Lung Cancer Screening with Low Dose Computed Tomography in Patients With and Without Prior History of Cancer in the National Lung Screening Trial.

Patients with a prior history of cancer (PHC) are at increased risk of second primary malignancy, of which lung cancer is the most common. We compared the performance metrics of positive screening rates and cancer detection rates among those with versus without PHC.
We conducted a secondary analysis of 26,366 National Lung Screening Trial participants screened with LDCT between August 2002 and September 2007. We examined absolute rates and age-adjusted relative risks (RRs) of positive screening rates based on retrospective Lung-RADS application, invasive diagnostic procedure rate, complication rate, and cancer detection rate in those with versus without PHC using a binary logistic regression model using Firth’s penalized likelihood. We also compared histology, stage, and treatment in those with versus without PHC.
4.1% (n=1,071) of patients had PHC. Age-adjusted rates of positive findings were similar in those with versus without PHC (Baseline: PHC=13.7% versus no PHC=13.3%, RR (95%CI)=1.04 (0.88-1.24); Subsequent: PHC=5.6% versus no PHC=5.5%, RR (95%CI)=1.02 (0.84-1.23)). Age-adjusted cancer detection rates were higher in those with versus without PHC on baseline (PHC=1.9% versus no PHC=0.8%, RR (95%CI)=2.51 (1.67-3.81)) but not on subsequent screenings (PHC=0.6% versus no PHC=0.4%, RR (95%CI)=1.37 (0.99-1.93)). There were no differences in cancer stage, histology, or treatment by PHC status.
Patients with PHC may benefit from lung cancer screening, and with their providers, should be made aware of the possibility of higher cancer detection, invasive procedures, and complication rates on baseline lung cancer screening, but not on subsequent LDCT screening examinations.