Lung Cancer Risk for Patients Undergoing Cardiac Chest CT: Identification of a New High Risk Population for Lung Cancer Screening.

BACKGROUND: Lung cancer screening (LCS) rates are low despite expanded eligibility criteria. Many patients receiving cardiac CT scans may also have risk factors for lung cancer. We aimed to identify an opportunity to increase LCS by quantifying this population. METHODS: All patients in our healthcare system from January 2011 to December 2023 who received a CT heart or CT angiogram heart were included. Lung cancer rates in this population were assessed. LCS eligibility was determined by USPSTF guidelines. RESULTS: A total of 31,684 patients received cardiac CT scans and 17,232 patients met the study criteria (documented smoking history, age 50-80 years, no prior diagnosis of lung cancer). Based on 2021 USPSTF guidelines, 114 (0.7%) patients were eligible for LCS compared to 0.37% of all patients in our healthcare system. A total of 73 patients undergoing cardiac CT developed a diagnosis of lung cancer. Among those meeting LCS eligibility, 1 (0.8%) developed lung cancer, 7 (6.1%) received a low dose CT, and 21 (18.4%) received a diagnostic chest CT. An additional 72 (0.4%) patients of patients who received a cardiac CT were subsequently diagnosed with lung cancer at a median of 19.8 (5.7, 51.7) months, yet did not meet LCS eligibility. CONCLUSIONS: Risk of lung cancer diagnosis among patients receiving cardiac CT scan is significantly higher than that of the general population. However, most of these patients did not qualify for LCS. Advocacy for more complete chest imaging in this population may facilitate identification of lung cancer for early intervention.