ASCO 2025 | Elevated lung cancer diagnosis rates in Mississippi Delta cohorts

What I’m presenting on Monday is the results of an ongoing prospective cohort study of lung cancer screening and incidental pulmonary nodule programs in a large regional community healthcare system, the Baptist Memorial Healthcare Corporation, that’s based out of Tennessee, Mississippi, and Arkansas. The healthcare system is a not-for-profit faith-based healthcare system that covers about 150 counties in six states, including parts of Kentucky and Missouri and Alabama. And what we did in 2015 was we started these two programs about the same time, a lung cancer screening program, which essentially takes people who meet eligibility criteria for lung cancer screening, and an incidental pulmonary nodule program in which patients who have a radiologic study for any reason that reveals the presence of a potentially concerning lung lesion, a spot in the lung, get tagged by the radiologist. And then we have an automated way to capture all such reports. And then we have a team that triages those patients to various pathways of care using the Fleischner Society’s guidelines. So what we show is that from 2015 to about June 2024, we have slightly more than 8,000 people enrolled in the screening program. And then we looked at the nodule cohort with a baseline nodule no bigger than 30 millimeters. And there was slightly more than 20,000 of those. So for every one patient in the screening program, we had approximately three patients in the nodule program. And over that span of time, we have seen that we have more than 400 lung cancer patients from the screening program and about 1,200 in the nodule program. And what we essentially looked at was the rate of diagnosis of lung cancer through both programs. The rate of diagnosis of lung cancer in the screening program within three years was about 4.8 percent. And in the Nodule program, it was about the same thing, just slightly less. But the key point we emphasize is that this is with only three years of follow-up, which compares to the national lung screening trial, which identified about 3.9% of lung cancer patients after six and a half years of follow-up. The point we’re making is that the lung cancer screening trials actually significantly underestimate the value of screening and early detection. We are actually finding twice as many people diagnosed with lung cancer, and the stage distribution of these patients is exactly what we desire, much heavier skewed into earlier stage than you would expect. So the implications of this are that the risk-benefit calculations that we make about the value of screening and its population impact are actually based on the lung screening trials, which significantly underestimate the value of this. So the cost effectiveness and the risk benefit equations are all using numbers that actually make screening look less valuable than it really is.

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