Screening for Lung Cancer

Silvestri, Gerard A.; Hanger, Morgan; Jett, James R.

doi:10.1378/chest.07-1349

Cited by 139 publications

(33 citation statements)

References 40 publications

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“…Four prior national surveys have evaluated primary care physicians' use of or recommendations for chest radiograph 15,16,21,22 ; however, those surveys took place more than 2 decades ago and did not include all 3 primary modalities that have been considered for lung cancer early detection. Our fi ndings that a majority of primary care physicians reported ordering lung cancer screening tests for asymptomatic patients and that patients have recently asked them about lung cancer screening suggest that ordering of these tests is common among these physicians, as are patient-physician discussions about lung cancer screening, even though at the time of the survey, lung cancer screening was not recommended by major expert groups in the United States.…”

Section: Discussionmentioning

confidence: 99%

Section: Lung C a Ncer Scr Eeningmentioning

confidence: 99%

“…[13][14][15] Whether expert groups will modify their lung cancer screening guidelines based on NLST results is at present unknown.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 To date, because of a lack of evidence from rigorous studies, major expert groups have not recommended screening asymptomatic individuals, even those with heavy or long-term smoking histories, for lung cancer. [13][14][15] Whether expert groups will modify their lung cancer screening guidelines based on NLST results is at present unknown.Past practice patterns raise concerns that NLST results may prompt overuse of lung cancer screening among average-risk patients. Despite the lack of strong evidence and guideline recommendations, prior studies have shown that many primary care physicians order chest radiographs to screen patients for lung cancer.…”

mentioning

confidence: 99%

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Lung Cancer Screening Practices of Primary Care Physicians: Results From a National Survey

Klabunde¹,

Marcus²,

Han³

et al. 2012

The Annals of Family Medicine

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PURPOSE Although current practice guidelines do not recommend screening asymptomatic patients for lung cancer, physicians may still order lung cancer screening tests. No recent national survey of health care professionals has focused on lung cancer screening. In this study, we examined the lung cancer screening practices of US primary care physicians and characteristics of those who order lung cancer screening tests. METHODSWe conducted a nationally representative survey of practicing primary care physicians in [2006][2007]. Mailed questionnaires assessed the physicians' knowledge of lung cancer screening guidelines, beliefs about the effectiveness of screening tests, and ordering of screening chest radiograph, low-dose spiral computed tomography, or sputum cytology in the past 12 months. Clinical vignettes were used to assess the physicians' intentions to screen asymptomatic 50-year-old patients with varying smoking histories for lung cancer.RESULTS A total of 962 family physicians, general practitioners, and general internists completed questionnaires (cooperation rate = 76.8%). Overall, 38% had ordered no lung cancer screening tests; 55% had ordered chest radiograph, 22% low-dose spiral computed tomography, and less than 5% sputum cytology. In multivariate modeling, physicians were more likely to have ordered lung cancer screening tests if they believed that expert groups recommend lung cancer screening or that screening tests are effective; if they would recommend screening for asymptomatic patients, including patients without substantial smoking exposure; and if their patients had asked them about screening.CONCLUSIONS Primary care physicians in the United States frequently order lung cancer screening tests for asymptomatic patients, even though expert groups do not recommend it. Primary care physicians and patients need more information about lung cancer screening's evidence base, guidelines, potential harms, and costs to avert inappropriate ordering. INTRODUCTIONL ung cancer is the leading cause of cancer death in the United States, 1,2 with a 5-year survival rate (16%) that is substantially lower than that for other common cancers. 3 Despite periodic debate about the utility of screening patients for lung cancer, 4-7 no randomized controlled trial has demonstrated that screening with chest radiograph or sputum cytology reduces mortality from lung cancer. [8][9][10][11] In the United States, a large, randomized controlled trial comparing chest radiograph vs usual care has completed accrual; results assessing impact on lung cancer mortality are expected in late 2015.10 A second large, randomized controlled trial comparing low-dose spiral computed tomography (LDCT) vs chest radiograph in current and former heavy cigarette smokers, the National Lung 102 LUNG C A NCER SCR EENINGScreening Trial (NLST), was halted in October 2010 after observation of a 20% reduction in lung cancer mortality in the LDCT group. 11,12 To date, because of a lack of evidence from rigorous studies, major expert groups have ...

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Section: Discussionmentioning

confidence: 99%

Section: Lung C a Ncer Scr Eeningmentioning

confidence: 99%

“…[13][14][15] Whether expert groups will modify their lung cancer screening guidelines based on NLST results is at present unknown.…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Lung Cancer Screening Practices of Primary Care Physicians: Results From a National Survey

Klabunde¹,

Marcus²,

Han³

et al. 2012

The Annals of Family Medicine

View full text Add to dashboard Cite

show abstract

“…8 The recently reported Prostate, Lung, Colorectal, and Ovarian cancer screening trial 9 randomized participants to screening with chest radiograph or observation and detected no mortality reduction from lung cancer in those who received screening. In the past 10 to 15 years, there have been a large number of clinical trials evaluating the role of low-dose (radiation) computed tomography screening for asymptomatic lung cancer.…”

Section: Screeningmentioning

confidence: 99%

Screening for Lung Cancer: Who Should Be Screened?

Jett

2012

Archives of Pathology &Amp; Laboratory Medicine

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Lung cancer is the most common cause of death from cancer in the United States. Previous studies of screening with chest radiographs and sputum cytology have not been shown to decrease lung cancer mortality. For the first time, a randomized screening trial with low-dose computed tomography scans has demonstrated a 20% lung cancer mortality reduction compared with screenings with a chest x-ray. Investigation is underway on many breath, sputum, and blood biomarkers to determine markers of high risk. The hope is that some (or one) of them will add to the early detection of lung cancer observed with low-dose computed tomography.

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Racial Disparities in Lung Cancer Resection

Colice¹

2010

JAMA

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M AJOR ADVANCES HAVE BEEN MADE IN THE ABILITYto image and identify lung tumors and metastases, diagnose and stage lung cancer with minimally invasive techniques, and safely resect earlystage lung cancers in medically tenuous patients. However, despite remarkable technological achievements, lung cancer is the leading cause of cancer death in the United States and 5-year survival is poor at 15.8%.1 In response to this situation in which advanced techniques have not resulted in meaningfully better outcomes, Cykert and colleagues, 2 in this issue of JAMA, explore fundamentally important questions about current management of lung cancer. The authors begin with the accepted premise that surgical resection is the preferred approach to managing stage I or II non-small cell lung cancer, and hypothesize that fewer blacks than whites will undergo curative-intent resection. Based on their study of 437 patients with biopsy-proven or probable early-stage lung cancer, the investigators confirmed their hypothesis and suggest that cultural differences might be the explanation.These provocative findings raise 4 points. Are the findings real? How are they explained? What information do the findings provide about community standards for managing lung cancer? What implications do these findings have for the controversial issue of lung cancer screening?Are there really disparities in surgical resection rates of stage I or II non-small cell lung cancer between blacks and whites? In the prospective study by Cykert et al, 2 the surgical resection rates for patients with tissue-confirmed non-small cell lung cancer were 63% for blacks vs 75% for whites (P=.03). In a retrospective analysis using Surveillance, Epidemiology, and End Results cancer registry data between 1985 and 1993, Bach et al 3 also had reported that blacks were significantly less likely to undergo surgical resection than whites for non-small cell lung cancer (64.0% vs 76.7%; PϽ.001). In addition, Bach et al 3 reportedthat5-yearsurvivalwassignificantlylowerforblacks, a finding associated with the difference in resection rates. Disparities in lung cancer care also have been found in other groups. For example, Wisnivesky et al 4 found that compared with white patients, Hispanic patients with stage I non-small cell lung cancer had lower rates of surgical resection and poorer survival.How are these lower surgical resection rates in blacks explained? Bach et al 3 did not find differences in comorbidities between blacks and whites diagnosed with lung cancer, but noted that blacks with lung cancer were younger than whites. Cykert et al 2 also found that among patients diagnosed with lung cancer, blacks were younger than whites and comorbidities were associated with surgical resection, but disproportionately for black patients. Differences in tumor resection rates between black and white patients were not explained by either baseline lung function or access to insurance. Findings from the questionnaires administered to study participants after discussion of the diagnosis but prior ...

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Screening for Lung Cancer

Cited by 139 publications

References 40 publications

Lung Cancer Screening Practices of Primary Care Physicians: Results From a National Survey

Lung Cancer Screening Practices of Primary Care Physicians: Results From a National Survey

Screening for Lung Cancer: Who Should Be Screened?

Racial Disparities in Lung Cancer Resection

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