Equity for under-served populations in lung cancer screening and treatment: Does mobile low-dose CT scanning lead to stage shift and diagnosis with potential cures at 4 years of follow-up?

8551 Background: Randomized trials proved that screening high-risk patients with LDCT of chest reduces lung cancer mortality. Under-served patients have missed this benefit in most studies through access issues. We showed that mobile LDCT improves access and now assess if this translates to equity of survival. Methods: We used two coaches with BodyTom © portable 32 slice low-dose CT scanners (Samsung) to screen uninsured and under-served heavy smokers for lung cancer (Oncologist, 2019). All films were reviewed by central panel using LUNG RADS technique. Protocol was approved by Advarra IRB. Medicare pts were excluded as insurance covered them for LDCT (causing negative bias for diagnosis as the elderly are at high risk). Results: We initially screened 1200 uninsured/under-insured subjects, mean age 61 years (range 55-64), with average pack year history of 47.8 (30-150); 61% male; 18% Black, 3% Hispanic/Latino; 78% rural. We found 97 pts with LUNG RADS 4 (high risk) lesions, 30 lung cancers (2.5%), including 18 at stage I-III treated with curative intent (60%); 5 incidental non-lung cancers (renal CA 2, head & neck CA 1, pancreas CA 2); > 50% with intercurrent cardiovascular disease and COPD seen on LDCT. Of eligible first-screen subjects, 51% attended 12 month repeat LDCT and 27% attended third LDCT. One pt (6%) treated with curative intent has relapsed to date (median follow up 2.5 years, with 25% beyond 3 years). An additional 288 screened pts revealed 9 lung cancers (5 stage I-III), confirming shift to early stage disease at diagnosis. Conclusions: Mobile LDCT yields higher screening rate for under-served pts than prior hallmark trials, with shift to early-stage detection of lung cancer, with sustained treatment-induced remissions beyond 4 years. This approach could be applied to improve national lung cancer survival in the under-served.