A study entitled “Education Level Drives Appropriate Follow-up of Incidental Findings from Lung Cancer” was recently awarded a 2019 Gold Merit Abstract Award in the Safety and Quality category by the American College of Radiology (ACR). Co-authored by Radiology faculty Kim Sandler, M.D., Alexis Paulson, MSN, APRN, WHNP-BC, TTS, and colleagues in the Vanderbilt Lung Screening Program, the research was performed by Vanderbilt University School of Medicine (VUSM) student Suraj Kapoor during his Research Immersion course.
According to data revealed by the ACR’s Lung CT Screening Reporting & Data System (Lung-RADS), nearly 10 percent of low-dose CT (LDCT) examinations result in clinically significant incidental findings. While alternative research in this area focuses primarily on frequency and cost of follow-ups for incidental findings on LDCT, Kapoor says that very limited data exists on factors that may influence appropriate follow-up of those findings.
“Appropriate follow up of clinically significant incidental findings is a well-recognized way of improving population health,” said Kapoor. “Education level is a significant independent predictor of appropriate follow-up of incidental findings, whether as an indicator of health literacy or as a surrogate of socioeconomic status beyond that of insurance.”
In their evaluation of 109 patients with clinically significant incidental findings, the overall appropriate follow-up rate was 81 percent. When looking at demographic factors, including age, sex and race, as well as insurance status, they found education level to be a statistically significant determinant of follow-ups. As a result of their findings, they have recommended that the lung screening shared decision-making visit be adapted to include health literacy and proficiency.
“Clinically significant incidental findings offer an opportunity for life-saving interventions for lung screening patients,” said Sandler. “This study identified an at-risk population within our program where patient care can be improved. Suraj has done wonderful work during his research immersion and has chosen to continue working with us next year. We are very fortunate to have him as part of our team.”
Kapoor will continue his work with Sandler and the Vanderbilt Lung Screening team to publish a manuscript that further details the findings of his research. Other collaborators on the project include Vanderbilt Drs. Stephen Deppen, Diane Haddad, Pierre Massion and James Cook.
Since its inception in 2013, the Vanderbilt Lung Screening Program has performed more than 2,000 screening examinations on over 1,500 patients. More than 50 cancers have been diagnosed including 6 extra-thoracic cancers that were initially reported as clinically significant incidental findings through lung cancer screening.
For additional information on the Vanderbilt Lung Screening Program and the screening recommendations, visit vumc.org/radiology/lung.
