Abstract
Opportunistic screening for lung cancer is commonly conducted in Korea in accordance with physician recommendations and screenee's preferences. However, studies have yet to thoroughly examine the public's understanding of the risks posed by lung cancer screening. This study was conducted to assess changes in intentions to undergo lung cancer screening in response to being informed about exposure to radiation during low-dose computed tomography (LDCT) tests and to identify factors with the greatest influence thereon among Korean men. We conducted sub-group interviews among men chosen from the 2013 Korea National Cancer Screening Survey (KNCSS), a nationwide, population-based, cross-sectional survey of men aged 40 to 74 years and women aged 30 to 74 years. From 4100 participants in the KNCSS, 414 men who underwent any cancer screening test within the last 2 years were randomly selected for inclusion in this study. Via face-to-face interviews, their intentions to undergo lung cancer screening were assessed before and after being informed about exposure to radiation during LDCT testing. Of the 414 participants, 50% were current smokers. After receiving information on the benefits of the test, 95.1% stated an intention to undergo screening; this decreased to 81.6% after they received information on the harms of the test. The average decrease in intention rate was 35.3%. Smoking status, household income, and education level were not associated with lowered intentions to undergo lung cancer screening. Participants who were older than 60 years old (OR=0.56; 95% CI=0.33-0.96) and those with less concern for radiation exposure (OR=0.56; 95% CI=0.36-0.89) were less likely to lower their screening intentions. The results of this study suggest that there is a need to educate both non-smokers and former smokers on the harms of lung cancer screening.
Highlights
Lung cancer is the most common cancer worldwide and the third most common cancer in the Republic of Korea
While most lung cancer patients are usually diagnosed at an advanced stage and have a very poor prognosis (Kasenda et al, 2013), the effectiveness of lung cancer screening by low-dose computed tomography (LDCT) in reducing mortality remains controversial: Many European clinical trials have been conducted to ascertain an effective manner for lung cancer screening, none have shown positive results (Infante et al, 2009; Saghir et al, 2012)
In anticipation of the accepted use of LDCT for early detection of lung cancer in Korea, this study evaluated intentions to undergo LDCT for lung cancer screening
Summary
Lung cancer is the most common cancer worldwide and the third most common cancer in the Republic of Korea. Lung cancer is the leading cause of death among all cancers in men from Korea and worldwide (Ferlay, 2012). In 2011, the National Lung Screening Trial (NLST), conducted by the US National Cancer Institute, showed reductions in lung cancer mortality (20.3%) and in all-cause mortality (7%) with LDCT in comparison to subjects who underwent single-view, posteroanterior chest radiography (Aberle et al, 2011). Of three randomized studies that have provided evidences on the effectiveness of LDCT screening on lung cancer mortality, the NLST, which was the most informative, studied the largest sample size (53,454 participants) (Bach et al, 2012)
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