1. Title: Presenters: Date: Proportion of Newly Diagnosed Non-Small Cell Lung Cancer Patients That Would Have Been Eligible for Lung Cancer Screening Division of Thoracic Surgery City of Hope National Medical Center Duarte, CA Geena X. Wu, MD; Leanne Goldstein, DrPH; Jae Y. Kim, MD; Dan J. Raz, MD

2. Disclosures Leanne Goldstein: Rockwell Medical, Inc Dan Raz: Cireca, LLC

3. Introduction Lung cancer screening (LCS) guidelines among major health organizations. LCS criterion Other (NLST derived)USPSTFCMS NCCNAATS PrimarySecondaryPrimarySecondary Age (years)55-7455-8055-7755-7450-7955-7950-79 Smoking History (pack-years) ≥30 ≥20≥30≥20 Quit time (years)15 none Other criteria---- Additional risk factor - Additional risk factor ↑ lung cancer risk ≥5% in 5 years American Lung Association. http://www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-guidelines/http://www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-guidelines/ Detterbeck FC. Chest 2013;143(5 Suppl):e78S-92S. Jaklitsch MT1. JTCVS 2012;144(1):33-38. Jensen T. Memo: CMS 2015. Report No.: CAG-00439N. Smith RA. CA Cancer J Clin 2014;64(1):30-51 Wood DE. J NCCN 2012;10(2)240-265. Moyer VA. Ann Intern Med 2013.

4. Methods 2,244 adults with NSCLC 2,030 NSCLC patients with complete smoking history Current smokers 630 (31%) Former smokers 873 (43%) Never smokers 527 (26%) 214 patients with unknown or incomplete smoking status or history Retrospective institutional cohort (1994-2014) Text-mining and manual review of EMR Final cohort Excluded from analysis Patients with history of malignancy 442 (22%) Identified in cancer registry Secondary LCS criteria Primary LCS criteria

5. Results: Applying USPSTF LCS Criteria Current smokers n=873 Former smokers N=630 Mean age (years)6369 Median pack- years smoked4630 Median quit- time (years)-15 LCS criteria met, n (%) All Age Pack-year Quit time 425 (67.5) 480 (76.2) 524 (83.2) - 273 (31.3) 685 (78.5) 497 (56.9) 440 (50.4) All 31.8% 26.9% 16.4% 40.7% 45.0% 36.6% 35.0% 29.2% 45.6% 26.5%

6. Results: Applying USPSTF LCS Criteria Current smokers n=873 Former smokers N=630 Mean age (years)6369 Median pack- years smoked4630 Median quit- time (years)-15 LCS criteria met, n (%) All Age Pack-year Quit time 425 (67.5) 480 (76.2) 524 (83.2) - 273 (31.3) 685 (78.5) 497 (56.9) 440 (50.4) M F 45.0% 36.6% 35.0% 29.2% 45.6% 26.5% 13.1% 5.8%

7. Results: Applying USPSTF LCS Criteria All criteria met n=698 (34.4%) +6.6% +9.3% +23.0% Exclude quit time n=832 (41.0%) Exclude quit time and age n=887 (43.7%) Exclude quit time and pack-year n=1,165 (57.4%)

8. Results: Comparing LCS Criteria

9. Discussion Summary –A third of NSCLC patients met all LCS criteria –Only half of former smokers met quit time criterion Limitations –Generalizability of data –Retrospective application of LCS to NSCLC patients –Inability to determine timing or benefit of LCS Future Directions –Prospective assessment of utility of current LCS criteria, especially the quit time maximum –Consensus on a uniform, validated set of criteria to promote LCS

10. Title: Presenters: Date: Thank You