The Grapevine

What Are The Risks Of Lung Cancer Screenings?

Doctors, as per guidelines, are advised to openly communicate and discuss both the benefits and risks of lung cancer screening. But researchers at the University of North Carolina (UNC) found adequate explanations are not always provided to patients.

The study titled "Evaluating Shared Decision Making for Lung Cancer Screening" was published in JAMA Internal Medicine on Aug. 13.

Among Americans, lung cancer is the leading cause of cancer-related death with 154,050 deaths estimated to be occurring in 2018. Chances of survival improve if the cancer is detected in the early stages.

The United States Preventive Services Task Force recommends lung cancer screening (LCS) for current smokers, those who have a history of smoking, and individuals aged 55 and 80 years old.

But there are three possible risks linked to the screening process. False-positive results could occur, wrongly suggesting the presence of cancer despite it not being present. This can lead to unnecessary tests and surgeries, which may result in complications.

Secondly, overdiagnosis can take place when the screening identifies cases of cancer that would have never progressed into a problem for the patient. This can also result in unnecessary treatment.

And lastly, being exposed to repeated radiation from numerous screening tests has been linked to a low risk of causing cancer in patients who were otherwise healthy.

"We're not taking a side as to whether lung cancer screening is good or bad, but there seems to be a consensus that we should be sharing these complex decisions with patients," said senior author Dr. Daniel Reuland, director of UNC Lineberger's Carolina Cancer Screening Initiative.

The findings of the research, which he described as a "fly-on-the-wall sample from real-world practice," revealed the practice may be far from what is intended by guidelines.

The team performed an analysis of audio recordings from office visit discussions between doctors and 14 patients who were presumed to be eligible for LCS. Most of the sample size comprised of female patients (9 out of 14) while the average patient age was 63.9 years.

The quality of conversations about LCS was found to be "poor" while discussions about potential harms and risks were "virtually nonexistent," the authors stated. On average, doctors spent around 59 seconds (8 percent of the total visit time) on the subject.

"Although the sample was small, the results were stark and confirmed what we thought we would find," Reuland said.

He encouraged the creation of effective systems and better infrastructure are needed to ensure that patients are adequately informed to make such medical decisions.

"Finding better ways of having clinical support staff help with the delivery of patient education, particularly using educational tools known as decision aids, will be important," he added.

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