Lung Cancer Screening for VA Patients May Strain Resources

CT lung cancer screening of U.S. Veteran Affairs patients will increase demand, resulting in substantial clinical effort for both patients and staff, according to a study published in JAMA Internal Medicine.

Researchers from North Carolina, Minnesota, Oregon, South Carolina, and Pennsylvania sought to estimate the number of Veterans Health Administration (VHA) patients who may be candidates for annual lung cancer screening (LCS) with low-dose computed tomography (LDCT). The project was conducted at eight academic VHA hospitals among 93,033 primary care patients who were assessed on screening criteria between July 1, 2013, and June 30, 2015. The researchers measured the percentages of patients who agreed to undergo LCS, had positive findings on results of LDCT, were found to have lung cancer, or had incidental findings; and the estimated number of VHA patients who met the criteria for LCS.

The results showed that 4,246 patients met the criteria for LCS; 2,452 (57.7%) agreed to undergo screening and 2,106 (2028 men and 78 women; mean age, 64.9) underwent LCS. Of the 2,106 patients screened, 1,257 (59.7%) had nodules. Among these patients:

• 1,184 (56.2%) required tracking

• 42 (2.0%) required further evaluation but the findings were not cancer

• 31 (1.5%) had lung cancer

There was also a variety of incidental findings, such as emphysema, other pulmonary abnormalities, and coronary artery calcification, noted on the scans of 857 patients (40.7%).

The researchers concluded that nearly 900,000 of a population of 6.7 million VHA patients met the criteria for LCS. Implementation of LCS in the VHA will likely lead to large numbers of patients eligible for LCS and will require substantial clinical effort for both patients and staff.