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Objective:
The calcium score screening CT (CSSCT) is widely recognized for its effectiveness in stratifying cardiovascular disease (CVD) risk and guiding preventive therapy. Given that CVD and lung cancer share several common risk factors (e.g., smoking, obesity, diabetes mellitus), it is imperative to consider the role of CSSCT in incidental lung cancer detection. Existing major guidelines lack specific recommendations concerning the imaging field of view (FOV) (small vs. wide), which can impact the detection of incidental lung nodules or cancers. Our study aims to share our institutional experience with incidental lung cancer detection through a no-cost CSSCT program.

Materials and Methods:
We conducted a review of 30,679 consecutive patients who underwent CSSCT between January 1, 2013, and February 29, 2019, under an IRB-approved protocol. The patient list was cross-referenced with an existing cancer registry through natural language processing (NLP) and checked against the Electronic Medical Record (EMR) for pathologically confirmed cancers. We analyzed the distribution of detected lung cancers in both small (cardiac) and full field of view (FOV) reconstructions. We also compared the detection rates between small (cardiac) and full field of view (FOV) reconstructions. Additionally, subset analyses were conducted focusing on sex distribution and smoking history within the cohort diagnosed with lung cancer. Descriptive statistics were used to summarize the patient characteristics and diagnosis rates. For the subset analyses, we employed chi-square tests to examine the distribution of sex and smoking history among those diagnosed with lung cancer. Additionally, percentage calculations were used to quantify the impact of FOV on lung cancer detection.

Results:
Out of 30,679 individuals, 2,887 (9.4%) patients were diagnosed with cancer following a calcium score screening examination. Among these, 170 were diagnosed with lung cancer, constituting 5.9% of the cancer-diagnosed subset. Out of these, 57 patients (17 males, 40 females; 33.5% of lung cancer cases) were identified as having, previously unknown, lung malignancy a direct result of the CSSCT program. Their smoking history indicated that 27 were former smokers (47.4%), 18 had an unknown smoking status (31.6%), 10 were never smokers (17.5%), and two were current smokers (3.5%). Our FOV data analysis revealed that 18 out of these 57 (31.6%) cases would have gone undetected in absence of full FOV reconstruction.

Conclusion:
Our study underscores the importance of incidental lung nodule observation, reporting, and follow up in calcium score screening examinations for early lung cancer detection and treatment. Additionally, we highlight the crucial role of full FOV reconstruction in enhancing the detection rates of incidental cancers.