Noteworthy Publications

For low-risk patients, screening for lung cancer can be a choice

Patients who are at low-risk for lung cancer may be able to defer screening, according to VA researchers. (Photo ©iStock/gmutlu)

Patients who are at low-risk for lung cancer may be able to defer screening, according to VA researchers. (Photo ©iStock/gmutlu)

Patient preferences should be considered when deciding to screen low-risk patients for lung cancer, according to the results of a study conducted by researchers at the VA Ann Arbor Healthcare System and the University of Michigan. 

The researchers' aim was to examine the effect of patient preferences—or the degree of dislike—on the benefits of lung cancer screening. Patient dislikes included negative feelings about going through the screening procedure, screening results, and follow-up care.

Dr. Tanner Caverly and colleagues used data to build a sample of 1 million people aged 55–80 years old who met the U.S. Preventive Services Task Force (USPSFT) criteria for heavy smoking. They then ran simulations to determine the potential outcomes of three years of screening versus no screening for patients with differing levels of risk for developing lung cancer.

The investigators found that overall, the average person with lung cancer risk between 0.3 and 1.3 percent experienced a net benefit from lung cancer screening, even if that person felt negatively about screening. That included close to 53 percent of the study population. For the remaining 47 percent, the researchers concluded that the best approach to screening depended on patient preference.

This approach can allow physicians and patients to have a discussion about the benefits and risks of lung cancer screening, say the researchers. To that end, they developed a web-based decision tool that patients can use to estimate their risk of lung cancer and help them decide whether screening is for them. The investigators also developed a decision tool intended to help physicians when counseling patients.

In 2013, the USPSTF issued guidelines that recommended annual screening for lung cancer for individuals aged 55-80 years old who have a history of heavy smoking. The potential downsides of screening for lung cancer are patient inconvenience, false negatives, and false positives that could result in further imaging, invasive procedures, or even death.