ABSTRACT
Background:
The management of pulmonary nodules
plays a critical
role in early
detection of
lung cancer. Computed
tomography (CT) has led to a stage-shift towards early-stage
lung cancer, but regional differences in
survival rates have been reported in
Denmark. This study aimed to evaluate whether variations in nodule management among Danish
health regions contributed to these differences. Material and
Methods:
The Danish
Health Data Authority and Danish
Lung Cancer Registry provided data on CT usage and
lung cancer stage distribution, respectively. Auditing of
lung cancer stage IA
patient referrals and nodule management of stage IV
lung cancer patients was conducted in seven Danish
lung cancer investigation centers, covering four of the five Danish
health regions. CT scans were performed up to 2 years before the
patients'
diagnosis from 2019 to 2021.
Results:
CT usage has increased steadily in
Denmark over the past decade, with a simultaneous increase in the proportion of early-stage
lung cancers, particularly stage IA. However, one Danish
health region, Region Zealand, exhibited lower rates of early-stage
lung cancer and overall
survival despite a CT usage roughly
similar to that of the other
health regions. The audit did not find significant differences in pulmonary nodule management or a higher number of missed nodules by
radiologists in this region compared to others.
Conclusion:
This study suggests that a high CT scan volume alone is not sufficient for the early
detection of
lung cancer. Factors beyond
hospital management practices, such as
patient-related delays in socioeconomically disadvantaged areas, may contribute to regional differences in
survival rates. This has implications for
future strategies for reducing these differences.
