Screening for Lung Cancer

Mazzone, Peter J.; Silvestri, Gerard A.; Patel, Sheena; Kanne, Jeffrey P.; Kinsinger, Linda; Wiener, Renda Soylemez; Hoo, Guy Soo; Detterbeck, Frank C.

doi:10.1016/j.chest.2018.01.016

Cited by 277 publications

(102 citation statements)

References 141 publications

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“…4,6,17 To achieve a moderate net benefit in U.S. community practice similar to that obtained in the NLST, the USPSTF cautioned that lung cancer screening needs to be limited to people at high risk, low-dose CT needs to be used, the interpretation of images needs to be standardized, and most false-positive tests need to be resolved without invasive procedures. 4,6 …”

Section: Discussionmentioning

confidence: 99%

“…A CHEST (American College of Chest Physicians) Lung Cancer Screening Guideline Panel concluded in 2018 that additional research is needed on the best way to promote smoking cessation in the context of lung cancer screening. 6 Smokers with a screen-detected nodule are more likely to quit smoking, whereas smokers with a negative screen may incorrectly believe that screening protects them from lung cancer and they continue to smoke. 6 …”

Section: Discussionmentioning

confidence: 99%

“…6 Smokers with a screen-detected nodule are more likely to quit smoking, whereas smokers with a negative screen may incorrectly believe that screening protects them from lung cancer and they continue to smoke. 6 …”

Section: Discussionmentioning

confidence: 99%

“…5 Both the USPSTF and CMS used the same smoking criteria as the NLST and 55 years as the starting age for lung cancer screening, but the USPSTF and CMS differed on the oldest age for screening. 6 The USPSTF recommended 80 years as the oldest age for lung cancer screening based on evidence from modeling studies. 4 By contrast, CMS determined 77 years as the oldest age for screening because this was the oldest age of participants at the end of the NLST screening period.…”

Section: Introductionmentioning

confidence: 99%

“…4 By contrast, CMS determined 77 years as the oldest age for screening because this was the oldest age of participants at the end of the NLST screening period. 6 …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Lung Cancer Screening Inconsistent With U.S. Preventive Services Task Force Recommendations

Richards

Doria–Rose

Soman³

et al. 2019

American Journal of Preventive Medicine

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Introduction: Prior studies suggest overuse of nonrecommended lung cancer screening tests in U.S. community practice and underuse of recommended tests. Methods: Data from the 2010 and 2015 National Health Interview Surveys was analyzed from 2016 to 2018. Prevalence, populations, and number of chest computed tomography (CT) and chest x-ray tests were estimated for people who did and did not meet U.S. Preventive Services Task Force (USPSTF) criteria for lung cancer screening, among people aged ≥ 40 years without lung cancer. Results: In 2015, among those who met USPSTF criteria, 4.4% (95% CI=3.0%, 6.6%), or 360,000 (95% CI=240,000, 535,000) people reported lung cancer screening with a chest CT; and 8.5% (95% CI=6.5%, 11.1%), or 689,000 (95% CI=526,000, 898,000) people reported a chest x ray. Among those who did not meet USPSTF criteria, 2.3% (95% CI=2.0%, 2.6%), or 3,259,000 (95% CI=2,850,000, 3,724,000) people reported a chest x ray; and 1.3% (95% CI=1.1%, 1.5%), or 1,806,000 (95% CI=1,495,000, 2,173,000) people reported a chest CT. The estimated population meeting USPSTF criteria for lung cancer screening in 2015 was 8,098,000 (95% CI=7,533,000, 8,702,000), which was smaller than the 9,620,000 people (95% CI=8,960,000, 10,325,000) in 2010. Conclusions: The number of adults inappropriately screened for lung cancer greatly exceeds the number screened according to USPSTF recommendations, the prevalence of appropriate lung cancer screening is low, and the population meeting USPSTF criteria is shrinking. To realize the potential benefits of screening, better processes to appropriately triage eligible individuals to screening, plus screening with a USPSTF-recommended test, would be beneficial.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…4 By contrast, CMS determined 77 years as the oldest age for screening because this was the oldest age of participants at the end of the NLST screening period. 6 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Lung Cancer Screening Inconsistent With U.S. Preventive Services Task Force Recommendations

Richards

Doria–Rose

Soman³

et al. 2019

American Journal of Preventive Medicine

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Screening for Lung Cancer

Force¹,

Krist

Davidson

et al. 2021

JAMA

927

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ung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228 820 persons were diagnosed with lung cancer, and 135 720 persons died of the disease. 1 Themostimportantriskfactorforlungcancerissmoking. 2,3 Smok-ingisestimatedtoaccountforabout90%ofalllungcancercases, 2 with a relative risk of lung cancer approximately 20-fold higher in smokers than in nonsmokers. 3 Increasing age is also a risk factor for lung cancer. The median age of diagnosis of lung cancer is 70 years. 4,5 Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. 1 However, early-stage lung cancer has a better prognosis and is more amenable to treatment. IMPORTANCE Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228 820 persons were diagnosed with lung cancer, and 135 720 persons died of the disease. The most important risk factor for lung cancer is smoking. Increasing age is also a risk factor for lung cancer. Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. However, early-stage lung cancer has a better prognosis and is more amenable to treatment.OBJECTIVE To update its 2013 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the accuracy of screening for lung cancer with low-dose computed tomography (LDCT) and on the benefits and harms of screening for lung cancer and commissioned a collaborative modeling study to provide information about the optimum age at which to begin and end screening, the optimal screening interval, and the relative benefits and harms of different screening strategies compared with modified versions of multivariate risk prediction models.POPULATION This recommendation statement applies to adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. EVIDENCE ASSESSMENTThe USPSTF concludes with moderate certainty that annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking.RECOMMENDATION The USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation) This recommendation replaces the 2013 USPSTF statement that recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

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Evaluating Shared Decision Making for Lung Cancer Screening

et al. 2018

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recommends that shared decision making (SDM) involving a thorough discussion of benefits and harms should occur between clinicians and patients before initiating lung cancer screening (LCS) with low-dose computed tomography. The Centers for Medicare & Medicaid Services require an SDM visit using a decision aid as a prerequisite for LCS coverage. However, little is known about how SDM about LCS occurs in practice. OBJECTIVE To assess the quality of SDM about the initiation of LCS in clinical practice. DESIGN, SETTING, AND PARTICIPANTS A qualitative content analysis was performed of transcribed conversations between primary care or pulmonary care physicians and 14 patients presumed to be eligible for LCS, recorded between April 1, 2014, and March 1, 2018, that were identified within a large database. MAIN OUTCOMES AND MEASURES Independent observer ratings of communication behaviors of physicians using the OPTION (Observing Patient Involvement in Decision Making) scale, a validated 12-item measure of SDM (total score, 0-100 points, where 0 indicates no evidence of SDM and 100 indicates evidence of SDM at the highest skill level); time spent discussing LCS during visits; and evidence of decision aid use. RESULTS A total of 14 conversations about initiating LCS were identified; 9 patients were women, and 5 patients were men; the mean (SD) patient age was 63.9 (5.1) years; 7 patients had Medicare, and 8 patients were current smokers. Half the conversations were conducted by primary care physicians. The mean total OPTION score for the 14 LCS conversations was 6 on a scale of 0 to 100 (range, 0-17). None of the conversations met the minimum skill criteria for 8 of the 12 SDM behaviors. Physicians universally recommended LCS. Discussion of harms (such as false positives and their sequelae or overdiagnosis) was virtually absent. The mean total visit length of a discussion was 13:07 minutes (range, 3:48-27:09 minutes). The mean time spent discussing LCS was 0:59 minute (range, 0:16-2:19 minutes), or 8% of the total visit time (range, 1%-18%). There was no evidence that decision aids or other patient education materials for LCS were used. CONCLUSIONS AND RELEVANCE In this small sample of recorded encounters about initiating LCS, the observed quality of SDM was poor and explanation of potential harms of screening was virtually nonexistent. Time spent discussing LCS was minimal, and there was no evidence that decision aids were used. Although these findings are preliminary, they raise concerns that SDM for LCS in practice may be far from what is intended by guidelines.

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Screening for Lung Cancer

Cited by 277 publications

References 141 publications

Lung Cancer Screening Inconsistent With U.S. Preventive Services Task Force Recommendations

Lung Cancer Screening Inconsistent With U.S. Preventive Services Task Force Recommendations

Screening for Lung Cancer

Evaluating Shared Decision Making for Lung Cancer Screening

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