Evaluation of Early Lung Cancer Detection in a Population at High Risk due to Occupation.

[BACKGROUND] We assessed the effectiveness of early lung cancer detection (ELCD) in reducing lung cancer mortality in a high-risk occupational cohort using low-dose CT (LDCT) with eligibility criteria that included age, smoking, and occupational risk factors without regard to time since having stopped smoking.

[METHODS] We investigated lung cancers diagnosed and mortality outcomes since the ELCD program's inception in 2011. Lung cancer mortality analyses included ELCD participants who completed at least a baseline scan and a control group of ELCD-eligible nonparticipants. Cox models estimated the relationship between ELCD program participation and lung cancer mortality, with deaths identified using the National Death Index.

[RESULTS] Lung cancer was detected in 57 (2.94%, 95% CI = 2.19-3.69) of 1941 ELCD participants. Forty-nine cases of nonsmall cell lung cancer (NSCLC) were detected, with 40 (81.6%) being Stage I or Stage II. A 49% reduction in lung cancer mortality was observed among ELCD participants (hazard ratio = 0.51, 95% CI = 0.32-0.81) with median follow-up 6.1 years. Applying the USPSTF 2021 eligibility criteria would have excluded nearly 40% of lung cancer deaths from screening.

[CONCLUSIONS] Lung cancer screening in this high-risk population, with screening eligibility adjusted for occupational risk factors and no time limit since last having smoked, is effective in reducing lung cancer mortality. Continued annual screening is important. Revisions to ELCD eligibility criteria are needed to include risk factors beyond age and smoking when supported by population-specific evidence.