Lung cancer screening programs can contribute significantly to the incidental identification of esophageal cancer in a high-risk population

Lung cancer screening (LCS) also identifies incidental esophageal abnormalities. We report the extent of incidentally found esophageal cancers during our initial 4 years of LCS in a VA (Veterans Affairs) population. A retrospective chart review of a single-center VA Medical Center LCS program in the underserved Southern Appalachia was performed. Esophageal findings of asymptomatic patients and subsequently diagnosed esophageal cancers were recorded and compared to the symptomatically-detected cancers. During the initial 4 years, 3,893 Veterans were screened. Of our healthcare system's detected esophageal cancers, 19% were detected by LCS asymptomatically, with a prevalence of 0.26%. During the same time, the prevalence of symptomatically-detected cancers was 0.097%. The prevalence of the LCS-detected asymptomatic cancers was 2.7× higher than the symptomatic cancers (<i>p</i> = 0.004). The LCS-detected esophageal cancers showed a significantly lower stage (<i>p</i> = 0.025). Strikingly, the number of stage IV cases was only 10% in the LCS group compared to 43% in the symptomatically-detected group. Lung cancer screening in a rural Veteran population identifies esophageal cancers more often than in unscreened Veterans. About 1/389 Veterans undergoing LCS was found to have an asymptomatic esophageal cancer. LCS-detected esophageal cancer presented at a lower stage. LCS programs should be vigilant regarding incidental esophageal findings.