A Cross-Sectional Evaluation of Guideline-Adherent Screening Eligibility Among Zimbabwean Patients Diagnosed with Lung Cancer

Introduction
Lung cancer screening enables earlier detection at more treatable stages, reducing mortality and healthcare costs. For high-risk individuals—identified by age and smoking history—it offers timely, effective treatment options. However, current screening criteria, mainly from the US and Europe, may not suit African populations due to differing demographics, risk factors, and life expectancy. This study assessed Zimbabwean cancer patients' eligibility for lung cancer screening using four established criteria.
Methodology
This cross-sectional study reviewed all lung cancer cases treated at Parirenyatwa Hospital in Harare, Zimbabwe over five years. We assessed each patient's eligibility for lung cancer screening one year prior to diagnosis using American Cancer Society (ACS), American Association for Thoracic Surgery (AATS), U.S. Preventive Services Task Force (USPSTF) and European Society of Radiology (ESR) criteria.
Results
A total of 30 female and 43 male lung patients were reviewed and had median age of 65 years (IQR52-71) and 61 years (IQR54-69), respectively. A history of smoking was present in 81% of males and only 3% of females with a median pack-year history of 28 (IQR15-40). Histologically non-small cell carcinoma comprised 97% in females and 94% males and 77% had distant metastases. Based on the ACS, AATS, USPSTF and ESR criteria 30%, 27%, 30% and 16% of the lung cancer patients were eligible for screening. The varied significantly between males and females- ACS 49% vs 3% (OR 0.04, 95% CI 0.005-0.3, P= 0.0018); AATS 44% vs 3% (OR 0.04, 95% CI 0.005-0.3, P= 0.0032); USPSTF 49% vs 3% (OR 0.04, 95% CI 0.005-0.3 P= 0.0018 and ESR 26% vs 3% (OR 0.1, 95% CI 0.01- 0.8, P=0.03).
Conclusion
The majority of lung cancer patients in Zimbabwe would not have qualified for screening under the current guidelines. This is partly a result of very low smoking rates among women and potentially other risk factors such as environmental exposures or genetic predispositions that require further investigation