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Eric Grogan



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    MA20 - Implementation of Lung Cancer Screening (ID 923)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 F
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      MA20.05 - Who Gets Screened for Lung Cancer? A Simple Adjustment to Current Guidelines to Reduce Racial Disparities (ID 13992)

      15:45 - 15:50  |  Author(s): Eric Grogan

      • Abstract
      • Presentation
      • Slides

      Background

      Background. The United States Preventive Services Task Force (USPSTF) recommends low-dose computed tomography screening for lung cancer in current or former smokers age 55-80 years with a minimum 30 pack-year history and having quit no more than 15 years ago. However, these guidelines were developed in the predominantly white population of the National Lung Screening Trial and therefore may not be generalizable to African Americans who have different smoking patterns. We evaluated USPSTF lung cancer screening guidelines in a predominantly African American prospective cohort with an elevated incidence of lung cancer.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Methods. The Southern Community Cohort Study (SCCS) is a prospective observational cohort of approximately 86,000 adults (two-thirds African American) aged 40-79 years enrolled primarily at community health centers from 2002-2009 across 12 Southern U.S. states. Former and current smokers were included in the present study and were followed for up to 9 years. We examined the impact of race and smoking history on eligibility for lung cancer screening using USPSTF guidelines.

      4c3880bb027f159e801041b1021e88e8 Result

      Results. Among N=50,524 adult (67% African American, 33% white) ever smokers at baseline (64% current smokers, median age 50 years at enrollment) in the SCCS, we identified 1,359 incident lung cancers. Among lung cancer patients, 32% of African Americans were eligible for screening following USPTSF criteria compared with 55% of whites (p<0.001). The lower percentage of eligible African Americans was primarily due to African Americans having smoked fewer pack-years than whites (14 vs 27 median pack-years, respectively, p<0.001). Lowering the smoking pack-year eligibility criteria to a minimum 20-29 pack-year history, increased the number of African Americans eligible for screening by 38%. With a lower smoking pack-year criterion for African Americans, sensitivity increased from 32% to 50% and specificity decreased from 87% to 78% yielding sensitivity and specificity values that were similar to whites (55% sensitivity, 75% specificity) using the USPSTF guidelines.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusion. Current lung cancer screening guidelines are too conservative for African Americans. A greater percentage of African Americans are excluded from screening opportunities primarily due to lower smoking histories. Adjustment of pack-years in lung cancer screening guidelines by race will result in more equitable screening for smokers at high risk for lung cancer.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.11-06 - A New Histoplasmosis Antibody Enzyme Immunoassay for the Diagnosis of Lung Benign Nodules (ID 13881)

      16:45 - 18:00  |  Author(s): Eric Grogan

      • Abstract

      Background

      Granulomas caused by infectious lung diseases often present as indeterminate pulmonary nodules on radiography. Newly available antibody enzyme immunoassay (EIA) test for histoplasmosis has not been studied for the evaluation of lung nodules suspicious for cancer. This study investigates serum biomarkers for histoplasmosis measured by a new CLIA-certified test as a response to exposure when positive and as a predictor of benign disease in indeterminate pulmonary lung nodules from a highly endemic region.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      376 serum samples from our biorepository of patients presenting with pulmonary nodules ≤30mm in maximum diameter were analyzed for histoplasmosis by the IgG and IgM EIA. Manufacturer-suggested levels for histoplasmosis diagnosis was used to indicate a positive test for antibodies. Final diagnosis was determined pathologically or by radiographic follow-up. Diagnostic test characteristics with 95% confidence intervals (CI) for benign lung disease were estimated.

      4c3880bb027f159e801041b1021e88e8 Result

      Cancer prevalence was 59% (n=223). Seventy-seven (20%) samples were positive for IgG anti-Histoplasma antibodies (Table 1). Twenty-one (5.6%) were IgM antibody positive and 84 (22%) were positive for either antibody. Positive diagnostic likelihood ratios (DLR) for benign disease were 3.22 (95%CI: 2.08,4.98) for IgG antibodies, 6.19 (95%CI: 2.13,18.1) for IgM antibodies each separately, and 2.92 (95%CI: 1.95,4.37) if either IgG or IgM were positive. When both IgG and IgM antibodies were positive then DLR was 42.2 (95%CI: 2.54,702). When both IgG and IgM were found (n=14), no nodules were cancerous. Only a positive EIA test offered clinically informative results.

      iaslc abstract table 1.tif

      8eea62084ca7e541d918e823422bd82e Conclusion

      A positive EIA test for both IgM and IgG strongly suggests benign granuloma and ruled out lung cancer for 9% of benign nodules arising from a highly endemic area of the country. The new EIA test may improve the diagnostic evaluation of indeterminate pulmonary nodules and avoid harmful invasive biopsies. Additional investigation in conjunction with other non-invasive cancer biomarker tests is warranted.

      6f8b794f3246b0c1e1780bb4d4d5dc53