Abstract Rationale Screening high-risk smokers using low dose CT (LDCT) chest has shown to reduce lung cancer-related mortality. High prevalence of tuberculosis (TB) potentially leads to increased false positives in lung cancer screening. Exposure to biomass fuel is associated with the development of lung cancer but the role of screening with LDCT has not been elucidated. We carried out a prospective study to understand the feasibility of lung cancer screening in a TB endemic population amongst high risk smokers and biomass fuel exposure in India. Methods Subjects aged 45-75 years with high-risk smoking history (smoking index 400 and current smokers or stopped 15 years) or biomass fuel exposure (BMFE index 100) were enrolled to undergo three annual rounds of CT chest scans (T0, T1, and T2). Reporting was done using Lung RADS v2022. Proportion of patients with a positive screen (RADS 3-4), lung cancer detection rate and the impact of TB sequelae on positive screen was calculated. Results A total of 347 high risk smokers (mean (SD) age 61.45 (7.67) years; 96.5% males) and 72 subjects amongst the BMFE group (mean (SD) age 61.28 (7.43) years; all females) underwent baseline (T0) scan. On this baseline scan, 10.6% and 6.9% of the respective groups had positive screen, of which seven lung cancers were diagnosed, all in the high-risk smoker group. 136 subjects underwent the first follow up annual scan (T1), of which 7.4% of the high risk smoker group and 7.1% of the BMFE group had positive screen. No lung cancer was diagnosed in these subjects, while one patient underwent wedge resection for a positive nodule which turned benign. Twenty subjects underwent the second annual scan (T2), of whom none had positive screen. Presence of radiological sequelae of tuberculosis was not associated with positive screen in either of the groups (p value (chi2) = 0.42). Conclusion Screening for lung cancer is feasible using LDCT in TB endemic countries with lung cancer detection rates comparable to those seen in larger cohorts. The potential role of annual follow up scans after an initial negative scan needs to be confirmed in larger cohorts.Further studies are needed to elucidate the potential utility of lung cancer screening in the high-risk BMFE group. This abstract is funded by: None
Bhatia et al. (Fri,) studied this question.