Lung Cancer Prevalence after 4 years of screening in a COPD/Emphysema centered screening program

<b>Introduction:</b> Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces mortality from lung cancer in high risk individuals. <b>Aim:</b> The objective of this study was to identify the prevalence of LC in a population of high risk subjects meeting NLST criteria with COPD and or emphysema as an additional risk factor for LC. <b>Material and Methods:</b> Prospective cross-sectional analysis of the LCS program cohort. A total of 1005 patients were included, of which 949 have at least one baseline LDCT. Follow up adhered to the well established i-ELCAP protocol. Prevalence of lung cancer, histology, CT findings, lung function and epidemiologic variables were recorded. <b>Results:</b> The prevalence of LC was 2,31% (n=22). 13% had an extra-pulmonary synchronic cancer. The most frequent type of LC was adenocarcinoma (64%), followed by squamous cell carcinoma (23%). Most LCs were operable (64% in stages I and II). Surgery was the most frequent treatment in 64% of the patients. Median survival at 4 years was 94%. Pulmonary emphysema was present in 86% of patients with LC, and 80% were active smokers. COPD and emphysema coexisted in 73% of the patients with LC. <b>Conclusion:</b> A COPD/emphysema based strategy for the selection of LCS candidates is feasible. The prevalence of LC in our high risk cohort was 2.31%. 64% of patients were operable, and median survival at 4 years was 94%.