Background: Alkylating agents and thoracic radiation put survivors of Hodgkin lymphoma (HL) at excess risk of lung cancer (30-year cumulative incidence 6.4%). Lung cancer screening (LCS) using low-dose CT thorax (LDCT) scans reduces lung cancer mortality in ever smokers in the general population by detecting early-stage lung cancers. We ran an LCS pilot in HL survivors, who are generally ineligible for LCS programmes aimed at the general population.
Methods: 218 5+ year survivors of HL treated with mustine or procarbazine and/or thoracic radiation were identified from a follow-up database (ADAPT) hosted at The Christie NHS Foundation Trust and sent a letter of invitation. Participants underwent a baseline LDCT scan. Scans were reported as negative/indeterminate/positive in accordance with lung nodule guidelines. Indeterminate nodules required a further LDCT scan 3-months later. Participants with a positive scan were referred to lung cancer services.
Results: Of the 218 invited to the study 54% were female, median age was 53 (range 25-80), median years since treatment 21 (6-45). 12 were ineligible. 127 (59%) expressed interest in participating. The uptake among eligible responders was 83% (102/123). Participation was not influenced by age or gender. Baseline LDCT scan results in 102 participants were: 90 (88.2%) negative, 10 (9.8%) indeterminate, 2 (2.0%) positive. 3-month surveillance LDCT scan results (n=9) were: positive (2), stable (5), with 2 pending. Among 4 participants with positive baseline or 3-month scans, 1 has been diagnosed with early-stage small-cell lung cancer and treated with curative intent, 1 is undergoing tests for presumed lung cancer and 2 are undergoing further surveillance. Coronary artery calcification was detected in 36.3%. Clinically significant incidental findings including emphysema, bronchiectasis, pulmonary inflammation/infection, metastatic breast cancer and vertebral insufficiency fractures were seen in 20 (19.6%). Notably, 3/35 participants who were ever smokers met the age and risk criteria for LCS through the programme aimed at the general population.
Conclusion: LDCT scanning protocols tested in the general population are appropriate for use in the HL survivor population in a future targeted LCS programme. The feasibility of such a programme is contingent on developing methods to identify and contact long-term survivors of HL at risk of lung cancer and on investigating and addressing barriers to uptake.