Researchers study implications of lung cancer screening.

Abstract

Two recent studies examined the implications of low-dose computed tomography (LDCT) lung cancer screening in patients. Based on findings in the National Lung Cancer Screening Trial, the US Preventive Services Task Force (USPSTF) recently recommended these screenings in patients aged 55 to 80 years with a 30 pack-year smoking history who currently smoke or quit within the past 15 years. In the first study, researchers from Roswell Park Cancer Institute in Buffalo, New York, and the Medical University of South Carolina found that the majority of current and former smokers would welcome screenings for lung cancer if their insurance covered spiral CT scans.1 The study surveyed more than 1200 adult current smokers about their attitudes toward lung cancer screening with spiral CT scans. Researchers found that 78.5% of current smokers and 81.4% of former smokers said they would be willing to be tested if they were advised to do so by a physician. Their reasons for not being screened included a lack of insurance coverage and a fear of being diagnosed with lung cancer . The most commonly cited reason for not being screened among former smokers was a belief that they did not have lung cancer. Andrew Hyland, PhD, chair of the department of health behavior at Roswell Park Cancer Institute, notes that the data indicate the need for insurance companies to cover the test. The National Lung Cancer Screening Trial reported a 20% reduction in mortality when lung cancer was diagnosed with spiral CT compared with annual chest x-rays. In addition to the USPSTF, other organizations recommending lung cancer screening with spiral CT are the American Association for Thoracic Surgery and the American Cancer Society. In a second study, presented by Joshua Roth, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, Washington, as an abstract at the ASCO annual meeting in June 2014, researchers developed a model to forecast the 5-year incremental outcomes of implementing USPSTF screening recommendations for LDCT versus no screening. They estimated the number of lung cancers detected, LDCT scans, and the total and per-member per-month budget impact in 2 scenarios. The first scenario included complete implementation with all eligible patients offered screening in all years, whereas the second scenario was a phased implementation, with an additional 20% of eligible patients offered screening each year. Their findings demonstrated that in the first and second scenarios, screenings resulted in 141,000 and 101,000 more lung cancers (mostly stage I) diagnosed, 37.5 million and 22.4 million more LCDT scans, and an increased overall expenditure of $27.4 billion and $17.6 billion, respectively. The researchers concluded that LDCT screening will increase the rates of lung cancer diagnosis and result in a greater number of cases diagnosed early while substantially increasing Medicare expenditures. They will next evaluate the resource demands of complete and phased screening in relation to current supplies of LDCT facilities and health professionals.