Trends in Lung Cancer Presentation and Survival in the Era of Screening

In December 2013, the U.S. Preventive Services Task Force recommended low-dose computed tomography (CT) screening for lung cancer in high-risk individuals (NEJM JW Gen Med Feb 15 2014 and Ann Intern Med 2014; 160:330). Randomized trials demonstrated that malignancies were diagnosed at earlier stages and survival improved in screened groups, but these effects have not been demonstrated in real-world populations.

Using U.S. national oncology databases, investigators identified >750,000 patients who received diagnoses of non–small-cell lung cancer (NSCLC) between 2010 and 2018. Among these patients, the percentage who received diagnoses of stage I NSCLC and median all-cause survival increased significantly more rapidly from 2014 to 2018 than from 2010 to 2013; in other words, rates of change in early diagnosis and survival increased starting around 2014. By 2018, the proportion of cases diagnosed at stage I had increased to 36%, and median all-cause survival had increased to 28 months. In 2018, for the first time, white patients more often received diagnoses of stage I than of stage IV NSCLC; however, stage IV cases continued to exceed stage I cases in other ethnic groups.