Abstract 1735P
Background
Among long-term cancer survivors (i.e., survived > 5 years since most recent cancer diagnosis) with a non-lung primary cancer, second primary lung cancer (SPLC) has the highest incidence (19%) and mortality (32%) rate among all secondary primary cancers. There are currently no separate screening guidelines for SPLC, though most providers have adopted the general USPSTF recommendation for lung cancer screening (LCS) in cancer survivors. We aimed to assess the differences in LCS eligibility rates among long-term cancer survivors under the USPSTF 2013 vs revised 2021 guidelines.
Methods
Smokers aged 50-79 years were selected from the 2017-2021 US Behavioral Risk Factor Surveillance System data. We assessed the eligibility of LCS using USPSTF 2013 criteria: current or former smokers (quit ≤ 15 years), 55-80 years of age and ≥ 30 pack-year smoking history, and the revised 2021 criteria (expanding age to 50-80 and pack-year to 20) in long-term cancer survivors. Weighted chi-square tests were used with SAS (9.4).
Results
A weighted total of 17,544,768 smokers were selected (2.7% were cancer survivors). The LCS eligibility rate of long-term cancer survivors using the 2013 criteria was similar to the non-cancer survivors (21.1% vs 22.4%; p=0.62) but lower when using the 2021 criteria (31.5% vs 38.0%; p=0.03). The 2021 criteria increased eligibility for long-term cancer survivors across all groups (Table). However, the degree of increase in eligibility rate in cancer survivors was lower than in non-cancer survivors.
Table: 1735P
Weighted eligibility rate % (95%CI) | Long-term cancer survivors (CS) | Δ % in CS | Δ % in non-CS | p-value* | |
2013 USPSTF | 2021 USPSTF | ||||
Overall | 21.1 (16.0-26.2) | 31.5 (26.0-37.1) | 10.4 | 15.6 | <0.01 |
Gender | |||||
Women | 20.5 (13.9-27.1) | 34.3 (27.3-41.5) | 13.8 | 15.8 | 0.43 |
Men | 21.6 (14.0-29.2) | 29.1 (20.9-37.4) | 7.5 | 15.4 | <0.001 |
Race | |||||
Non-Hispanic White | 23.2 (17.4-29.0) | 34.0 (27.8-40.1) | 10.8 | 16.1 | <0.01 |
Non-Hispanic Black | 9.9 (0.2-19.6) | 16.6 (4.3-29.9) | 6.7 | 14.2 | 0.08 |
Other races | 9.0 (0.0-19.0) | 21.5 (2.4-40.5) | 12.5 | 13.5 | 0.90 |
*P-value compares non-cancer survivors vs cancer survivors in the change of eligibility rate from 2013 to 2021 USPSTF criteria.
Conclusions
The increase in eligibility from the revised 2021 USPSTF appears to be less in long-term cancer survivors than in non-cancer survivors. Cancer survivors are facing a significant burden from SPLC due to their prior diagnostic tests and treatments (e.g., chest irradiation), genetic susceptibility, and shared risk factors. Tailored LCS eligibility criteria are urgently needed in the growing cancer survivor population.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
M.L. Hsu: Financial Interests, Institutional, Advisory Board: Regeneron, MJH Life Sciences. A. Dowlati: Financial Interests, Institutional, Research Grant: EMD Serono, Tesaro, Roche, Regeneron, Vertex, Eli Lilly, Bayer, Takeda, Ipsen, United Therapeutics, Mirati, Bristol Myers Squibb, Incuron; Financial Interests, Personal and Institutional, Research Grant: AbbVie, AstraZeneca, Millenium, Seattle Genetics; Financial Interests, Personal, Financially compensated role: Ariad. All other authors have declared no conflicts of interest.
Resources from the same session
1902P - Comparison of cabozantinib (CABO) versus sunitinib (SUN) following first-line (1L) nivolumab plus ipilimumab (NIVO+IPI) for metastatic renal cell carcinoma (mRCC): A target trial emulation using real-world data from the International mRCC Database Consortium (IMDC)
Presenter: Audreylie Lemelin
Session: Poster session 23
1903P - Tumor response by baseline metastases in patients (pts) with renal cell carcinoma (RCC) treated with lenvatinib (L) plus pembrolizumab (P) vs sunitinib (S): Post hoc analysis of the CLEAR trial
Presenter: Viktor Gruenwald
Session: Poster session 23
1904P - Treatment options and outcome of metastatic renal cell carcinoma patients with brain or bone metastases: A real-world evidence from a German retrospective multi-center analysis
Presenter: Pia Paffenholz
Session: Poster session 23
1905P - Heterogeneity in tertiary lymphoid structures predicts the distinct prognosis and immune microenvironment of clear cell renal cell carcinoma
Presenter: Wenhao Xu
Session: Poster session 23
1906P - Metastasized non-clear cell renal cell carcinoma: Which entities are dangerous? Results learned from reference pathology of the SuniForecast study
Presenter: Arndt Hartmann
Session: Poster session 23
1907P - Multi-omics mapping positions antigenic myeloid-T cell crosstalk at the core of advanced renal cell carcinoma (aRCC) response to immune checkpoint blockade (ICB)
Presenter: Lisa Kinget
Session: Poster session 23
1908P - Utility of circulating tumor (ct)DNA testing for molecular residual disease (MRD) detection and treatment response monitoring in patients (pts) with renal cell carcinoma (RCC)
Presenter: Michael Smigelski
Session: Poster session 23
1909P - Baseline cytokine levels according to the line of treatment in patients with metastatic clear cell renal cell carcinoma treated with nivolumab: NIVOREN GETUG-AFU 26 translational study
Presenter: Larissa Rainho
Session: Poster session 23
1910P - Evaluation of a genome-wide methylome enrichment platform for circulating tumor DNA quantification and prognostic performance in renal cell carcinoma (RCC)
Presenter: Brian Rini
Session: Poster session 23
1911P - Effect of VHL mutations on efficacy of immune checkpoint inhibitors in renal cell carcinoma
Presenter: Guojie Yu
Session: Poster session 23