Comprehensive Lung Cancer Screening Is Complex Task With Many False Positives

MedicalResearch.com Interview with:

Dr-Linda-Kinsinger.jpg

Dr. Linda Kinsinger

Linda Kinsinger, MD, MPH
National Center for Health Promotion and Disease Prevention
U.S. Department of Veterans Affairs
NW Washington DC 20420

MedicalResearch.com: What is the background for this study? 

Response: The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose computed tomography (LDCT) for current and former heavy smokers ages 55 to 80.

However, clinicians have questioned the practical aspects of implementing lung cancer screening. VA provides care for 6.7 million Veterans each year, mostly older men – many of whom are current or former smokers – thus the implementation of a lung cancer screening program for VA patients would require substantial resources. In order to understand the feasibility and implications of this for patients and clinical staff, VA implemented a three-year Lung Cancer Screening Demonstration Project (LCSDP) in eight geographically-diverse VA hospitals. Investigators identified 93,033 primary care patients at eight sites who were assessed on screening criteria, of whom 2,106 patients were screened between July 2013 and June 2015.

MedicalResearch.com:  What are the main findings?

The main findings are:

1) participants in the LCSDP found implementing a comprehensive lung cancer screening program to be challenging and complex, requiring new tools (e.g., electronic tools to capture necessary clinical data in real time) and patient care processes for staff, in addition to dedicated patient coordination;

2) there was wide variation in processes and patient experience among the study sites (for example, across the eight sites, 58% of patients who were offered screening agreed to be screening, ranging from 34% to 66% across the sites), and

3) overall, 60% of the 2,106 Veterans screened for lung cancer had a positive result.

This included having nodules needing tracking (56.2%), workup for possible lung cancer (2.0%), and diagnosed lung cancer (1.5%).

MedicalResearch.com: What should readers take away from your report?

Response: Providing a lung cancer screening program is a complex process that requires strong collaboration and coordination among staff in several clinical services and between clinical staff and patients who may be or are being screened. Many patients who undergo screening may have findings that raise concerns but are not cancer.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future research should:
1) examine closely the impact of screening on smoking cessation;
2) study design and use of decision aids to support shared decision making for lung cancer screening; and 3) explore the significance of and patient experience with incidental findings on LDCTs.

MedicalResearch.com: Is there anything else you would like to add?
Response: Two of the co-authors disclosed potential conflicts of interest (as listed in the article).

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Kinsinger LS, Anderson C, Kim J, Larson M, Chan SH, King HA, Rice KL, Slatore CG, Tanner NT, Pittman K, Monte RJ, McNeil RB, Grubber JM, Kelley MJ, Provenzale D, Datta SK, Sperber NS, Barnes LK, Abbott DH, Sims KJ, Whitley RL, Wu RR, Jackson GL. Implementation of Lung Cancer Screening in the Veterans Health Administration. JAMA Intern Med. Published online January 30, 2017. doi:10.1001/jamainternmed.2016.9022

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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