br Conclusions The implementation of new lung cancer screening guidelines
Conclusions: The implementation of new lung cancer screening guidelines did not change clinical practice in the management of patients with LC and many patients do not receive recommended screening. Further study concerning potential barriers to eﬀective evidence-based screening and coordination of care is warranted.
Worldwide, head and neck cancer (HNC) accounts for > 550,000 cases and 380,000 deaths annually and its incidence is expected to rise in the future [1,2]. Even though the incidence of HPV-related HNSCC has been steadily rising over last decade, smoking and alcohol con-sumption remain major risk factors . Smoking as a causative agent of head and neck cancer is even more pronounced in laryngeal cancer, as the majority of diagnosed laryngeal cancers are HPV-negative [4,5].
Smoking is a risk factor not only for head and neck cancer, but also for lung cancer, which has an incidence greater than HNC in smokers and is one of the leading smoking-related cause of death [6,7]. These
factors have led to intensive investigation of the role of screening for primary lung cancer, facilitated by the technological development of widespread CT scanners. After the publication of large clinical trials, in January 2014 the U.S. Preventive Services Task Force (USPSTF) re-commended annual lung cancer screening with low-dose CT in a well-defined group of high-risk smokers . The formal criteria for screening are: adults aged 55–80, with at least 30 pack-years smoking history in those who currently smoke or have quit within the past 15 years. These screening programs have been shown to prevent a substantial number of lung cancer–related deaths in patients who were screened with three CT scans over the course of two years .
There is significant overlap between the at-risk Colcemid for
☆ Conflict of Interest: None of the authors have any conflicts of interest or financial ties to disclose.
☆☆ The authors whose names are listed immediately above certify that they have NO aﬃliations or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in eras manuscript.
☆☆☆ Financial Support: Financial Support for this study was provided by the NIDCD Mentored Patient-Oriented Research Career Development Award 1K23DC014758 (S. Best).
K. Piersiala, et al.
laryngeal cancer and lung cancer given the risk factors for these re-spective diseases. Smokers make up at least 85% of patients with lar-yngeal cancer , with an average age of 65 , demographic fac-tors clearly in line with the screening criteria for primary lung cancer. Further evidence for the overlap between these populations is the fact that the 5-year survival rate for laryngeal cancer is only 63% , in part because the incidence of secondary primary lung cancer (SPLC) in this group is high, ranging from 5 to 19%, which in turn has a sig-nificant impact on overall survival [13–16].
Physicians who treat patients with laryngeal cancer are therefore encountering a highly-selected group of patients with risk factors for primary or secondary lung cancer, and a significant proportion of pa-tients with laryngeal cancer (LC) meet the formal screening criteria for annual lung CT scans. We hypothesized that clinical practice regarding ordering of chest CTs would change as a result of the introduction of these evidence-based guidelines. We further sought to identify the factors that led to patients receiving or missing the recommended screening and the practice patterns that facilitate the implementation of these guidelines.
2. Materials and methods
The study was approved by the institutional review board of Johns Hopkins School of Medicine, Baltimore, MD, USA. Informed consent was not required for this retrospective chart review.
We conducted a retrospective chart review of patients diagnosed with LC and treated at Johns Hopkins Hospital who met USPSTF criteria for annual chest screening and were followed for at least 3 consecutive years in the years surrounding the January 2014 publication and in-troduction of screening guidelines (January 2010 to December 2017). Eligible patients therefore met the following criteria: 1) age of 55 to