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Access to blood-based lung cancer screening test raises screening rate in primary care Key takeaways: - The proportion of patients who received any lung cancer screening was significantly greater in clinics with vs. without FirstLook Lung blood test access. - This was also the case for low-dose CT receipt. ORLANDO — More patients in primary care practices with vs. without access to a blood-based lung cancer screening test received screening, according to findings presented at the American Thoracic Society International Conference. “It looks like access to this particular blood test does, in fact, increase lung cancer screening rates and increases them in a way that would be clinically meaningful,” James M. Davis, MD, medical director for Duke Center for Smoking Cessation, director of the Duke smoking Cessation program and co-director of the Duke-UNC tobacco treatment specialist credentialing program at Duke Cancer Institute, said during his presentation. In the cluster randomized interventional FIRSTLUNG study, Davis and colleagues assessed 2,953 individuals who qualified for low-dose CT (83.7% never screened; 7.5% behind on screening [≥ 15 months]) from 28 primary care practices to determine the impact of blood-based lung cancer screening via the FirstLook Lung blood test on receipt of lung cancer screening vs. usual care. “Currently, lung cancer screening rates are a little north of 18%, which is really painfully low,” Davis said. “18.2% for lung cancer screening really pales in comparison to our other cancers,” he added. “We see breast cancer screening, cervical cancer [and] colon cancer screening between 65% and 70% uptake.” In his presentation, Davis highlighted that the FirstLook Lung blood test has previously showed high screening-population sensitivity (80%) and a negative predictive value (99.8%). Screening-population specificity was lower at 56%. “This is a test that stratifies patients based on the likelihood that they would have cancer,” Davis said. “A person would get a blood test, and then those who have a relatively high likelihood would go on to low-dose CT, and those who have a very low likelihood would not go on to low-dose CT. With those patients who are found to have a very low likelihood, the blood test itself would be considered sufficient screening. “As a clinician, which I am, negative predictive value is probably the most important number that I’m looking for in a test,” he added. “That tells me that if I order a test on a patient and it comes back negative, I am 99.8% confident that that patient’s going to be OK. It’s not perfect, it never is with a screening test, but that’s a high level of confidence.” Providers from 13 clinics (100% urban; median patients per clinic, 79; median clinicians per clinic, nine) had access to the FirstLook Lung blood test (intervention arm; n = 1,291; 83.1% never screened; 6.8% behind on screening), whereas providers from 15 clinics (87% urban, median patients per clinic, 89; median clinicians per clinic, 7) had access to low-dose CT (usual care arm; n = 1,662; 84.2% never screened; 8.1% behind on screening). In the usual care arm, providers from nine clinics had access to CME on lung screening in addition to low-dose CT (n = 737), whereas providers from seven clinics did not (n = 925). “The patient sample in this study was patients who qualified for lung cancer screening according to U.S. Preventive Task Force guidelines but were not receiving lung cancer screening by those guidelines,” Davis said. “We’re not actually retesting patients who are successfully getting their annual low-dose CTs,” he continued. “We’re focused on the patients who should be getting CTs, but they’re not getting screening.” In both sets of patients, researchers found comparable ages (mean: intervention, 64.3 years; usual care, 64.6 years), pack-years (median, 33.8; 35) and years since quitting (mean, both 7.5). Additionally, the groups were similar in sex (women: 51.7%; 50.8%), race/ethnicity (non-Hispanic white individuals: 64.7%; 71.5%; non-Hispanic Black: 27.7%; 21.1%), smoking status (current: 51.4%; 50.3%) and comorbidities (COPD: both 46.3%; cardiovascular disease: 46.6%, 45.7%; asthma: 21.1%, 17.7%). The proportion of patients who received any lung cancer screening (low-dose CT or blood test) was significantly greater in the intervention vs. usual care arm at 11 months (20.9% vs. 8.4%; adjusted HR = 2.73; 95% CI, 1.91-3.89). When looking at only those who received low-dose CT, researchers again found a significantly larger proportion of patients in the intervention vs. usual care arm at 11 months (13.4% vs. 8.4%; aHR = 1.47; 95% CI, 1.14-1.89). “These are the people who, by and large, qualify for low-dose CT but had not been getting it in the past, so any increase in this patient population is a significant win in terms of lives saved,” Davis said. Researchers also divided patients up by health network, age, sex, race/ethnicity, smoking status, pack-years and COPD. In each subgroup, a larger proportion of patients received any lung cancer screening in the intervention vs. usual care arm. In addition to assessing receipt of lung cancer screening, Davis noted that they modeled the 5-year population health impact of blood-based lung cancer screening access and observed more screen-detected cancers with blood test plus low-dose CT access vs. only low-dose CT access (65,361 vs. 41,369). “There was a significant increase in detecting cancers at stage one, which is really critical, and a decrease that was a concomitant reflexive decrease in detecting cancers at stage four,” Davis said. “We’re detecting them at an earlier stage instead of a later stage. “Modeling showed that over a 5-year period we saved roughly 3,000 lives from lung cancer death,” he continued.