15 Jul Recommended Low-dose CT Scanning For Lung Cancer Often Not Understood or Implemented
MedicalResearch.com Interview with:
Jan Marie Eberth, PhD
Assistant Professor, Department of Epidemiology and Biostatistics
Deputy Director, SC Rural Health Research Center
Core Faculty, Statewide Cancer Prevention and Control Program
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Large, randomized clinical trials have shown that chest x-rays do not reduce mortality from lung cancer. Low-dose computed tomography (LDCT) screening, however, was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial.
The most significant risk of LDCT screening is the high rate of false-positives (about 25%), which subsequent studies have shown can be reduced by using new nodule management criteria such as Lung-RADS. Less than half of the physicians surveyed in our study reported reduced lung cancer mortality as a benefit of LDCT screening. Many also reported concerns about radiation exposure (50%) and unnecessary follow-up procedures (88%) as risks. Since the majority of family physicians surveyed did not know that organizations such as the US Preventive Services Task Force or National Comprehensive Cancer Network recommend high-risk individuals receive annual LDCT screening, it is not surprising that some family physicians would continue to order a chest x-ray for screening, despite the lack of scientific evidence. Similarly, only 36% of physicians reported that high-risk patients should be screened annually (vs. every 6 months, 2 years, or 3 years).
MedicalResearch.com: What should readers take away from your report?
Response: Our survey was conducted before the Centers for Medicare and Medicaid Services released details regarding payment of LDCT screening and its accompanying counseling visit (such as appropriate billing codes), which may have also impacted the low referral rates we found. Over 50% of physicians surveyed reported that their patients had asked about screening in the past year, however. This presents a unique opportunity to discuss the risks and benefits of LDCT screening, as well as smoking cessation with persons at high-risk for lung cancer. Since physicians do not always know the most current cancer screening recommendations, patients should be prepared to initiate screening conversations with as much evidence as possible. Decision aids such as those provided by the Agency for Healthcare Research and Quality are a good starting point.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Since studies have shown that many persons with diagnosed lung cancer would not meet the eligibility criteria for LDCT screening according to the US Preventive Services Task Force, future research is warranted to explore the value of screening in other populations. Additionally, studies are needed to explore whether the results we observed generalize to more representative samples, and amongst different types of primary care providers, including non-physicians.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Jennifer L. Ersek, Jan M. Eberth, Karen Kane McDonnell, Scott M. Strayer, Erica Sercy, Kathleen B. Cartmell, Daniela B. Friedman. Knowledge of, attitudes toward, and use of low-dose computed tomography for lung cancer screening among family physicians. Cancer, 2016; DOI:10.1002/cncr.29944
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