Repeated methodological flaws in published research result in misinformation that may cause eligible patients to forego or not be offered lung cancer screening (LCS), according to a joint publication from the Society of Thoracic Surgeons (STS), American Society for Radiation Oncology (ASTRO), and American College of Radiology® (ACR®).
Lung cancer kills more people in the United States each year than breast, colon and prostate cancers combined. Annual screening of high risk patients with low-dose CT scans (LDCT) is proven by multiple renowned studies to significantly reduce lung cancer deaths.1,2 However, less than 18.2% of eligible persons are screened.
"Lung cancer screening saves lives. Multiple high-quality studies have clearly demonstrated its benefit. Despite this strong evidence, persistent misinformation about perceived harms continues to limit the uptake of this life-saving test,” said Elliot Servais, MD, FACS, study author and interim chair, Department of Surgery at Lahey Hospital & Medical Center. “In this paper, we address these misconceptions head-on with the goal of expanding access to screening and saving more lives from lung cancer."
Published in the Journal of the American College of Radiology – the article highlights three specific examples that may contribute to reduced screening knowledge and access:
- Overestimation of downstream imaging and procedural complications after LCS.
- Misrepresentation of the lung cancer screening false-positive rate (FPR).
- Flawed analysis of oncogenic risk associated with radiation from CT scans.
STS, ASTRO and ACR urge clinicians and researchers to be mindful of these methodological pitfalls when interpreting LCS data and encourage journals and the medical community to perform similarly informed, diligent peer review.
“The multi-specialty joint statement demystifies the common misunderstandings about the benefits and risks of lung screening and should increase decision making quality and screening rate,” said Ruth C. Carlos, MD, MS, editor-in-chief, Journal of the American College of Radiology.
Updated federal guidelines nearly doubled the number of persons eligible for lung cancer screening. Private insurance and Medicare cover yearly screening for those who meet age and smoking history requirements. Research shows high-risk patients are more likely to be screened as recommended when their doctor engages them in shared decision-making discussions.
Black men and women are more likely to develop and die from lung cancer than other races. Latinos are more likely to be diagnosed with advanced lung cancer - but less likely to get treatment.3 Wider screening in underserved communities can help address such disparities. The joint paper is also published in the Annals of Thoracic Surgery and International Journal of Radiation Oncology, Biology, Physics.
For more information or to arrange an interview, contact ACR Public Affairs.
1 DOI: 10.1056/NEJMoa1911793
2 DOI: 10.1056/NEJMoa1102873
3 Lung Cancer and Clinical Trials in the Hispanic and Latino Populations | American Lung Association
