Innovative Approach to Early Lung Cancer Detection: Integrating a Comprehensive Screening Program and an Incidental Pulmonary Nodule Clinic

Abstract

Background: Lung cancer (LC) is the leading cause of cancer-related death. Early detection strategies include LC screening (LCS) with low-dose computed tomography (LDCT) and incidental pulmonary nodule clinics (IPNCs). This study describes the structure, workflow, and outcomes of an integrated early diagnosis strategy combining LCS and IPNCs.

Material and methods: We conducted a descriptive analysis of a prospective observational study (May 2023–June 2025) implementing an integrated IPNC-LCS model. All IPNC patients underwent initial LCrisk assessment: highly suspicious lesions were referred to a fast-track diagnostic pathway, low-risk patients to primary care (PC), and high-risk individuals to the LCS program. Additional referrals to the LCS program were received from pulmonology clinics and PC. The LCS program followed the I-ELCAP protocol, including LDCT, lung function testing, 1-antitrypsin deficiency (AATD) screening, and smoking cessation support.

Results: The IPNC evaluated 481 individuals: 30 (6.2%) had suspicious lung lesions, with four stage I LC confirmed; 282 (58.6%) were classified as low-risk; and 150 (31.2%) as high risk of whom 97 were enrolled in LCS. The LCS program also received 199 referrals from PC and 122 from pulmonology clinics, totaling 418 participants at baseline (63.2% male; mean age 63.0 ± 6.43 years; 52.9% former smokers; 39.7% with COPD; 67.9% with emphysema). New diagnoses included emphysema (n = 106), COPD (n = 25), and AATD mutations (n = 95). Smoking cessation referral was accepted by 74% of smokers. LC was detected in 17 participants (4.07%), 14 (82.4%) at stage I, all receiving curative-intent treatment.

Conclusions: This integrated IPNC–LCS model achieved high early-stage LC detection and enabled curative treatment, while uncovering unrecognized respiratory comorbidities and promoting smoking cessation.