 were enrolled in the LCS cohort and 24 858 were enrolled in the IPN cohort. Cumulative LCDRs at 36 months were 3.8% and 4.3% in the LCS and IPN programs, respectively. The LCDR was similar to or exceeded the 3.97% reported in the National Lung Screening Trial after a median follow-up of 6.5 years. The authors conclude that these findings suggest that LCS and IPN programs may have greater LCDRs than projected from clinical trial data.