Narrative review of the psychological impacts of lung cancer screening—consequences and how to address them?

Abstract

: Lung cancer has a high mortality, mainly due to advanced stage diagnosis. However, when detected in an early stage, 5-year survival rate can increase to 82%. Primary prevention of lung cancer, by not smoking, is by far the best option to minimize the risk of getting the disease. Nevertheless, there are still a substantial number of people who are ex- or current smokers. For this group, and for people who have been exposed to carcinogenic substances, such as asbestos, secondary prevention—screening, could be life-saving. A lot of countries are already familiar for years with breast, cervical and colorectal cancer screening programmes. This is less the case for lung cancer screening (LCS). However, some countries already introduced LCS and the interest in it is growing. A big randomized, controlled trial in the USA and recently one in Europe, have shown that LCS might decrease the cause-specific mortality rate with one fifth to one fourth. Apart from the effectiveness of a screening programme in saving lives, however, there are also potential harms for participants. It is known from breast cancer screening, that psychological distress caused by taking part in a breast cancer screening programme, can last for a long period. For that reason, it is worthwhile to explore whether this would also be the case for LCS. In this review we look at possible psychological impacts of LCS. We found that false-positive and indeterminate results can lead to psychological distress, however, mostly in the short term. Without doubt, also stigmatisation will undeniably lay a huge psychological burden on participants. Psychological distress due to participating in LCS, should be minimised by taking measures which are as well screening-related, e.g., decreasing false-positive results as society-related, e.g., decreasing stigmatisation of lung cancer as a disease which is fully attributable to the smokers behaviour.